Free Daily Headlines :

  • COVID-19
  • Vaccine Info
  • Money
  • Politics
  • Education
  • Health
  • Justice
  • More
    • Environment
    • Economic Development
    • Gaming
    • Investigations
    • Social Services
    • TRANSPORTATION
  • Opinion
    • CT Viewpoints
    • CT Artpoints
DONATE
Reflecting Connecticut’s Reality.
    COVID-19
    Vaccine Info
    Money
    Politics
    Education
    Health
    Justice
    More
    Environment
    Economic Development
    Gaming
    Investigations
    Social Services
    TRANSPORTATION
    Opinion
    CT Viewpoints
    CT Artpoints

LET�S GET SOCIAL

Show your love for great stories and out standing journalism

CT’s newest insurer emphasizes its differences. Will that win customers?

  • by Arielle Levin Becker
  • October 14, 2013
  • View as "Clean Read" "Exit Clean Read"

Wallingford – In the quest to build an insurance company from scratch, Kenneth Lalime sees opportunity in mistaken phone calls.

The new insurer Lalime runs is called HealthyCT, and it’s not uncommon for people to call trying to reach the state’s health insurance exchange, which is called Access Health CT.

So the people who answer the phones at HealthyCT can transfer callers to Access Health, or they can answer questions themselves. Lalime hopes callers will remember that HealthyCT was helpful.

Mistaken identity is just one of the quirks of being “the new guy on the block” at a time of major change for the health care and insurance industries.

HealthyCT is trying to carve out a niche for itself as a different sort of insurance company, a nonprofit with consumers on the board that’s set to compete with for-profit carriers in a state where dissatisfaction with the industry led to a sustained — albeit unsuccessful — campaign for a public insurance option.

Its roots and start-up funding come from a provision of the federal health reform law that’s drawn boosters with hopes of transforming insurance markets and critics who question the wisdom of the concept and the viability of the companies it’s funding.

HealthyCT is still in the process of building a network of doctors and other health care providers to treat members once its health plans take effect Jan. 1. So far, the company says it has 70 percent of the state’s hospitals and about 5,000 doctors and other providers on board.

And it has to attract customers. Lalime hopes to have more than 25,000 in the first year. Of the companies offering coverage on the state’s health insurance exchange, HealthyCT has some of the highest prices for individual market plans.

The company received its first application for coverage early in the morning on Oct. 1, before its website even officially launched. Two days later, the site had surpassed 100,000 visitors.

But how much will helpful phone interactions, or interested web visitors, or the company’s nonprofit status matter when customers decide what to buy? Will having a new and different sort of insurance company be enough to make customers consider foregoing cheaper premiums from other carriers?

Lalime thinks price and provider network will drive customers’ choices, but he thinks there’s room for identity to matter too. “I think being new in the marketplace gives us a little bit of an edge,” he said.

If people hear that HealthyCT is not for profit, a new insurer created as part of the federal health law, Lalime thinks, “Some people will go, ‘Gee, maybe it is [worth] $20 here or there.’”

How viable is the model?

For the record, HealthyCT’s name was in place before Access Health’s. The company was created by the Connecticut State Medical Society and the medical society’s association of independent physician practices, and was awarded nearly $76 million in federal loans made available through the health law commonly known as Obamacare.

It’s one of 23 “consumer oriented and operated plans,” or CO-OPs, funded with nearly $2 billion in federal money. 

The existence of CO-OPs in the health law stems from a political compromise, a way to mollify liberals who wanted a public insurance option to compete with private carriers. The law included $6 billion to establish nonprofit insurance companies that would participate in states’ individual and small-group markets, although the funding has since been reduced to $2 billion.

The CO-OPs will start offering coverage next year, offering a chance to show how the theory works in practice.

John Morrison, president of the National Association of State Health CO-OPs, is unsurprisingly bullish about their future.

“It’s important to realize that a health CO-OP, in order to be successful, doesn’t have to get all the consumers,” he said. “It doesn’t have to get a majority of consumers. It can simply get its fair share, and then some, of consumers.”

And he believes some shoppers will be drawn to CO-OPs because of their business model.

In their first year, CO-OPs might not look much different from other companies, Morrison said. But he believes they will ultimately be able to offer lower premiums than their competitors because their business model will make them better positioned to make changes in how care is paid for and delivered, helping to rein in costs.

“Everybody else right now in the marketplace wants to make money,” Morrison said. “The health insurance CO-OP doesn’t want to make money. The health insurance CO-OP wants to provide good health to their members as affordably as possible.”

