CONTACT:
FOR IMMEDIATE RELEASE
CA
HMO RATE 2001 REVEALS: ‘MEMBER
PREMIUMS DON’T MAKE UP THE PAYMENT GAP FOR LOW HCFA PAYMENT COUNTIES;
DIFFERENCES IN TOTAL MEDICARE HMO REVENUE BY COUNTY ARE SIMILAR TO COMMERCIAL
HMO PREMIUM TRENDS BY-COUNTY EXCEPT FOR L.A. WHERE MEDICARE PAYMENTS FAR EXCEED
COMMERCIAL TRENDS’
MODESTO, CA, June 4, 2001 ---- MCOL(tm) (mcol.com), the leading health care information technology company specializing in delivering business-to-business managed care knowledge resources, today announced findings from its analysis of Medicare HMO premium and HCFA payment data included in its just released CA HMO Rate 2001 CD-ROM. CA HMO Rate 2001 is a suite of California HMO premium rate data and tools that provides detailed HMO premium rate intelligence for use by health plans, provider organizations, employers, and consultants to the managed care industry.
Says Claire Thayer, MCOL
Vice-President of Research and Development, "We examined California 2001
Medicare HMO premiums and HCFA payments by county, and also compared them to
differentials in Commercial HMO premium rates by county. We found that: (1)
member premiums averaged 9.2% of total plan revenue, but this amount varies
widely by county (ranging from 2.5% in Los Angeles to 14.4% in San Luis Obispo);
(2) member premiums do not make up the difference for low paying counties; nine
of the bottom ten counties in HCFA payment rates were also in the bottom ten for
combined revenue including member premiums; (3) the differences in total
Medicare revenue by county divided by the statewide Medicare baseline, compared
to differences in commercial HMO premium rates by county divided by the
statewide Commercial baseline, were somewhat closer than expected; the average
Medicare to Commercial variance for this county factor was 9%. Two specific
regional trends were observed: four San Francisco bay area counties had
virtually identical trends when comparing Medicare and Commercial factors (all
with variances under 1.5%); and Los Angeles had the highest variation, with its
Medicare factor 21.1% higher than its commercial factor.”
According to Thayer, these are
the most significant conclusions: (l) The fact that low HCFA payment counties
are still very low total-revenue counties would seem to indicate that plans
should relatively increase their member premiums in those counties; (2) While
the rest of the state seems to somewhat mirror the commercial marketplace trends
by county, Los Angeles County HCFA payments aren’t reflective of the market
forces that impact commercial premiums in that area; (3) Thus the county with
the most HMO enrollment has an artificially high total reimbursement rate; (4)
Perhaps if HCFA focused on correcting a few high impact counties nationwide like
L.A. that are not reflecting market force pricing, there would be more money to
go around for other underpaid counties. For detailed information on these findings, go to http://www.medicarehmo.com/cahcfa01.htm
Adds Clive Riddle, MCOL President, "While our just-released CA HMO
Rate 2001 product focuses on providing extensive Commercial HMO premium rate
data and tools, including a survey database with 18,009 sets of 2001 by-county
by-plan premium rates, a Medicare database is also included that provides
by-county by plan member premium rates for the past three years and HCFA
by-county payment rate tables from 1996 through 2002."
CA HMO Rate 2001 is available for the price of $2,695, and the CA HMO Rate Report is available for just $575. Detailed product information, including a downloadable product brochure, and order forms are available at http://www.mcareol.com/carate.htm, or by calling 209.577.4888.
MCOL is a six-year-old health care Internet company
delivering business-to-business managed care resources. MCOL has become the
recognized Internet leader in the delivery of knowledge resources to
professionals involved in managed care. MCOL business lines include:
Membership-based services through Managed Care On-Line and Global Health
Resources.Com; e-Commerce through the Managed Care Store; and Business
e-Solutions. MCOL is based in Modesto, California, with additional offices in
Portland, Oregon. For more information, please visit www.mcol.com/about.htm.
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