Skipping bread and pasta to lose weight? Carbs are an essential part of your diet, and here's how skipping them can hinder your weight loss goals.
WASHINGTON, July 21 (Reuters) - Humana Government Business Inc, a unit of Humana Inc, and Health Net Federal Services LLC have been selected to provide managed care support to the U.S. Defense Department's TRICARE healthcare program, the Pentagon said on Thursday.
Zacks Industry Outlook Highlights: Cigna, UnitedHealth Group, Aetna, Anthem and Humana
"В рамках рынка Health Net (Интернет + медицина - прим. ред.), если мы говорим об информационных технологиях, на данный момент порядка $90 млрд", - сказал Михаил Самсонов
Centene Corp. (CNC) is scheduled to report first-quarter 2016 results before the opening bell on Apr 26. Let's see how things are shaping up for this announcement.
Amid unprecedented health insurance industry consolidation, Centene's $6B purchase of Health Net is the first of three major deals to be approved by federal and state regulators. Still to be approved is Anthem's bid for Cigna and Aetna's takeover of Humana amid intense antitrust scrutiny of health plans
On Mar 11, 2016, we issued an updated research report on Health Net, Inc. (HNT).
Health Net, Inc.'s (HNT) fourth-quarter 2015 operating income came in at 66 cents per share, in line with the Zacks Consensus Estimate.
U.S. Health Insurers Provide Defense Amid Volatility
Zacks Industry Outlook Highlights: UnitedHealth Group, Aetna, Cigna, Molina Healthcare and Centene
Health Net is poised to beat at earnings season given its favorable Zacks Rank and an ESP in positive territory.
ObamaCare Increases the Salience of Antitrust in Health Insurance Markets from "Important" to "Essential"
As the extremely-sharp Aaron Edlin has taught me, apropos of the current wave of proposed health insurance mergers--[Aetna-Humana](https://news.aetna.com/2015/08/aetna-to-acquire-humana/), [Anthem-Cigna](http://www.forbes.com/sites/brucejapsen/2015/12/03/antitrust-hurdles-await-anthem-cigna-after-shareholders-approve-merger/#5ba1c33b67b0), and [Centene-HealthNet](http://www.bizjournals.com/losangeles/news/2015/10/26/health-net-stockholders-approve-centene-merger.html): The coming of ObamaCare makes any willingness on the part of antitrust authority to allow these mergers to go through extremely dangerous and destructive policy indeed. The imposition of the individual mandate to purchase health insurance makes maintaining competition in health insurance markets significantly more important. Usually, the exercise of market power and the ability to easily collude implicitly or explicitly made possible by large market shares are curved by the possibility of exit. The "exit the market and buy something else" option for consumers is the one competitor that the firm cannot acquire and merge with. It is the one competitor with which the firm cannot collude, implicitly or explicitly. Imposing an individual mandate to purchase is a wise policy in a market place where the major market failure is adverse selection. It threatens to be a catastrophic policy in the marketplace where the major market failure is the exercise of sellers market power.
We issued an updated research report on Health Net, Inc. (HNT) on Jan 7, 2016.
