Dr. John Espinola Promoted to EVP of Health Care Services

Dr. John Espinola, Premera EVP of Health Care Services

Dr. John Espinola, EVP of Health Care Services

We are happy to announce that Dr. John Espinola has been promoted to the position of Executive Vice President of Health Care Services. In his new role, Dr. Espinola will look to further develop Premera’s relationship with doctors and hospitals across the state. He will also drive efforts to improve our members’ healthcare experience and provide them with access to quality, safe and cost-effective care.

Dr. Espinola has more than 15 years of experience in Geriatric Medicine in group and private practices and over 10 years working directly with health plans. He joined Premera in 2010 as the Medical Director for Utilization Management and most recently he served as the Vice President for Quality, Medical Management and Provider Engagement. Prior to Premera, Dr. Espinola served as the National Medical Director at Essence Healthcare and as the Executive Director and Medical Director at Evercare, a division of UnitedHealth Group.

“Dr. Espinola’s combination of clinical background, business acumen, customer focus, and record of achievement makes him well qualified to lead Premera’s Health Care Services team,” said Roe. “Having worked as a licensed provider, Dr. Espinola understands the opportunities healthcare professionals have to improve the health and healthcare experience of customers. We are very fortunate to have Dr. Espinola join our Executive Management Team and be an instrumental part of Premera’s future.”

Don’t Overlook the Lentils!

511394333By Heather Snively MS, RD

When it comes to prevention of chronic diseases, no single food will make or break your health. The key is to focus on whole foods – lots of vegetables, lean proteins, fruits, whole grains and healthy fats. Some of your best preventive-food options are classic “unsung heroes,” meaning you usually don’t think of them first.

Take lentils for example. They are an excellent food to incorporate into a diet for so many reasons.

High in fiber – Lentils are an excellent source of soluble fiber. This is important because not only does fiber help give a lasting feeling of fullness, it also helps maintain blood sugar levels. Stable blood sugar means control over cravings, making it easier to say “no” to extra calories from tempting treats that show-up in the break-room.

Need another reason? High-fiber foods reduce the risk of heart disease and help maintain a healthy weight.

Good source of protein – Look no further than lentils for a fantastic source of plant-based protein. One cup of cooked lentils has 18 grams. Including protein in each meal is essential for building and repairing muscles and enzymes that our body needs to function properly.

Rich in vitamins and minerals – Lentils are high in many vitamins and minerals that are important for many functions including cell production, proper nerve function and carrying oxygen to cells. Lentils also contain antioxidants which protect cells from damage caused by free radicals.

How to cook lentils – It’s easy! Take 3 cups of water per 1 cup of lentils – no pre-soaking required. Bring the water to a boil, add the lentils and turn the heat down to simmer. Allow 20 – 30 minutes for cook time or until they are tender.

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Heather Snively, MS, RD, is a nutrition and wellness manager at Guckenheimer, an on-site corporate restaurant management and catering company. She received her Master of Science in Nutritional Sciences from the University of Washington in 2011. Heather is passionate about helping others determine the best way to enjoy food and stay healthy. Her food philosophy is simple: moderation in all things, except for vegetables—eat all the vegetables you like.

Premera Announces Extended UW Medicine Offerings for Members in 2015

Premera is pleased to announce that UW Medicine will be part of its value-based networks serving Premera’s individual and small group customers effective Jan. 1, 2015. UW Medicine includes the following:

These changes apply to Premera members on individual metallic plans under the Affordable Care Act who have the Heritage Signature network as part of their health plan, as well as employer group members whose health plan includes the Heritage Prime network. This expansion applies to health plans purchased directly through Premera and its affiliates or through the Washington Healthplanfinder. By adding UW Medicine to our value-based networks, Premera members will have added choice and flexibility when it comes to choosing where they go for care.

Premera members on ACA plans will continue to have in-network access at Northwest Hospital & Medical Center and Valley Medical Center for the remainder of 2014. Members with questions about how the UW Medicine expansion impacts them should call the customer service number on the back of their Premera ID card.

An Opening Game to Remember: A Fan’s Surprising Seahawks Experience

Nichole-Marcus-Trufant

Nichole and former Seahawks Pro Bowl CB Marcus Trufant.

Have you ever entered a contest, only to think to yourself “There’s no way I’m winning”? This is one of those experiences, but it’s one with a happy ending.

“I was absolutely stunned when I got the email that I won tickets,” said Nichole Ayres, the winner of Premera’s first #FitHawksFan contest for Seahawks home game tickets.

The surprise could not have come at a better time for Nichole and a friend she shared the experience with. “Our husbands recently deployed together (active duty Army) so it was a great distraction from the stress of that separation.”

And, of course, how did she react after learning of her prize? “The first thing I did was call the biggest Seahawks fan I know… my mom!”

Nichole and her mother enjoying the game.

Nichole and her mother enjoying the game.

Her game experience exceeded her expectations. She took a picture with former Seahawks Pro Bowl Cornerback Marcus Trufant and got autographs from Seahawks Hall of Famer Walter Jones and former Seahawks Quarterback and Ring of Honor member Jim Zorn. Prior to kickoff, she listened to Pharrell Williams and Soundgarden rock SoDo.

