Archive for the ‘Health Insurance Exchanges’ Category

2017 Healthcare Success Formula: Care Management Sophistication and ‘Patient Stickiness’

November 29th, 2016 by Patricia Donovan

HIN's 13th annual planning session provided a roadmap to key healthcare issues, challenges and opportunities in 2017.

Whether concerned with healthcare delivery or reimbursement for services rendered, providers and payors alike will need to be nimble in the coming year to survive and thrive in a sharply shifting, value-based marketplace, advises Steven Valentine, vice president, Advisory Consulting Services, Premier Inc.

"Be aware: the competitors you've had in the past are changing, and you're seeing more competition with various Internet providers, CVS, Apple, Watson. It's all going to change," said Valentine during Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a November 2016 webinar now available for replay.

But what healthcare shouldn't panic about, at least for the immediate future, is the demise of the Affordable Care Act (ACA).

"[The ACA] is not going to be canceled any time soon," Valentine emphasized during the thirteenth annual planning session sponsored by the Healthcare Intelligence Network. "We would expect it would take two years, at least, to begin to put in some kind of a replacement program."

Assuring participants that within all this industry flux are opportunities, Valentine suggested they follow the lead of retail pharmacy CVS. "CVS envisions itself as a full service healthcare organization with a goal of 'patient stickiness.' In other words, CVS is saying, 'I need patients to rely on me as their source of getting started for healthcare.'"

Later in the program, he offered participants a four-point plan for improving patient stickiness.

As for care management sophistication, Valentine pointed to the pairing of hospitals with a case manager, with incentives for care managers and hospitalists to manage down length of stay, or manage resource consumption.

"We're probably gravitating more toward care management models that are outside the four walls of the hospitals...which will give us better economies, better outcomes, people more specialized in the areas they're in that could really help provide better quality at a lower cost."

And while the healthcare thought leader believes Medicare will remain essentially untouched by the incoming presidential administration, he did identify nearly a dozen areas where President-Elect Donald Trump's 'Better Way' might eventually make its mark on healthcare, including more price transparency and the sale of insurance across state lines.

Moving on to sector-specific forecasts, Valentine outlined four expectations for health plans, including a push for more access points like telehealth and urgent care centers and added pressure to reduce chronic care costs.

Healthcare providers should focus on population health and immerse themselves in data analytics to better prepare for MACRA and the narrow, quality-based provider networks that will result.

Both sectors should expect more consumer demand for accountability, Valentine said, since patients and health plan members are fed up with rising costs and armed with more transparency information and health awareness.

Valentine concluded his presentation with eight guiding principles for 2017 success, including collaboration between health plans and physicians.

And in the Q&A that followed, Valentine offered guidance on a number of issues, including how providers can grow their population bases; identifying and addressing social health determinants; succeeding in value-based healthcare, and offering efficient, integrated behavioral healthcare services.

Click here to listen to advice from Steven Valentine on employing technology for patient engagement.

Infographic: Insurance Coverage Rates

August 5th, 2016 by Melanie Matthews


The percentage of Americans under age 65 who lack health insurance decreased from 2010 to 2015, according to new data from the Agency for Healthcare Research and Quality (AHRQ).

An AHRQ infographic examines the uninsured rate among poor people, young adults, and across all races.

Private Insurance Exchanges: Adapting Insurer Strategies to the New MarketplacesSkyrocketing private exchange participation rates — industry estimates predict more than 40 million people may be enrolled in private insurance exchanges within three years — carry implications for health insurers in terms of how the various market segments are succeeding or failing to attract business.

Private Insurance Exchanges: Adapting Insurer Strategies to the New Marketplaces details the radical transformation underway in how employers and consumers offer and shop for coverage. It discusses the current status of private exchanges, reviews the inventory in existence today, and shares thoughts from market consultants and insurance executives on how new business strategies will be influenced by new entrants to the private exchange space and the participation of insurers and brokers.

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Infographic: 2 Key Features of the 2016 Federal Marketplace Drug Coverage

November 11th, 2015 by Melanie Matthews

Americans fill more than 12 prescriptions per year, per person, according to a new infographic by April L.J. Seifert, Ph.D.

