Such was was the initial reaction of the male DMCB when it opened the hood and stared at the just-released National Association of Insurance Commissioners' (NAIC) "Blanks Proposal." Readers may recall that this is the NAIC's long awaited response to the Affordable Care Act's requirement that health insurers use 80% to 85% of their premium dollars toward patient care. Defining just what comprised "patient care" was left up to the NAIC.
In typical actuarial fashion, the released "Blank" is a maze of obscure boxes terms and calculations that defies easy understanding. Looking down at it, it made the DMCB want a reset by hitting an "Easy" button. However, since the DMCB has changed oil, swapped air filters, replaced brake shoes, repaired mufflers, topped brake fluids, drained radiators and rotated tires, it figured it would dive right in anyway. That didn't work. So, it took an important cue from the spouse. It got on the cell phone and called some folks for some much appreciated help.
Here's what it found.
As the DMCB understands it, the "Blank" is the proposed form that would need to be completed by health insurers when they submit information about their expenses to their respective State Departments of Insurance. Close examination reveals that on line "7" on page 2, the preliminary MLR includes "total incurred claims" plus "total of defined expenses incurred for improving health care quality." The DMCB then headed over to page 16 of the document and found that the NAIC would like to define "improving health care quality" as....
"... plan activities that are designed to improve health care quality and increase the likelihood of desired health outcomes in ways that are capable of being objectively measured and of producing verifiable results and achievements.... [They] should be grounded in evidence-based medicine, widely accepted best clinical practice, or criteria issued by recognized professional medical societies, accreditation bodies, government agencies or other nationally recognized health care quality organizations. They should not be designed primarily to control or contain cost, although they may have cost reducing or cost neutral benefits as long as the primary focus is to improve quality..... [They] can include case management, care coordination and chronic disease management .... such as providing coaching or other support to encourage compliance with evidence-based medicine" (italics DMCB).