Arches on Good Things Utah

Arches on Good Things Utah Oct 01, 2013

Watch us from 9:00-11:30am. We will be debunking the myths of the ACA and explaining subsidies and what that means to families. We will also discuss the benefits of our plans

Small Business Owner Learns Affordable Care Act From Arches

  
Kathie Chadbourne  Avenue Bistro on Third Director talks about her business and why she chose Arches Health Plan for her employees.

Learn More:
Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117
801.312.9860

Individuals and Families - Arches Health Plan

Arches Health Plan is the only nonprofit
coop in Utah, and as such offers a new
delivery care model for members. Without shareholders, profits instead go to
reducing premium costs or improving benefits for members. Additionally, because the
coop is member owned, the best interests of members are always assured.
The Arches model for delivering care allows for greater communication and
collaboration between doctors and patients. This approach encourages members to
take responsibility for their own health through a health action plan that they develop
themselves with their doctor. The results are simple yet powerful: better care and
lower costs. And speaking of costs, the Arches model provides true price
transparency, meaning that we attach fixed costs to all medical procedures. Unlike any
other health plan, we actually tell you what something will cost before you have to pay
for it — yet another example of the Arches difference.

Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117
801.312.9860
utah health insurance

Arches Health Plan Brokers and Consultants

Brokers and consultants - arches health plan from Arches Health Plan

Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117
801.312.9860
cheap health insurance in utah

Arches Plan For Individuals and Families

Individuals and families - arches health plan from Arches Health Plan

 Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117
801.312.9860
cheap health insurance in utah

Marrying What Your’re GOOD at and what you LOVE!

So where do we start? I plan on these weekly blogs to become meetings where we talk about how to accomplish living a healthy life. These topics needs to be practical and worth yours and my time. Otherwise, what are we doing here? So onward! Last week we talked about Eating Healthy and Exercising to be simplistic enough. That’s great and all but now what? Start! “Where?”, you say. My response, “do something or a variety of physical activities that you are good at and that you like doing.” Find things you currently enjoy or in your past you enjoyed and focus doing them. I don’t believe the majority of people will succeed living a healthy life in the long term if they choose a physical activity they hate. I really don’t like lifting weights. Every once in a while I will try my hand at them again and guess what, still hate it. To me it seems pointless to pick up something heavy unless it is some heavy object which fell and is smashing someone. Similarly, I remember back in Junior High and High School I was a pretty good runner. In 9th grade I ran and 4:51 minute mile with very little training, it came naturally. I just ran as hard and fast as I could to win the race then collapsed on the track while struggling for air. I had a lot of raw potential in running but I hated it! Round and round and round that stupid black rubberized track. I thought, “How pointless, I put in all this effort and what do I get out of it? I end right where I started and all I see is the same boring scenery over and over and over again.” However, I loved to ride my bike. We lived near Millcreek Canyon and I loved to time trial 4.5 miles up to from the stop sign to the gate. I was able to do it in 19 minutes which was a 14 mph pace, ok for a 13-14 year old. Most of all it was beautiful and at the end I was able to effortlessly coast downhill viewing the majesty of this beautiful canyon. When I started at Skyline High School I played football and basketball. I was then asked to run long distance for the track team. I said that I would and began with the track team. I thought they would be good with me training the way I had in Junior High, on my bike! Unfortunately, they said I had to run on the track I hated so badly. I lasted two weeks and found myself not running track but I continued to ride my bike up the canyon a lot. How does this information help me know? First, I know from my history I was a pretty good natural runner. Additionally, common sense tells me most people typically like doing things they are good at. So why did I hate running so bad when I was younger? Second, I know I hate track and field tracks. Third, I love the canyons and mountain trails I grew up on. Fourth, aren’t there trails I can run on? I realized if I was more mature at 15 I would have negotiated to run on the trails instead the track. It seems so logical now. I learned that I love to run, I just don’t like to run on tracks. I enjoy the experience of getting away from the masses of folks in the city and being alone to think while I get in shape. Whether it is on a bike or a run, I like to get away on a secluded trail where humans are hard to find. The perfect marriage of what I love and am I’m good at. Each of us has things we are good at and things we love. I recommend right now everyone write down the physical activities you are good at, the physical activities you enjoy or love and then the other related things you love. If you love music and dancing then you have a place to start. If you love music and the mountains then Utah is your oyster! Armed with your Ipod and some time, you’re on your way. Just look at your list and find a way to marry what your good at and things you love and marry the two together. Dr. Douglas Roland Smith is a graduate of the Medical College of Wisconsin and Chief Medical Officer of Arches Health Plan.