A cool product by itself is not a company. And being a military veteran is great training for starting up. The importance of using customer feedback to shape Minimum Viable Products and why world-class founders are disciplined were topics discussed by the guests on the latest episode of Entrepreneurs are Everywhere, my radio show on SiriusXM Channel 111. Joining me in the Stanford University studio were: DJ Jayalath, co-founder of Athos fitness apparel Mark Hatch, co-founder of TechShop prototyping studios Listen to the full interviews by downloading them from SoundCloud here and here. (And download any of the past shows here.) Clips from their interviews are below, but first a word about the show: Entrepreneurs are Everywhere airs Thursdays at 1 pm Pacific, 4 pm Eastern, on Sirius XM Channel 111. It follows the entrepreneurial journeys of founders sharing their experiences of what it takes to build a startup - from restaurants to rocket scientists, to online gifts to online groceries to entrepreneurial education and more. The program examines the DNA of entrepreneurs: what makes them tick, how they came up with their ideas; and explores the habits that make them successful, and the highs, lows and pivots that pushed them forward. While studying electrical engineering at the University of Waterloo, DJ Jayalath and his co-founder, Chris Wiebe, devised the Athos workout gear to address their own fitness needs. Interest from a VC catapulted the two, post-graduation, into doing a startup. One thing DJ learned is that inventing a cool product doesn't equal having a business: You can develop whatever you want to develop (but) until you have customers giving you feedback, none of it counts. ... The product's great but you really need all the feedback you can get so you can improve on it. You want to move as fast as possible to be able to get that feedback and that might not be the perfect product you wanted to build. You want to have at least some of the earlier versions of it out there like ... a minimum viable product that at least demonstrates a key component so that people can start like giving you feedback. ... it might inspire some of the things you're not doing and also validate some of the thoughts you had before. To hear the clip, click here. Mark Hatch is one of the leaders of the Maker Movement. Prior to co-founding TechShop, the former Green Beret was an exec at Kinko's, Avery Dennison and Health Net. Author of The Maker Movement Manifesto, Mark was recognized by as one of the Bay Area's Most Admired CEOs and by Popular Mechanics as one of 25 movers and makers reinventing the American Dream. Mark explained why being a Green Beret is good training for entrepreneurs: (I learned) confidence, leadership, discipline, stick-to-it-iveness, the ability to function on very small amounts of sleep. ...Discipline (is most important for entrepreneurs). ... I think most successful entrepreneurs are very disciplined at some level. ... even if you're not necessarily disciplined with your schedule, you're always running in the back of your head, "here are the important things that have to get done," and there's really nothing that's going to stand in your way between getting them done and not getting them done. ... You have to get them done, so you'll find a way. ... Failure is not an option. ... I think I had part of (those traits) in me, but the military really helped unpack it in a very substantial way. Becoming a Green Beret is not a really easy feat. ... 5 percent graduate, 8 percent graduate, something like that. At the end of it, you know you can do just about anything that you put your mind to, and in (Special Forces), in particular, we've got a lot of really bright guys. ... You have a decent IQ and then you have to be able to operate in extreme environments for extended periods of time. ... It's a perfect ... training ground for an entrepreneur. To hear the clip, click here. -- Before college, DJ dreamed of making robotic prosthetics. An internship set him on a different path: ... I thought I wanted to study mechatronics engineering... to make robots, because robots are cool. ... I wanted to make intelligent prosthetics. (For example) a leg that bends at the joint, that's actually smart enough to adapt to you. ... (However) I quickly realized I liked making cell phones much better. ... I worked at Qualcomm and RIM at the time ... for my internships. ... I worked on Android there and it was cool. ... That was definitely a thing I was really interested in, hardware design. How all these things went together and how you can work with manufacturers to help you do all the work. ... Steve: So much for making limbs to make people's lives better. DJ: Exactly. ...This is way cooler. To hear the clip, click here. DJ and Chris created Athos' technology to fill a personal need: All the time that we spent at the gym, not knowing exactly how to get the most out of the time. We'll go there for an hour and lift a bunch of weights, but how do we know that's the most we can get out of that time? Being engineers we wanted to optimize that. We couldn't really afford a personal trainer; for us $50 an hour was a ridiculous amount of money. .... We started looking at what type of information we could get that was really valid about what is going on with your body. ... (At the time, it was less about building a company and) much more about we needed a project for our final design project. ... We wanted to do something that was a little more ambitious. ... it needed to be a product that we wanted to use. ... (This was important because) when you're able to relate to the problem