Becker's ASC Review

93 Coding, Billing & Collections 2009, according to the Kaiser report. But, deductibles differ based on the size of the employer: • Small employers (ree to 199 workers): $1,797 • Large employers (200 or more workers): $971 8. In 2003, employer-sponsored health plan deductibles comprised 2 percent of median income. In 2013, de- ductibles comprised 5 percent of median income, ac- cording to e Commonwealth Fund. 9. From 2003 to 2013, average per-person deductibles under employer-sponsored plans more than doubled in all but six states (Alabama, Arkansas, Hawaii, Louisi- ana, Mississippi and Wyoming) and Washington, D.C., according to e Commonwealth Fund's State Trends in the Cost of Employer Health Insurance Coverage, 2003-2013 report. 10. e increase in patient financial responsibility has played a role in patients delaying medical treatment. In 2013, 25 percent of patients with private health insur- ance delayed treatment due to the amount they would have to pay. at number increased to 34 percent in 2014, according to a 2014 Gallup poll. Here is the per- centage of patients who put off care due to cost, based on annual household income: • Under $30,000: 35 percent • $30,000 to $74,999: 38 percent • $75,000 or more: 28 percent n Capital Digestive Care, Cigna Partner on Value- Based Colonoscopy Model: 5 Things to Know By Carrie Pallardy C apital Digestive Care, based in Silver Spring, Md., has part- nered with Cigna to develop a pro- gram designed to improve quality and cost of care for colonoscopy patients. Here are five things to know about the new program. 1. e new program is part of Cigna Collab- orative Care, a value-based model that uses incentives to engage healthcare providers. 2. Cigna Collaborative Care initially focused on large primary care physician groups, but now has branched out to include smaller PCP groups, hospitals and specialists. 3. rough the program, Capital Digestive Care will continue to be reimbursed for ser- vices it provides Cigna customers, but the group will also be eligible for incentives if certain quality and cost benchmarks are met. 4. e GI group's physicians will look at pa- tients' health holistically throughout the entire episode of care in an effort to reduce the like- lihood of any complications or readmissions. 5. "We've seen great results from our Cigna Collaborative Care arrangements with pri- mary care physician groups and are able to apply these successful strategies to specialty care, including gastroenterology," said Julia Huggins, president of Cigna Mid-Atlantic. "By focusing on the value of care and provid- ing financial incentives to doctors who meet quality and cost targets, we expect an even greater experience for our customers." n How Big 5 Insurer Mergers Could Affect Market Share in 4 States By Tamara Rosin T he merger mania among health insurers is evoking concern among many industry experts that consolidation could negatively affect hospitals, especially those in certain states. According to Wells Fargo's Municipal Securities Research report released July 29, consolidation among insurers could lead to increased leverage for the soon-to-be Big ree, which could, in turn, pressure hospital pricing. "It is difficult to assess the local impact of these proposed mergers on indi- vidual hospitals, but the already large scale of the Big Five is likely to make many submarkets, including the health insurance exchange markets, less competitive," authors of the report wrote. Citing data from Kaiser Family Foundation's Commission on Medicaid & the Uninsured, the authors said hospitals in the following state insurance submarkets could experience the most notable effects on market share post- mergers. Some markets will have a new No. 1 in town, while others have insurers that are already so far ahead a merged entity still won't come close. Individual insurance market • Georgia: Anthem was previously the No. 1 insurer in the state, but Aetna-Humana's 46 percent combined market share would push it to a dominant position over Anthem's 36 percent. • Louisiana: Aetna-Humana's combined market share would reach 19 percent, but this is still substantially less than Blue Cross and Blue Shield of Louisiana's 73 percent market share. Large group insurance • New Hampshire: Anthem-Cigna's combined market share of 67 per- cent would be more than twice Harvard Pilgrim Health Care's 28 percent market share. Small group insurance market • Kansas: Aetna-Humana's market share would be 23 percent, though this would be just one-third of Blue Cross and Blue Shield of Kansas' leading market of 64 percent. • Georgia: Aetna-Humana's combined market share would be 54 percent, pushing ahead of Anthem's 27 percent market share. Generally, insurer market share concentration is higher than that of hos- pitals in each state. Citing Kaiser, the report said the leading insurer in each state owned an average statewide market share of 57 percent in 2013. In several states, the dominant insurer held more than 90 percent of total statewide business, and the top three health insurer market leaders held more than 86 percent of statewide market shares. n

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