HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that through the first three quarters of 2008, a majority of Florida's largest health insurers saw on average a 25 percent increase in per-member, per-month costs for emergency room (ER) and out-of-area services. Additionally, analysis of hospital utilization and charge costs data suggests that Medicaid, uninsured and self-pay patients may be using the ER as their primary-care provider, according to the latest Florida Health Plan Analysis. These trends, combined with increasing numbers of uninsured patients in Florida, have added greater financial pressure on both providers and insurers in a state that has already seen fully-insured commercial enrollment fall dramatically in the past year. Drug coverage could help improve the situation, reducing the need for patients to be sick enough to visit the ER.
HealthLeaders-InterStudy analysis finds that among Florida's major carriers that break out ER and out-of-area data on filings, costs for these services increased by 19 percent to $74 million through the first three quarters of 2008. On a per-member, per-month basis, the increase is closer to 25 percent because of decreasing enrollment numbers.
According to the report, commercial insurance and Medicare comprise a disproportionate share of charges for hospital ER visits. In 2007, commercial and Medicare patients signified 46 percent of emergency room patients but represented 61 percent of all charges. The analysis indicates that individuals with Medicaid and the uninsured are using the ER for primary care visits while Medicare and commercial insurance patients are using the ER only for the most severe instances.
"Rising numbers of Medicaid and uninsured patients will put further strain on hospitals and insurers that are already feeling financial pressure, particularly in markets where ER use by these patients is greatest," said Roy Moore, analyst with HealthLeaders-InterStudy. "Looking forward, insurers will find it difficult to increase premiums in 2010 because many employers already cut back benefits because of 2009 premium increases. At the same time, they will likely not be able to cut back reimbursement to providers, who will continue to be burdened with charity care. Both insurers and providers will be looking for ways to divert patients with non-life-threatening conditions to less expensive treatment options such as prescription drug usage and walk-in clinics to better control these costs."
Why Pharmaceutical Companies Need Health Plan Analysis
Health Plan Analysis identifies key health plan trends, allowing pharmaceutical companies to create comprehensive strategic plans and sales strategies at state and local levels. Updated quarterly, Health Plan Analysis provides a detailed look at plan design and financials, as well as information about mergers, legislation and other influencers driving healthcare in a particular region.
HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com.
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