Robert Laszewski, president of the Washington D.C. consulting firm Health Policy and Strategy Associates, is skeptical about the viability of CO-OPs. To attract enrollment and succeed, he said, they’ll have to offer customers value — that is, competitive prices or superior networks of health care providers. 

But he said they’re starting out with enormous disadvantages: With no membership, they have limited clout in getting health care providers to join their networks at rates that can help keep premiums down. They don’t have claims experience, so they lack the data needed to set prices. They don’t have the data systems or economies of scale that existing insurers have. And they’re competing in what are traditionally the hardest parts of the insurance marketplace, selling coverage to individuals and small groups.

“They flat out don’t have a good chance of survival,” Laszewski said. “This is a big boys’ game. This is not a game for altruists. This is a cutthroat market.”

What matters to customers?

As an insurance agent, John Calkins, president of Bozzuto Associates in Watertown, likes the idea of new carriers in the market, regardless of their business model.

“It gives me more options to show my clients,” he said. “Everybody will have their own little wrinkles that will be attractive to some people and maybe not to others. That just gives us more tools in our toolbox.”

What matters to clients in deciding which carrier to select? Calkins says it’s price and which doctors are covered.

“One of the toughest things in my business is to tell an employee that their wife has to change their ob-gyn because they don’t participate,” he said. “I can tell you, that’s usually a nonstarter.”

HealthyCT is still building its provider network. It’s selling insurance both on and off the exchange, but plans to maintain only one network, so all providers who sign on will accept patients with plans bought through the exchange or outside it. The payment rates for providers won’t differ whether patients are covered by exchange or non-exchange plans.

That’s in contrast to the how many insurers nationally are handling their exchange plans, signing up fewer doctors and hospitals and offering lower payment rates as a way to keep premiums down. Other carriers in Connecticut are also expected to have separate on-exchange and off-exchange networks, although the extent of the differences is limited by Access Health’s requirement that carriers’ exchange networks be substantially equal to their commercial networks.

Insurer identities

One of the ways HealthyCT hopes to differentiate itself is through its focus on patient-centered medical homes, a model that involves primary care providers taking a more active role in coordinating patient care. (Other carriers also have initiatives involving medical homes and care coordination.)

HealthyCT provided funds to help 75 medical practices go through the process of becoming recognized as patient-centered medical homes.

The assistance didn’t come with any requirement for joining HealthyCT’s network, but Lalime hopes the practices “would recognize the contribution that we had made to help them get there.” Either way, it’s a wise investment in the marketplace because care coordination can change outcomes and the medical home approach can help stabilize costs, he said.

Another selling point Lalime likes to point to is the inherently local nature of HealthyCT. Although it’s applying for federal approval to serve as a CO-OP in Rhode Island, the company isn’t intended to grow nationally.

ConnectiCare, another insurer offering coverage through Access Health, also touts its local focus.

“When choosing a health plan consumers should consider several factors like health plan quality rating, provider network, benefit coverage, price, market reputation and personal local service,” President Michael Wise said in a statement. “ConnectiCare products are nationally recognized for quality and service and offer comprehensive coverage with a broad provider network and local caring service.”

By contrast, one of their key competitors on and off the exchange, Anthem Blue Cross and Blue Shield, the state’s largest insurer, has a national brand. Its parent company, Wellpoint, offers plans in 14 states.

Anthem spokeswoman Sarah Yeager said the role of insurance companies is changing “alongside the evolving health insurance landscape,” including a marketplace that is more consumer and retail-focused. For Anthem, that means in part developing tools to help consumers shop for coverage and navigate health insurance.

And she emphasized the company’s history and standing in the market.

“With more than 76 years as a the leading carrier in the state, Anthem is a market place leader in the individual and small employer markets and we are uniquely positioned to succeed in the health benefits exchanges,” she said.

Sign up for CT Mirror's free daily news summary.

Free to Read. Not Free to Produce.

The Connecticut Mirror is a nonprofit newsroom. 90% of our revenue comes from people like you. If you value our reporting please consider making a donation. You'll enjoy reading CT Mirror even more knowing you helped make it happen.

YES, I'LL DONATE TODAY

ABOUT THE AUTHOR

Arielle Levin Becker

SEE WHAT READERS SAID

RELATED STORIES
Medical providers are taking nature therapy seriously
by Jenifer Frank | C-HIT.ORG

In a time of social isolation and staying home, sometimes a walk in the park is the best medicine.

Have a case of a COVID variant? No one is going to tell you
by Christina Jewett and JoNel Aleccia | Kaiser Health News and Rachana Pradhan

Federal rules around who can be told about the variant cases are confusing, and tests have not been approved.