you ... get to make the trade-offs very easily because you understand, OK it needs to be like this otherwise it's not going to be really useful. ... We recognized ... that we were lazy. We forgot to take a pen and paper to take notes as to what kind of workout we did. There was no chance that we'd take another piece of hardware to go to the gym, so we had to build (the technology) into something that was already a part of our existing routine. ... We (built it) into gym clothes because we already took our gym clothes. ... (We thought) let's make it as easy as possible for people to use something, so that it increases the likelihood for them to adopt it, because you don't have to build a new habit or routine to use it. To hear the clip, click here. Here's how their idea became a startup: We got lucky. ... We were demonstrating this at our final year symposium. ... Somebody ... came by who talked at us for about 10 minutes. We had no idea who he was (but) he was better dressed than everybody else was. That was a hint. ... He said, "Really cool guys," and ... walked away. (Turns out he was a VC.)... a couple weeks later he sent us an email saying, "... I'm really interested in what you guys are doing. ... I want to fund you guys, and keep working on this. Can we talk some more?" Steve: ... while you are thinking this just happened, I'll suggest entrepreneurs make their own luck. If you hadn't ... noticed this guy with the nice clothes, and you probably spent another extra couple minutes with him, rather than someone else. ... You made a connection in a way, that while you think it was just luck, I'll contend you actually influenced the event. To hear the clip, click here. DJ said developing a founder's mindset was challenging: When you're an engineer, you're always used to working towards the right answer or the correct answer, but (for a founder) there is no concept of a correct answer. It's more like writing an English essay where you can do your best job, but you never know if you've had the right answer until you're looking back when you got the graded paper. ... You just can do your best (but) you don't know that you're doing the right thing or if you're doing the best thing until ... later on. To hear the clip, click here. -- TechShop, Mark said, is Kinkos for geeks: (TechShop co-founder) Jim Newton... built (TechShop) for himself. He built a 20,000-square-foot facility with every tool you need to make anything on the planet. ... Machine tools ... mills and lathes ...It had every tool you'd need to make anything. ... You (can) build (an) entire (prototype) from the ground up. Steve: If it's something mechanical, this was the ultimate toy store. Mark: Absolutely. ... the Kauffman Foundation says that 50 percent of all successful companies come out of the founders' personal need. This happens to be one of those stories. Jim needed access to these tools ... because he had ... 200 new product ideas in his inventor's notebook. ... He sat down and said, "Here are all the tools I need to do every single one of these," and that became the minimum set, which was magical. Nobody else on the globe had come up with this concept for a minimum set for an inventor's paradise. ... To hear the clip, click here. He explained the Maker Movement's impact on entrepreneurism: I talked to three different entrepreneurs back to back, and each one of them told me that they had saved 98 percent of their startup costs by using the TechShop platform. ... (this) quote came to mind: The future is already here; it's just not evenly distributed. ... ... if you can reduce the cost of a startup by 98 percent, you've completely changed the economic reality for a very significant piece of the economy. To hear the clip, click here. Mark added that founders should take the media's fairy-tale startup stories with a grain of salt: It's a lot harder than it looks. Don't believe the magazine articles. ...The magazines always tell you the success stories. They don't tell you the 95 percent of the other people who failed. Steve: Right, and your co-founder quitting and your biggest customer going away. ... Mark: ... And firing your best friend, laying people off. If you're not prepared to let people go, then you're just not really setup to be able to do this. ... ...The enterprise tells you what it needs, and if you're not prepared to listen to it, and give it what it needs, then you're probably going to fail at some point. You got to listen very carefully. Listen to your customers, listen to your staff, and then make the modifications as early as you possibly can. That's a hard thing to learn. To hear the clip, click here. And he offered this advice to other founders: Focus on your strengths as an entrepreneur. (The management consultant) Peter Drucker talked about this in one of his classes. He ... said, "Nobody ever became great working on their weaknesses." ... the intriguing thing is that ... if you're in a big company and HR talks to you, they typically use that conversation around what you're bad at as a reason why you didn't get a promotion or whatever. Then they tell you this is what you need to work on. That's the worst possible advice. ... To hear the clip, click here. Listen to my full interviews with DJ and Mark by downloading them from SoundCloud here and here. (And download any of the past shows here.) Next on Entrepreneurs are Everywhere: Wayne Sutton, co-founder of BUILDUP; and Dave Kashen, co-founder and CEO of Worklife. Tune in Thursday at 1 pm PT, 4 pm ET on Sirius XM Channel 111. Steve Blank's blog: www.steveblank.com -- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.
