Jesse Caplan Quoted in Article, “Utilization Uptick, Greater Regulatory Scrutiny Could Spark Stormy Rate Battles”

AIS' Health Plan Week

Jesse Caplan, a Member of the Firm in the Health Care and Life Sciences practice, in the Washington, DC, office, was quoted in an article titled "Utilization Uptick, Greater Regulatory Scrutiny Could Spark Stormy Rate Battles."

Following is an excerpt:

Nearly two years of low medical utilization — combined with more regulatory scrutiny, reductions in administrative expenses and increased pressure on providers to improve efficiencies — have helped many health insurers hold rate increases to single digits.

Caplan says it's difficult to determine how effective the federal rate review program has been so far and whether it will influence future rate-hike requests. Since September, the federal government has cited only a half-dozen rate filings by insurance carriers as excessive. The insurers, however, argued the rates were justified, and ultimately none was rescinded or reduced, he says.

The threat of federal rate review might have caused some health insurers to "sharpen their pencils" when calculating rate increases and more aggressively negotiate lower reimbursement rates from providers, he says. "If that has allowed insurers to file rates that are below the 10% threshold, then arguably the program has had some measure of success," said Caplan.