Open-housing debate in Woodbridge: Define racism
by Thomas Breen | New Haven Independent

Can a town’s laws be racist even if they do not explicitly state: “No Blacks Allowed?”

Lamont’s new vaccination priorities are simple and smart
by Richard Davies

Connecticut Gov. Ned Lamont’s new age-eligibility vaccine plan is simple, smart and straightforward. The more complicated the rules are, the greater the chance of screw-ups and of well-connected people getting their shots before they should. The governor is doing a good job.

CT teachers are expected to get vaccinated for COVID at local clinics, but other options could cause problems
by Dave Altimari

School employees could end up on two lists, which means some vaccine might go to waste, officials said.

Support Our Work

Show your love for great stories and outstanding journalism.

$
Select One
  • Monthly
  • Yearly
  • Once
Artpoint painter
CT ViewpointsCT Artpoints
Opinion Lamont’s new vaccination priorities are simple and smart
by Richard Davies

Connecticut Gov. Ned Lamont’s new age-eligibility vaccine plan is simple, smart and straightforward. The more complicated the rules are, the greater the chance of screw-ups and of well-connected people getting their shots before they should. The governor is doing a good job.

Opinion Gas pipeline will threaten water quality, wildlife and wetlands
by Susan Eastwood

The Connecticut Department of Energy and Environmental Protection has granted tentative approval of the 401 water quality certification for the Pomfret to Killingly natural gas pipeline. I urge DEEP to deny the 401 certification, as the proposed pipeline would violate the Connecticut’s water quality standards, and the conditions in the draft certification fail to protect our streams, wetlands, and wildlife.

Opinion Connecticut and the other Connecticut. Which will endure?
by Ezra Kaprov

What comes to mind when you hear the word ‘Connecticut’? Possibly, you think of a 43-year-old Puerto Rican man who arrived here with his family following Hurricane Maria. He works full-time as a machinist at the Sikorsky plant, and he coaches a prizefighter on the side.

Opinion COVID-19 increases urgency for legislature to pass medical aid-in-dying law
by Dr. Gary Blick

The COVID-19 crisis has exposed the profound tragedy of loved ones dying alone, in a hospital or nursing home, without the care and comfort of loved ones surrounding them. This pandemic also demonstrates the fragility of life, the limits of modern medicine to relieve suffering, and has magnified the systemic racial disparities in our healthcare system, resulting in higher hospitalization and death rates for people in communities of color. We must eradicate these disparities, so everyone has equal access to the full range of end-of-life care options.

Artwork Grand guidance
by Anne:Gogh

In a world of systemic oppression aimed towards those of darker skintones – representation matters. We are more than our equity elusive environments, more than numbers in a prison and much more than victims of societal dispositions. This piece depicts a melanated young man draped in a cape ascending high above multiple forms of oppression. […]

Artwork Shea
by Anthony Valentine

Shea is a story about race and social inequalities that plague America. It is a narrative that prompts the question, “Do you know what it’s like to wake up in new skin?”

Artwork The Declaration of Human Rights
by Andres Chaparro

Through my artwork I strive to create an example of ideas that reflect my desire to raise social consciousness, and cultural awareness. Jazz music is the catalyst to all my work, and plays a major influence in each piece of work.”

Artwork ‘A thing of beauty. Destroy it forever’
by Richard DiCarlo | Derby

During times like these it’s often fun to revisit something familiar and approach things with a different slant. I have been taking some Pop culture and Art masterpieces and applying the vintage 1960’s and 70’s classic figures (Fisher Price, little people) to the make an amusing pieces. Here is my homage to Fisher -Price, Yellow […]

Twitter Feed
A Twitter List by CTMirror

Engage

  • Reflections Tickets & Sponsorships
  • Events
  • Donate
  • Newsletter Sign-Up
  • Submit to Viewpoints
  • Submit to ArtPoints
  • Economic Indicator Dashboard
  • Speaking Engagements
  • Commenting Guidelines
  • Legal Notices
  • Contact Us

About

  • About CT Mirror
  • Announcements
  • Board
  • Staff
  • Sponsors and Funders
  • Donors
  • Friends of CT Mirror
  • History
  • Financial
  • Policies
  • Strategic Plan

Opportunity

  • Advertising and Sponsorship
  • Speaking Engagements
  • Use of Photography
  • Work for Us

Go Deeper

  • Steady Habits Podcast
  • Economic Indicator Dashboard
  • Five Things

The Connecticut News Project, Inc. 1049 Asylum Avenue, Hartford, CT 06105. Phone: 860-218-6380

© Copyright 2021, The Connecticut News Project. All Rights Reserved. Website by Web Publisher PRO