About the Health Benefits Industry
Quick Facts
- Health benefits organizations manage health care quality and costs for over 2.2 million Louisiana residents.
- Louisiana's health plans embrace health care reform and bring decades of expertise to assist the state in improving health outcomes.
- Health insurance premiums are a reflection of health care costs themselves. Of every premium dollar, 87 cents goes to pay for health care provider services.
- Mandated benefits raise the cost of health coverage and cause more Louisiana citzens to become uninsured.
- Health plan members are healthier and costs are lower because of health plans' coordination of care.
- Contracts between health plans and health care providers save money for consumers and employers and help to assure quality.
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Louisiana health plans have an outstanding record of claims payment.
Inside the Industry
Health plans have decades of experience using the ingredients expected to be parts of any health care reform system, including:
- Coordination of care, using health care professionals to conduct quality improvement, utilization management, case management, disease management and other programs.
- Development and use of evidence-based standards of care.
- Close management of disease states prevalent in Louisiana.
- Use of comprehensive health care provider networks to ensure access to care.
- Emphasis on primary care and preventive care.
- Increasing access to health care, setting the stage for the use of medical homes.
- Innovations in benefit design to provide affordable consumer coverage options.
- Integration of behavioral health and prescription drugs benefits.
- Effective use of information technology, including pioneering in electronic health records and electronic prescribing.
- Management of administrative costs, including measures to detect fraud.
These are the reasons that at least 37 other states have turned to health plans to be integral parts of their health care reform programs. Louisiana's health plans are prepared to offer the use of their experience and expertise to help improve public health care.
Improving Health Outcomes
Health plans maintain a number of programs used to constantly measure and improve the health of their members. They are accustomed to being held accountable by employers and the government for their performance in health outcomes.
Regulation
The industry has for a long time been one of the most heavily regulation industries in the nation and in Louisiana. Major entities regulating the industry include the Louisiana Department of Insurance, the Louisiana Department of Health and Hospitals, the Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services, and the U.S. Department of Labor.
While health insurance regulation is intended to protect consumers, at times it has had the side effect of increasing costs and, therefore, premiums. The health benefits industry is committed to providing quality, affordable health care benefits to consumers and employers. To achieve this end, industry leaders are always ready to work with others, including legislators and regulators, to address health care issues.
About the Industry
>> Health Care Costs
>> Mandated Benefits
>> Disease Management
>> Provider Contracting
>> Reform in Louisiana