Health benefits provider expanding role in Colorado

Craig Hall, The Business Times:

One of the most difficult issues to address in an economy such as we have now is in just how many fewer service people may use,” says Neil Waldron, Chief Marketing Officer and VP of Strategic Services for Rocky Mountain Health Plans (RMHP), “When coupled with the fact that people have less discretionary income and their premiums continue to rise, you indeed have a very interesting marketplace for health insurance.”

Many changes are still to come in the health insurance arena due to the step by step process in which the federal and state health care laws are being implemented. One area is in the health care exchanges now being mandated in states that need to be implemented by 2014. In Colorado, the deadline is 2012 and there will plenty of discussion leading up to a final, operational structure being put into place. And while there will still be options for the insured outside the exchanges, the dynamic of how insurance is offered to employees and in the pricing of insurance premiums is bound to change according to Waldron.

“I envision RMHP’s voice to be very integral as to how the legislative process proceeds,” says Waldron, “And while each carrier in Colorado will indeed have the same kind of role and certain advantages in their particular marketplace, we anticipate that we will indeed grow our share of the market with the products and services we have to offer and as a result of our non-profit status.”

The market has changed dramatically over the past few years with some areas seeing more competition, like on the Front Range, to options being less in Western Colorado. Also, seniors have had to work though cuts and changes in MediGap coverage. Future changes and price increases in Western Colorado will be seen in prescription coverage; as the newer drugs coming on to the market will be targeted to a smaller population while having the same cost to develop, and in the overall cost of care; as the population ages both in terms of the general population and in the age of the workforce. “Put simply, a more targeted prescription product costs more and as the age of the insured increases, so does the cost,” adds Waldron.

In the short term, Waldron sees not too much change in premium pricing and insurance costs as the markets catch up with previous price increases and utilization of health care services should increase as the economy rebounds. However, he is quick to point out that with all of the laws and regulations being implemented, it is important to see just how employers react and that the dropping of employee coverage may be a major factor in prices changing, particularly if the economy continues to lag.

Finally, the market is relatively steady as opportunities are consistently available for individual health insurance needs. Waldron explains that the pools are reasonably predictable and that competitors can be aggressive with their pricing based on trying to enter a particular market, so it is important for small businesses to keep its options open and to look at other options frequently as companies in this arena will adjust their rates up or down on a quarterly basis.

It is very important that the insured understand that medical underwriting evens out over time and is a process. Premiums on risk are lower early on in the insurance buying cycle and increase as the insured get older. But overall, Waldron says RMHP is committed to serving it clients in receiving the best coverage in a cost effective manner. “RMHP will continue to talk with our clients to fully assess their needs and we are committed to being a strong voice and advocate in the legislative process in getting the best possible results for all Colorado health care customers.”