The infographic looks at the types of prescription drug coverage available through the federal marketplace for 2016 and factors that consumers should consider when selecting health insurance coverage.

2 Key Features of the 2016 Federal Marketplace Drug Coverage

Innovative Plan-Provider Ventures: Case Studies From Anthem and Aetna provides the details of two case studies of plans and providers that are collaborating on value-based care models:

  • Vivity, a collaboration between seven prestigious California health systems and Anthem Blue Cross of California, promises to improve quality and share cost savings among the participating entities.

  • Innovation Health, the northern Virginia health plan owned 50-50 by Aetna Inc. and Inova Health System, represents a great example of an "alignment" structure, with the new health plan allowing the provider and carrier to tap into each other's expertise to lower costs, grow market share and move to value-based payment.

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Infographic: A Comparison of ACA Marketplace and Employer Health Plan Costs

October 16th, 2015 by Melanie Matthews

Healthcare premium costs for lower-income enrollees in the ACA Marketplace are similar to those with employer coverage, according to The Commonwealth Fund.

A new infographic by The Commonwealth Fund examines the premium levels of marketplace and employer plan enrollees, as well as deductible levels for these segments.

A Comparison of ACA Marketplace and Employer Health Plan Costs

2014 Performance Measures for Individual, Small-Group and Large-Group Risk-Based Plans

Commercial Health Plan Market Metrics provides a snapshot of the rapidly evolving commercial risk health insurance market, by assessing the impact of the individual mandate, exchanges and other Affordable Care Act initiatives. Filled with charts and statistics applying metrics such as membership, premium revenue and claims expenses, it measures which plans made profits—and how profitable they were—in various segments of this market during the first full year of ACA implementation.

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Infographic: Healthcare Coverage and Access for Men

July 8th, 2015 by Melanie Matthews

Fewer men than women gained health insurance coverage between October 2013 and March 2015, and the uninsured rate continues to be higher for men than women, according to a new infographic by the Henry J. Kaiser Family Foundation.

The infographic also examines cost barriers to care and the likelihood of males to obtain regular screenings.

Private Insurance Exchanges: Adapting Insurer Strategies to the New MarketplacesSkyrocketing private exchange participation rates — industry estimates predict more than 40 million people may be enrolled in private insurance exchanges within three years — carry implications for health insurers in terms of how the various market segments are succeeding or failing to attract business.

Private Insurance Exchanges: Adapting Insurer Strategies to the New Marketplaces details the radical transformation underway in how employers and consumers offer and shop for coverage. It discusses the current status of private exchanges, reviews the inventory in existence today, and shares thoughts from market consultants and insurance executives on how new business strategies will be influenced by new entrants to the private exchange space and the participation of insurers and brokers.

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3 Factors Driving Healthcare’s Transition from Volume to Value

December 9th, 2014 by Patricia Donovan

Long term, the healthcare industry's well-documented transition from a value-based system to one that rewards value will ultimately promote consolidation in the industry, putting some companies out of business while making consumers more accountable for their care, predicted Steven Valentine, president of The Camden Group, during HIN's eleventh annual healthcare trends forecast.

But how rapidly will the market complete this transformation? Valentine shares three factors that will impact the change.

People always say how fast our market will change. There are three factors to consider as the market transitions from volume to value.

The first is the time frame for the transition. Driving the time frame are concerns such as competitors’ activities, payor payment models (capitation, shared savings, case rates). What is going on in payor models that will help move the market? Another driver is managed care penetration. Some parts across the country have little to no managed care penetration. Those will be areas with lower change in terms of that market.

The second factor is the delivery system change. Impacting this is the physician-hospital economic alignment. We look for contiguous geography. A hopscotch strategy doesn’t work very well for transitioning the market. We look at the integration along the continuum, starting with doctors through a minimum, then the ambulatory and acute area. Our belief is that this year, post-acute begins to show up. We see most of the money that can be made in bundled payment really comes from a longer period of time to be at risk: 90 to 120 days. We find it in the post-acute care arena to save the money. Other drivers for change in the delivery system include the use of population health tools (PCMH, ACOs and chronic care centers), as well as clinical integration.

