News: Independent CT hospitals discussing tiered networks, Pre-ACA CID routinely approved very high rates for Aetna

Print Friendly, PDF & Email

The Hartford Business Journal is reporting that some smaller, independent CT hospitals are in discussions with each other and with insurers about options that improve their efficiency and make coverage more affordable. The hospitals are talking with insurers about value-based insurance designs or tiered networks where consumers who choose to access care at lower priced facilities benefit with lower cost sharing, making care even more affordable. Lower costs are often not found in large networks and facilities. The talks are in part a response to large, for-profit hospital networks forming across the state. An agreement that may include physician practices among six to ten small hospitals could happen within a few months.

The CT Mirror is reporting that before the Affordable Care Act’s insurance reforms Aetna benefited from years of higher than usual margins, about 55% medical loss ratios compared to 70 to 80% for other CT insurers during the same years. The ACA requires medical loss ratios of at least 80%. There is no evidence that the CT Insurance Dept. ever rejected a rate increase request from Aetna before the ACA changed the rules. This year Aetna asked for and was approved for an 8.75% increase in individual policies.