Jul 13 2011
Competitiveness & Transparency
Making health insurance and health services a better value by increasing competitiveness between health plans and between providers. This includes:
– Increasing the purchaser’s ability to find health insurance plans which best meet their needs in terms of benefit design, network flexibility, risk, price and health outcomes.
– Increasing the patient’s ability to choose the provider which will provide the best service and outcomes for the price which the patient is willing to pay.
1. Review of ability of South Carolina purchasers (employers and individuals) to find health insurance which best meet their needs in terms of benefit design, network flexibility, risk, price and health outcomes.
2. Review of patient’s ability in South Carolina to choose the provider which will provide the best service and outcomes for the price which the patient is willing to pay.
3. Review of best practice existing and proposed mechanisms for increasing purchasers and patients ability to find the best value.
4. Analysis of the federal government’s health insurance exchange mandate and its cost and benefits to South Carolina.
5. Recommendations to the steering on potential courses of action to pursue in South Carolina in increase value for
Consumer Protection / Medical Liability
The Consumer Protection/Medical Liability Subcommittee will look at market innovations to improve quality and value. (Improving medical quality will reduce poor outcomes thereby reducing costs and liability.) The Subcommittee will review what, if any, legal reforms that would improve quality relative to cost. It will review market information in terms of size, concentration and policy costs.
1. Review market information for individual, small group and large group policies
2. Review market concentration, including number of carriers, market share and market structure
3. Review what providers and consumers can do to improve quality and control costs
The Information Technology Subcommittee will explore and report on the various technical options available to South Carolina for developing and/or connecting to a health insurance marketplace. The Subcommittee will identify and review insurance marketplace solutions currently in operation, evaluate the technical approach, and understand the costs and business models associated with each approach and/or technology.
1. Criteria for evaluating insurance marketplace technologies for South Carolina
2. Review of existing health insurance marketplace technologies
3. Review of costs and/or business model associated with each approach
4. Review of options and technical ability to integrate South Carolina Medicaid eligibility with each approach
5. Review of technical readiness of existing South Carolina insurance providers to participate in a health insurance marketplace
6. Evaluation of successful technical approaches and identification of the key criteria for success