affordable health insurance utah
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117
801.312.9860
Source: http://okespanol.com/marrying-what-yourre-good-at-and-what-you-love/

The Importance of Eating Healthy and Being Active - Arches Health Plan

One of the most frustrating yet potentially powerful conversations I have with patients is about their lifestyle. It is not uncommon for me on a daily basis to discuss patients poor lifestyle and how it is affecting not only their health but their wallet. Being sick costs a lot of money and good years of life. It is estimated 2/3 of us in the USA are either obese (BMI 30+) or overweight (BMI 26-30). Along with being overweight, there is an increased risk of high blood pressure, diabetes, arthritis, high cholesterol, heart disease, stroke, cancer, sleep apnea, heart failure, depression, liver disease, menstrual problems, infertility, gallbladder problems, etc. Holy-smokes, that is a boat load of problems and all because of me not doing the things every day to invest in myself.

My experience is when people change their lifestyle by eating the right things and exercising every day they lose weight and as they lose weight they also lose many things including medication, pain, depression and progression of the above mentioned problems. I have had the conversation many times which goes as follows, “I just want you to know that I do care for you and really enjoy you as a patient. But, when you go home tonight and have “your” stroke or heart attack, I will go to my home and have dinner with my wife and kids. When you are lying in your bed having someone change your diapers because you can’t, I am out riding my bike or enjoying a run. Though I do care for you as a person and patient, no one cares for you as much as you do! Will I lose sleep because of what you did to yourself? I will feel really bad for you but the answer is-No, If I did I would never sleep! Then I would be at risk of bad health.

So what do you need to do? Start! Start today to invest in yourself! If you’re worried about starting, see your doctor. Once you start do so moderately and don’t go out full steam which likely will set you back a few steps with an injury. Progress as you can tolerate and before you know it you will feel great! Go watch a great documentary which inspired me to take better care of myself called “Fat, Sick and Nearly Dead.” If they can do it you can. I hope this inspires you as much as it did me. Is change easy? No! Is it worth it? Only you know what is worth it to you but I would suggest it is!

Find us on Facebook in English and Spanish:
http://www.facebook.com/ArchesHealthPlan
https://www.facebook.com/pages/Arches-HeDr. Douglas Roland Smith is a graduate of the Medical College of Wisconsin and Chief Medical Officer of Arches Health Plan.

 Arches Health Plan
 medical insurance in utah
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117
801.312.9860

Bases para empezar a correr - Arches

No se imagina la cantidad de veces que me piden que vea por qué a alguien le duelen los pies cuando empieza a hacer ejercicio. La consulta típica es “Me propuse ponerme en forma y entonces decidí empezar a correr.

Read More Here: http://okespanol.com/bases-para-empezar-a-correr/

(801) 550-3197
http://archeshealth.org
tmcgarry@archeshealth.org
5505S 900E, Ste. 100,
Salt Lake City, UT 84117

Creating Gold, Silver and Bronze Benefits – Vanilla or Spumoni

I’ve talked to a lot of agents (and other folks) that believe that the Affordable Care Act requires all Exchange benefits to be basically the same – Gold, Silver or Bronze. They believe that these metallic benefits are highly regulated and will eliminate “qualified high-deductible health plans” (QHDHP) which support Health Savings Accounts. They think that there is virtually no wiggle room in Silver. At least that is the rumor. Fortunately this is not true, or at least it doesn’t have to be true.

First a recent counter-example: The California Health Benefits Marketplace exchange (called Covered California) announced that they were going to standardize their metallic plans and require all health plans offer only those identical plans. Competition would occur only by way of premiums and provider panels. Their reasoning was that consumers needed a true, identical apples-to-apples comparison to properly shop.

You can see their approved benefit structure here:

http://www.coveredca.com/media/10748/CoveredCA-HealthPlanBenefitsComparisonChart.pdf

As you can see, Covered California will not offer QHDHP’s. Hopefully this will not become the norm with other state exchanges.

Most exchanges, including the federal marketplace, will allow health plans the ability to create their own plans – as long as they meet metallic guidelines and include required “essential health benefits”.  Various combinations of deductibles, coinsurance, copayments and out-of-pocket limits will be allowed – as long as they can be actuarially “scored” as proper metallic values. If a QHDHP can be created within the guidelines, they should and often will be allowed.

METALLIC BENEFITS

The rule for being certified metallic is that the “actuarial value” (AV) of the benefits comply with the following chart:

Bronze (60%) – must score between 58% & 62% AV

Silver (70%) – must score between 68% & 72% AV

Gold (80%) – must score between 78% & 82% AV

Platinum (90%) – must score between 88% and 92% AV

Catastrophic (57%) – with specific benefit requirements

What does actuarial value mean? It is the average expected payout by the health plan when a large standard population’s claims are run through the benefits. So if on “average” a particular health benefit plan design would pay 70% of the claims, then that would be considered a Silver plan. As you can imagine, there are numerous combinations of benefits (deductibles and copays, etc…) that could yield Silver benefits. It turns out that even a QHDHP can garner a Silver (or Bronze or even Gold) ranking.