Finally, we look at the payment system—incentives, pay for performance, shared savings—any value-based purchasing programs put in place. You will need to take risks. Organizations that take risks, especially well organized medical groups, will help to drive a market and the transition to value much more quickly.

healthcare trends 2015
Steven T. Valentine, MPA, is president of The Camden Group, a national healthcare management consulting company. With more than 35 years of healthcare consulting experience, he has considerable expertise in the areas of strategic planning, business transactions, mergers, hospital-physician relationships, and financial analysis.

Source: Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare Industry

Infographic: Assessing the Affordable Care Act

October 29th, 2014 by Melanie Matthews

There are a number of measures that could be used to evaluate the effectiveness of the Affordable Care Act, according to the Commonwealth Fund.

To date, the ACA's implementation has been associated with significant progress, reflected in a new infographic by the Commonwealth Fund. The infographic looks at the ACA marketplaces and health insurance enrollment and uninsured trends since the ACA's implementation.

Asessing the Affordable Care Act

Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower CostsPursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs shares compelling stories that are emerging in locations ranging from Pittsburgh to Seattle, from Boston to Oakland, focused on topics including improving quality and lowering costs in primary care; setting challenging goals to control chronic disease with notable outcomes; leveraging employer buying power to improve quality, reduce waste, and drive down cost; paying for care under an innovative contract that compensates for quality rather than quantity; and much more. The authors describe these innovations in detail, and show the way toward a healthcare system for the nation that improves the experience and quality of care while at the same time controlling costs.

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Infographic: Health Insurance Affordability Through ACA’s Marketplaces

October 1st, 2014 by Melanie Matthews

Sixty-one percent of adults paying health insurance premiums through the Affordable Care Act's marketplaces are reporting they are somewhat or very easy to afford.

The Commonwealth Fund summarizes the experiences of health insurance marketplace customers in terms of affordability and plan satisfaction in a new infographic.

Physician Adoption of Health IT

Public Exchanges Data: Premium Analysis and Carrier Participation for 2014 As health plan operators last year were preparing to offer plans on the state-run and federally facilitated health insurance exchanges, they could only guess at the age and health of the population that would enroll, and they had no information about how their competitors would price their plans.

Now that open enrollment is over, Public Exchanges Data: Premium Analysis and Carrier Participation for 2014 takes a look at how it all played out. This report offers a highly detailed overview of where carriers participated, the types of products they offered and how their prices stacked up against their competitors.

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Infographic: Healthcare Quality in Insurance Marketplaces

August 11th, 2014 by Melanie Matthews

Under the Affordable Care Act, some health insurance marketplaces have taken steps to improve healthcare quality and delivery in their states.

A new infographic from The Commonwealth Fund examines which states and how the marketplaces are improving quality.

13 States Are Using the Health Insurance Marketplaces to Improve Quality

The new health insurance exchange marketplaces, public and private, will have a profound impact on the under- and uninsured...and will permanently alter the way health insurance is bought and sold.

AIS's Health Insurance Exchange Directory and FactbookAIS's Health Insurance Exchange Directory and Factbook is the definitive health industry guide to health insurance exchange implementation and stakeholder strategies, with in-depth coverage of every big-dollar business issue related to the new marketplaces — including technological infrastructure, consumer support tools, benefit design, marketing, FFEs and much more.

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Infographic: ACA’s Impact on People Seeking Healthcare

August 1st, 2014 by Melanie Matthews

Sixty percent of people with new coverage through the Affordable Care Act have visited a doctor, gone to the hospital, or filled a prescription, according to a new infographic by The Commonwealth Fund.

The infographic explores how the ACA has impacted previously uninsured adults and young adults, how the Medicaid expansion has impacted the uninsured rate and whether the newly insured would have been able to afford care previously.

ACA's Impact on People Seeking Healthcare

As health plan operators last year were preparing to offer plans on the state-run and federally facilitated health insurance exchanges, they could only guess at the age and health of the population that would enroll, and they had no information about how their competitors would price their plans.

Now that open enrollment is over, Public Exchanges Data: Premium Analysis and Carrier Participation for 2014 takes a look at how it all played out. This report offers a highly detailed overview of where carriers participated, the types of products they offered and how their prices stacked up against their competitors.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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