But the highlight? As Nichole put it: “Our SEAHAWKS BEAT THE PACKERS!”

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Want a chance to win?

Premera’s #FitHawksFan contest awards four free tickets to one winner for each Seahawks home game during the 2014 season. Entering is easy. Take a picture of how you’re fit and healthy in your Seahawks gear and submit it here. We’ll draw random winners each week through October 6 for each regular season home game from our entrants. Rules can be found here.

Statement on Premera’s Individual Market Plans in Alaska Under the ACA

The Alaska Division of Insurance has approved Premera’s request to increase rates for 2015 for individual market plans under the Affordable Care Act (ACA). This will result in a significant rate increase for many of our customers purchasing individual and family plans.

We recognize this is a very difficult situation, especially for our affected customers. We have found there’s a problem with Alaska’s individual market that requires an Alaskan solution.

The problem

The market for individuals and families purchasing coverage has changed since the implementation of the ACA. This is a situation unique to Alaska and not sustainable. We’ve seen a large influx of individuals with very significant medical needs and related medical costs purchasing new coverage under the ACA.

Who is impacted?

We’re implementing a large rate increase to cover very high medical costs for our members in plans in the individual market under the ACA, including those purchased in the Exchange. Those plans cover approximately 7,000 members today. We know this will be a significant financial challenge for some of our customers and are working with key leaders in Alaska to find an Alaskan solution to this problem.

Who is not impacted?

This does not affect our members on individual and family plans in Alaska that were in effect before January 1, 2014. Those plans cover approximately 6,000 members today. This also does not affect members on our employer plans.

Why is this happening?

Implementation of the ACA has changed the Alaska individual market. The combination of guaranteed access to coverage and the comparatively small number of individual consumers creates an individual market that may not be sustainable. In short, there are not enough healthy members in Alaska’s individual market to offset the cost of members with very high medical costs.

How did things work before the ACA?

Alaska’s high-risk pool (ACHIA) previously provided coverage to individuals with significant medical needs and spread that cost across the entire insured market, including employer groups.

Since the implementation of the ACA in January, 50% of ACHIA enrollees and 100% of the federal Pre-existing Condition Insurance Pool members in Alaska have left those plans and have likely now purchased coverage in the individual market.  A disproportionate share of these individuals likely chose Premera plans.

Why are Premera’s rates for individual plans under the ACA going up?

We have seen a significant influx of new members with exceptionally high medical cost buying plans under the ACA. These members have significant medical conditions such chronic heart failure.That’s having a unique impact given the size of Alaska’s individual market.

Again, it’s important for these individuals to have coverage. And all Alaskans deserve a more stable, competitive individual market with affordable choices.

What kind of high medical costs are we talking about?

Between Jan. 1 and June 30, 2014, we had more than $7 million in medical claims from only 33 Alaska members on individual plans under the ACA. That’s roughly one-third of all the medical claims costs for all 7,000 members on our individual plans under the ACA.

We’re currently paying an average of $723 in medical claims per month for our members on these plans compared to receiving only $540 on average in premiums. We expect to lose $3.7 million in 2014 serving individual market on these plans.

How much are rates increasing?

We need a 71.5% average rate increase to break even in 2015. We have instead filed for and received approval for a 37.3% average rate increase. Actual rate increases for members will vary based on age and geography so no customer will likely see an exact 37.3% increase, but the average makes clear that rising medical costs are driving up rates.

We expect to lose $5 million in 2015, even with this rate increase, in the absence of a state supplemental reinsurance program to stabilize Alaska’s individual market.

The key here is the lack of a large enough pool to spread the costs of members with very significant medical needs. Again, these individuals deserve access to coverage and we’re working with state officials to find a solution to this challenge for Alaskans.

What should happen now?

We believe action is necessary to re-establish the balance that existed in the individual market prior to the implementation of the ACA.

Our members with very significant medical needs should have coverage.The key is finding a way to stabilize the market for all Alaskans looking to purchase individual and family coverage. We want Alaskans to have affordable options for coverage. That will require a competitive market that is stable and sustainable, without significant swings in premiums.

Premera is working with state government officials and other leaders to develop and implement a program to stabilize the market and keep costs affordable for individual consumers.

We encourage the state to implement a supplemental state reinsurance program, which can reestablish market stability by spreading high medical costs across the entire insured market and mitigate the need for large rate increases by Premera and other insurers in the individual market in the future.

We also support proposals at the federal level that would provide insurers with greater flexibility to design options for consumers, such as “copper plans” that would potentially give consumers a more affordable option.

What’s next?

Premera is committed to creating a more sustainable healthcare market for Alaska, to make the cost of care and coverage more affordable for our members.

Premera has been serving the Alaska market for over 60 years. Because of its size and geography Alaska has a comparatively volatile market and high care costs compared to other states. We know Alaskans and are committed to finding a sustainable solution for all consumers in the individual market.

We look forward to working with state officials to implement a supplemental reinsurance program to address this challenge for Alaskans.