Lisa DiDio, Director of Sales for AmeriHealth New Jersey, a member of the Quality Institute’s Plan Council.

For our readers, please share which health insurance markets AmeriHealth New Jersey participates in? 

With the onset of the Affordable Care Act, we’ve been committed to offering health plans in the individual market, which we all know has expanded coverage for residents across the state of New Jersey. We also participate in New Jersey’s state-based exchange, established in 2020. And we also focus on plans designed for small employers, mid-sized businesses, with a focus on municipalities and school systems across the state. Public sector groups have been a focus of ours.

The Quality Institute’s White Paper on the small employer market contained recommendations to strengthen the market. Which recommendation or issue raised would make the most difference for small businesses and organizations trying to buy affordable health insurance for their employees?

The White Paper includes multiple strategies to address health care affordability and price transparency for small employers and consumers. But if we had to pick one issue to address, we would pick the recommendation to modernize the regulations in the market so regulated insurers could better compete with the alternative market. That recommendation — the third in the White Paper — focuses on strengthening the small group market by eliminating the alternative markets. We need to level the playing ground, so everyone plays by the same rules. We think that’s the best reform.

We want to remain committed and competitive in the small group market. And these alternative plans really are focused on groups that have a relatively healthy employee base. It’s a great option for those groups, but it’s not really meeting the needs of all small employers.

How is AmeriHealth trying to balance the costs of covering high-priced, life-changing medications while also keeping insurance affordable?

The bottom line is that New Jersey health care costs have grown three times faster than the incomes of New Jersey residents. And we’re also ranked among the lowest performing states in terms of the cost burden for working families. Providing cost-effective health coverage is really one of our main priorities. Prescription drug prices continue to be one of the single greatest drivers of health care costs. And we must ensure that health care premium dollars are being spent on safe, effective, and appropriate care. So, this really means identifying lower priced and equally effective alternatives.

A lot of health care providers have tools that help them easily access information on what resources their patients have to pay for medications, based on their specific health plan. And these tools really can offer information when lower cost alternatives are available. That is something that doctors could play a part in, and we’re committed to ensuring that we’re doing everything to provide effective and appropriate care while also lowering costs with effective alternatives.

What information technology tools are your customers asking for and using to access care and manage their benefits?

Engaging our members with self-service tools and technology that didn’t exist decades ago is a primary goal of ours. We recently launched an enhanced version of what we call our cost care estimator tool that allows members to compare their estimated out-of-pocket costs across different providers. It’s based on the claims data and the benefit plans. The tool also allows them to estimate the cost of their prescriptions at different pharmacies. With members now having these high deductible plans and a lot of skin in the game, this cost care estimator tool is really one of those game changers. … And we’re doing member-specific text messaging and emails to send out reminders and important information.

Finally, we like to ask people something beyond just their professional life. So, who is your favorite New Jersey artist?

This is difficult because so many great artists were born and raised in New Jersey. But if I had to pick one, I would have to say it’s Paul Simon. His songs are timeless and heartfelt. And when I was growing up, one of my favorite songs was Me and Julio Down by the Schoolyard. Every time I hear that song, it brings a smile to my face. Not everyone knows that while Paul Simon grew up in New York, he was born in New Jersey.