Most people who have explored options or purchased health insurance on the Affordable Care Act's exchanges learned quickly that premiums and deductibles are closely related--the lower the premiums, the higher the deductibles will be. This is the insurance industry's come-on way of attracting enrollees, which may work at first but not in the longer run. Here we examine what this inter-relationship means for many millions of Americans as premiums go up and coverage goes down. Looking first at premiums, these are the current trends. Although presidential candidate Barack Obama once promised that his health care reform bill would save the typical or average American family about $2,500 a year on their health insurance premiums (1), that promise fell by the wayside long ago. Since many of the ACA's requirements had not kicked in for the first and second enrollment periods in 2013 and 2014, insurers had some latitude in keeping their premiums low to attract enrollees in the early years. But those days are over as these premium projections for 2016 tell us: (2) Blue Cross/Blue Shield plans, market leaders in many states, are seeking rate increases of 23 percent in Illinois, 25 percent in North Carolina, 31 percent in Oklahoma, 36 percent in Tennessee, 37 percent in Kansas, 51 percent in New Mexico, and 54 percent in Minnesota. (2) The Geisinger Health Plan in Pennsylvania has filed for a 40 percent premium increase, while the Scott & White plan in Texas wants a 32 percent rate increase. Insurers defend these hikes in various ways, including claims that enrollees were sicker or older than expected, and that some costs were higher than anticipated, such as those for hospitalization, emergency room services, and specialty drugs. Regulation of premium rates falls to the states, where the insurance lobby tends to prevail in avoiding significant regulation of premiums. As one example of industry-friendly regulation, the Oregon insurance commissioner, after a rigorous review of the experience of Health Net, actually approved a 34.8 percent increase in premiums, almost four times what had been requested, over concerns that "inadequate rates could result in companies going out of business in the middle of the plan year, or being unable to pay claims." (3) As premiums keep going up, so do deductibles. A 2014 survey by the Kaiser Family Foundation found that average deductibles for bronze plans, which cover just 60 percent of health care costs, were more than $5,000 for individuals and $10,000 for families, while deductibles for silver plans were $2,907 and $6,078, respectively. (4) Narrow networks have become endemic under the ACA, which initially permitted insurers to include just 20 percent of "essential community providers" in their plans. A backlash soon broke out among hospitals and physicians on being arbitrarily excluded, forcing disruption of their established relationships with patients and breaking up continuity of care. In response, the Department of Health and Human Services raised its requirement to 30 percent, but this is still a major problem for many patients, especially since out-of-network costs are typically not covered by insurers. Since insurers, hospitals, and physician groups continue to negotiate and re-negotiate their contracts, networks are subject to change at any time, which patients (and physicians) find difficult to keep up with. A recent study found that many health plans sold through the ACA's exchanges in 2015 were so narrow as not to include such specialists as endocrinologists, rheumatologists, and psychiatrists; 15 percent of these plans did not include a single in-network physician in at least one specialty. (5) What do these well-entrenched trends mean for patients with private health insurance, whether through their employers or ACA plans purchased on the exchanges? These are three major impacts, with no resolution in sight under the ACA: Disruption and churning of coverage The Urban Institute estimated that 9 million people would shift between Medicaid and the ACA's exchanges in 2014. (6) We can expect that instability of coverage will continue indefinitely as insurance markets change, requiring a massive bureaucracy trying to mitigate the adverse effects of these shifts. Now, in the ACA's third open enrollment period, the Obama administration is actually encouraging enrollees to switch plans as a way to avoid steep increases in premiums, acknowledging that 86 percent of people who have coverage through the federal exchange can find a better deal (at least for premiums) by switching. (7) Unfortunately, this volatility of coverage is likely to lead to increased costs as new providers become involved in patients' care (often repeating laboratory tests and procedures that were done in the recent past