UNLOCK YOUR INNER ACTUARY

I recently was referred to the government’s actuarial calculator. It is the exchange’s official scorekeeper. When an actuary comes up with a benefit plan, they run it through this calculator to get the official metallic certification. If the benefits do not meet the essential health benefit, then the calculator “fails” the plan and it cannot be sold in any exchange. If the official AV calculator certifies the plan’s unique benefits, then they are good to go in the appropriate metallic band (except in California of course).

The good news is that I was able to come up with all kinds of different Silver plans. I started with a few common plan designs and then, when I got comfortable with the AV calculator, I went wild. I thought up all kinds of goofy Silver and Bronze plans that no one would sell (or would they?!). It wasn’t too hard to come up with several Bronze and Silver QHDHP benefit designs. It was a bit more difficult with Gold, but do-able. Then I got serious about designing innovative (…or stupid, I’m not sure yet…) plan designs. It’s nice to be able to think outside the box, but not have to spend money on actuaries to rate each crazy idea.

If there are any doubts, I really had a blast with this.

If, like me, you think designing metallic benefits are a fun pastime (or if you are suffering from insomnia and want a non-chemical solution) try unleashing your inner actuary:

No password needed. Have fun!

http://cciio.cms.gov/resources/files/av-calculator-final-2-20-2013.xlsm

Let me know if you come up with a winning plan design. We may use it for one of Arches Health Plans.

EXCHANGE PRODUCTS AND SUBSIDIES

Every health plan within an exchange is required to offer at least one Silver plan and one Gold plan. If the plan chooses, they may offer a Platinum plan and/or a Bronze plan and/or a catastrophic plan (explained below).  Some exchanges, such as Covered California may require plans to offer all metallic products, not just Gold and Silver. Most health plans will want to offer Bronze and Catastrophic plans alongside of the required Gold and Silver. Most plans will not want to offer Platinum benefits, believing them to be a magnet for the really expensive cases.

The subsidy value is based on the premiums of the second lowest priced Silver plan of those available in the zip code of the enrollee. The actual subsidy is based the enrollees income. Once the subsidy is determined, then the enrollee may choose different plans, but would be responsible for the incremental difference in premium (whether higher or lower).  It is possible that in some unique cases, a particular Bronze plan may actually have zero premiums after the subsidy.

In addition to a premium subsidy, there are certain “benefit enhancements” required for Silver plans chosen by the lowest income families. When incomes are less than 150% of the federal poverty level, enrollees are entitled to enhanced “Silver” benefits. The exchange will assign Silver levels of 73%AV, 87%AV and 94%AV. These enhanced Silver plans are not “sold” but rather assigned by the exchange based on the enrollees income.

Covered California has published their required benefits for those enhanced Silver levels:

http://www.coveredca.com/media/10745/CoveredCA_HealthPlanBenefitsSummary.pdf

Another type of exchange product will be the “Catastrophic Plan”, with a 57% AV. The Catastrophic benefit structure is pretty well defined by code. It must include exactly three first dollar offices visits, but no other first dollar benefits. It is only sold to those aged 21 through 29 and to some strange situations where a person does not qualify for a subsidy, but Silver coverage is technically “unaffordable”. (This is a quirk where an older person, who has higher rates than a younger person, has income just outside the subsidy range but the Silver plan costs more than 9.5% of their income – rare but worth mentioning.)

Another required plan benefit design is exclusively for Native Americans with incomes less than 300% FPL. Qualified Native Americans are entitled to special benefits with 100% AV. Of course a 100% AV plan means that there are zero co-payments, deductibles and co-insurances due from the Native American enrollee. (Not much plan design work needed there.)

For all the enhanced benefit plans, the federal government will reimburse the health plans for any benefits paid beyond the standard benefits.

CONCLUSION

The bottom line is that the federal actuarial value calculator has surprisingly few restrictions. Many thousands of different plan designs are possible. The only limitations are the imagination of the health plan, the ability to administer the benefits and an exchange flexible enough for innovation and out-of-the-box thinking. In my view, it is unfortunate that Covered California will only allow vanilla plan designs. The benefit world is so much more satisfying with 31 flavors (or more).

Arches Health Plan will be benefit design innovators. Because if Arches Health Plan doesn’t change things, how is healthcare going to get better?