Earley Stresses Being Better Consumers of Health Care

WHEELING – The key to effective consumer health care services is people having a better understanding of the cost of services, said Fred Earley, president of Highmark Blue Cross Blue Shield West Virginia.

“We’re going to have to make everyone a better consumer of health care services,” Earley said. “We’re going to have to make better tools and I think the health care system is years behind what has occurred in other businesses such as retail and banking in the systems in place to help people. We don’t purchase health care like we do other services in our life whether it be a home, a car – we have to get to that point. People need to understand the cost of their services.”

Earley made his remarks this morning during the West Virginia Press Association Convention at Oglebay Park. He also talked about the federal Affordable Care Act and its impact on individuals and businesses.

‘”We have to work with providers to reduce costs. … Maybe reform has served as a catalyst for this,” he noted. “That’s not an overnight process.”

Earley noted his company also is working to meet the reforms in more way than one.

”We have to work as hard as we can to reduce administrative costs. We have to become more efficient,” he said.

While some elements of the act have started, Earley said the bulk of it will begin in 2014. Next year, all individual and group health plan requirements will increase wellness incentive programs; prohibit discrimination based on health status; provide coverage for approved clinical trials; extend dependent coverage to 26-years-olds; and prohibit excluding people because of pre-existing medical conditions.

Earley noted for now small businesses with 50 workers or less are not required to offer health insurance to employees. But starting in 2016, that requirement will change to 100 employees or less.

“If a company has 50 or more full-time or equivalent employees, it has to offer a plan and it must be affordable,” Earley said, adding the company will otherwise face fines ranging from $2,000 to $3,000 per worker.

The act also calls for health care plans to offer essential benefits which include: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health benefits and substance abuse disorder services including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services including oral and vision care.

Earley said his company has set up a website to help not only its customers but anyone looking for more information about the act: www.highmarkonhealthreform.com.