by former providers), as well as decreased quality of care. Unaffordability of health insuranceMore than 2 million exchange enrollees are not getting subsidies/tax credits because they selected a non-qualifying plan, such as a bronze plan with the lowest premiums and an actuarial value of only 60 percent. (8) Although the median household income in the U. S. is about53,650, Americans are spending an average of more than5,000, just for health insurance, without factoring in all the other costs associated with actual health care. By the fall of 2015, among adults age 19-64 visiting the ACA's exchanges, 57 percent could not afford a health plan. (9) The latest study by the Commonwealth Fund found that 43 percent of privately insured adults say their deductible is difficult or impossible to afford, while one-half of low- and moderate-income adults express difficulty affording their deductibles. (10) Inability to afford health care According to the 2015 Milliman Medical Index (MMI), total health care costs, including insurance, for a family of four with an average employer-sponsored insurance PPO plan in 2015 came to24,671, including payroll deductions and out-of-pocket costs, and is expected to exceed25,000 in 2016. (11) More than one-half of privately insured adults with incomes under 200 percent of the federal poverty level (23,340 for an individual and47,700 for a family of four) had unaffordable health care costs, while 30 percent of adults with moderate incomes (up to46,680 for an individual and95,400 for a family of four) had unaffordable costs, double the rate of higher-income adults. (12) As we look at these trends, it seems clear that the health insurance industry needs more and more help from government and taxpayers to stay alive. Though denied by its supporters and lobbyists, it is in a death spiral and would already be in dire straits without these bailouts by the federal government over many years: Employers' contributions to employer-sponsored health plans have been tax-deductible for many years Subsidized markets through the ACA's subsidies/tax credits The industry continues to seek out healthier enrollees, shifting sicker patients to public programs The ACA's "risk corridor program" protects insurers from losses in qualified health plans sold in the individual and small group markets; as one example, Blue Cross Blue Shield, the largest insurer in North Carolina, received almost295 million in federal payouts even as it was seeking a 25.7 percent rate increase for its individual policies. (13) Today, in effect, the Obama administration is being held hostage by the health insurance industry, since it is dependent on it to carry out its signature domestic policy success. No further bailouts are warranted. The public, including patients, families, business and taxpayers, are the patient, not the insurance industry. The industry has had a long run and failed the public interest. It is time to replace it with a more accountable system with universal access, cost containment, lower administrative overhead, and a service-oriented culture--single-payer national health insurance (NHI). References: 1. Wogan, JB. No cut in premiums for typical family. The Obameter. PolitiFact, August 30, 2012. 2. Pear, R. Health insurance companies seek big rate increases for 2016. New York Times, July 3, 2015. 3. Ibid # 2. 4. Goodnough, A, Pear, R. Unable to meet the deductible. New York Times, October 17, 2014. 5. Dorner, SC, Jacobs, DC, Sommers, BD. Adequacy of outpatient specialty care access in marketplace plans under the Affordable Care Act. JAMA 314 (16): 1749, October 27, 2015. 6. Bergal, J. Churning between Medicaid and exchanges could leave gaps in coverage, experts warn. The Washington Post, January 5, 2014. 7. Goodnough, A. Now, finding a health plan is annual rite for shoppers. New York Times, November 19, 2015. 8. Andrews, M. Study: 2 million exchange enrollees miss out on cost-sharing assistance. Kaiser Health News, August 21, 2015. 9. Collins, SR, Gunja, M, Dotie, MM. To enroll or not to enroll? Why many Americans have gained insurance under the Affordable Care Act while others have not. The Commonwealth Fund, September 25, 2015. 10. Issue Brief. How High Is America's Health Care Cost Burden? Findings from the Commonwealth Fund Health Care Affordability Tracking Survey, July-August 2015. 11. Milliman. 2015 Milliman Medical Index, May 2015. 12. Ibid # 10. 13. Murawski, J. Blue Cross eligible for $295 million ACA bailout, seeks rate increase. Charlotte Observer, July 7, 2015. Adapted and excerpted, in part, from my soon-to-be-released book, The Human Face of ObamaCare: Promises vs. Reality and What Comes Next. (See advance press release at: http://www.johngeymanmd.org) -- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.