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Arijit Guha recently made the news by convincing Aetna to pay all of his outstanding medical bills once he exceeded his lifetime max on his university sponsored student health plan.  The healthcare consumer landscape continues to evolve as payer executives venture into social media platforms such as Facebook and Twitter. 

Mark Bertolini is not afraid to enter the public conversation regarding healthcare in the United States.  He demonstrated this when he first took the post as Aetna CEO, during the debate of the Affordable Care Act (ACA), and now in this situation as well.  Regardless of his stance or opinion, his willingness to address change is admirable.  I’m intrigued to see how he and Aetna back it up and whether or not his leadership style will marshal any changes amongst the other large payers, especially in light of Angela Braly’s resignation from WellPoint. 

Health insurance is at its core a hedge against getting sick. We pay premiums to health insurance companies to protect ourselves against such physically and financially disastrous situations as cancer.  This is the primary argument Arijit makes against the health plan he purchased.  For the premiums he paid, Arijit was only covered for $300,000 in healthcare services – which obviously in this situation was not enough.  Legislators have taken Arijit’ s side (through the enactment of the ACA) by banning lifetime maximums so that situations like this will be prevented in the future.   But there are potential consequences to this expansion of benefits including the likelihood of increased premiums.  We are already witnessing the debate unfold after the Kaiser Family Foundation released survey results stating that average premium cost for family plans increased 9% from 2010 to 2011 (click here for source).  The balance between consumer protection (annual/lifetime maximum bans, minimum coverage requirements, non-consideration of pre-existing conditions, etc.) and health plan cost will be interesting to see play out as the ACA takes full effect and health care reform continues. 

Arijit references within one of his tweets a study performed by the New York Times (click here for link) that shows the percentage of premiums paid out by different health plans at different universities and colleges.  The medical loss ratios (MLR) are highly variable and downright poor in certain instances.  For example, from 2004 to 2007 at the New York Institute of Technology, the university sponsored Aetna student health plan paid out an average of $0.38 for every $1.00 in premiums paid.  The ACA specifically addresses MLR deficiencies by requiring health insurance companies to spend 80%-85% of premium dollars on medical care (or pay a reimbursement penalty if they do not meet these standards).  While industry averages for MLR are vague and inconsistent, the Kaiser Family Foundation has estimated that consumers and businesses are expected to receive an estimated $1.3 billion in rebates from health insurers who are not compliant with the new MLR requirements (click here for source) (additionally – click here for an excellent synopsis of this debate).  This represents a tremendous opportunity for improvement within these companies, especially in the areas of: technology consolidation, automation, and process re-engineering.  We at West Monroe Partners have had an opportunity to play a significant role in all three of those phases at past healthcare payer clients. 

Arijit used social media to advance not only his own cause but to advance the national healthcare discussion as well.  There’s a problem with American healthcare education in that too many people don’t know enough about this essential service.  The more we are able to discuss things like Lifetime Maximums, MLR, and the regulations that have recently gone into effect the more conscious we will be as consumers within the healthcare market.  While the ACA does require health insurance companies to simplify and standardize plan language, we as individuals need to take greater ownership of our healthcare decisions. 

How do you think social media will impact the way healthcare is delivered in the U.S.? 

For more information on Arijit Guha and his recent conversation with Aetna and it’s CEO Mark Bertolini, check out the following links: 


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