Coming Sept. 1: Association Health Plans

On 10th Jul 2018
payer contract management

New Association Health Plans Coming Sept. 1: The Effect in Payer Contract Management

New low-cost coverage options to introduce more complexity in payer contract management practices

In September, small businesses and self-employed individuals will be allowed to purchase a new type of low-cost health insurance through trade groups and industry associations. These association health plans will allow employers to bypass expensive traditional small-group and individual insurance markets when obtaining coverage for themselves and their employees. How will this affect healthcare provider's payer contract management?

They come with an important caveat: The cost savings with these plans is due primarily to a recent executive action exempting AHPs from a wide range of consumer protections like offering Affordable Care Act-mandated essential health benefits. By some estimates, there are 11 million small business owners in the United States who could purchase AHPs, and 4.3 million individuals are expected to ultimately be covered by these discount health insurance plans.  

Expect uncertainty, disruptions

While these plans may wind up offering small business owners and their employees more affordable insurance options, for health systems, hospitals, ambulatory surgical centers and other providers, this new type of insurance means wading into the unknown and managing an even larger volume of healthcare payer contracts.

Starting September 1, hospitals and ASCs will brace for an increased volume of AHP-covered patients, but they are uncertain of how to staff or budget for the expected census increase. Most providers already are managing a large volume of fee-for-service and value-based healthcare payer contracts, each of which includes multiple plans with different rates. AHPs, which also will be allowed to be sold across state lines, will add a new type of reimbursement model to providers’ revenue cycles.

Traditional payers are barred from setting up AHPs directly, so a flood of untested payers — perhaps all with different reimbursement rates and terms — could enter individual markets, depending on the local consumer demand. Still, the American Academy of Actuaries predicts that some AHPs may end up renting network access from existing HMOs, adding yet another potentially complex wrinkle to the fast-changing payer landscape:   

“It is unlikely that any AHP would be able to achieve the critical mass of enrollees needed to negotiate the deep provider discounts that large health maintenance organizations (HMOs) and insurance companies currently obtain. A more realistic scenario is one in which AHPs ‘rent’ provider networks and pay access fees that depend in part on market leverage and savings. Some of these networks are owned by HMOs and insurance companies that rent out their networks to smaller competitors.”

Find clarity

Revenue Masters can help providers eliminate the financial uncertainty associated with seeking correct reimbursement and healthcare contract management complications from AHPs. Our flexible technology can model and manage any contract, from any payer, no matter how simple or complex. Revenue Masters’ proprietary technology allows providers to look across multiple facilities, payers, plans and timeframes to find and overturn healthcare denials and underpayments. It also enables facilities to drill down to the individual physician and service level and model an expected reimbursement to the claim level, based on multiple calculations. Our technology gives providers peace of mind by simplifying healthcare contract management and modeling, while also generating projected snapshots of expected net revenue within the next 30, 45 and 60 days.

Interested in learning more about how our technology can help you simplify healthcare contract management in the upcoming changes with Associated Health Plans? Call us today at (877) 591-2590 or email us at to book an introductory call with one of our senior reimbursement experts. Revenue Masters is dedicated to combining healthcare cloud contract modeling and management with fast and efficient payment recovery workflows to create the most advanced platform that enables 100 percent collections across all payers.

Our team has decades of experience in managed care, as well as commercial and government payer strategies, providing our partners with unique insights on healthcare market dynamics.

Revenue Masters also helps facilities improve efficiency and workflows. We offer the most modern, powerful, accurate and affordable healthcare contract management software, all while being the undisputed price performance leader — providing the best value for the best price. Our software increases efficiency and revenues, provides all necessary reports and can help you ensure 100 percent payer collections.