PressGo! Industry Guide

Size: px
Start display at page:

Download "PressGo! Industry Guide"

Transcription

1 PressGo! Industry Guide To Health Care The US health care industry is going through a period of unprecedented change driven by regulation, technology and demographic changes. One of the largest sectors of the US economy, in 2011 health care accounted for over 17% of GDP and employed roughly 11 percent of the country s workers according to the McKinsey Global Institute. With average annual increases in health care expenditures of 5 percent over the past decade, the need for reform and productivity improvements is reshaping the industry. Legislative changes intended to control costs and increase access to health insurance are creating a consumerdriven market for the first time. Meanwhile, consumers increasingly are turning to digital channels to research and make their medical and insurance decisions. Coupled with intense cost-cutting pressures, this consumer interest in web, mobile and social channels is driving health care companies to migrate communications online. However, the industry is still highly dependent on print for many types of communications and is seeking ways to improve the performance and productivity of print. TABLE OF CONTENTS Market Segments 2 Table 1. Market Overview 2 Market Concentration and Brand Equity 3 Table 2. Brand Strength of Health Care Companies Source HarrisInteractive.com 3 Table 3. Ranking of Largest US Payors and Providers 4 Learning the New Rules 5 Impact on Business Communications 6 Table 4. Key Payor Business Communications 6 Table 5. Key Provider Business Communications 8 Helping Your Health Care Customers 9 Table 6. Opportunities to Help Payors 9 Table 7. Opportunities to Help Providers 11 Summary 12 Resources for Further Learning 13 Communications across all channels are becoming more strategic, segmented and measurable. Service providers with the ability to help health care communicators to control costs and increase effectiveness will find many opportunities in this market. 1

2 MARKET SEGMENTS When pursuing opportunities in the health care market, it is important to understand the two major groups that dominate the US market: Health Insurance companies and their distribution partners Healthcare Providers like Hospitals, medical practitioners and laboratories Many of the biggest challenges in the health care industry stem from coordination between Insurance companies and hospitals, or Payors and Providers who compete for the premium dollars paid by insured individuals or health plan members. In addition to these main groups, there are an increasing number of hybrid Payor/Provider organizations where insurance coverage is tied to a specific group of providers or where hospitals and hospital networks are owned by major insurance firms. TABLE 1. MARKET OVERVIEW Payors Health Insurers Pharmacy Benefi t Managers (PBMs) Traditional offers: Group health plans (through employers) Individual health plans Medicare advantage plans (replaces Medicare coverage and may provide additional features) Medicare supplement plans (offered in addition to Medicare coverage) Supplemental offers: Vision coverage Dental coverage Pharmacy coverage Providers Traditional: Community hospitals Hospital systems Hospital networks Individual physicians/specialists Labs and diagnostic services Hybrid: Accountable Care Organizations (ACO) Health Maintenance Organizations (HMO) Preferred Provider Organizations (PPO) Point of Service (POS) Marketing focus: Employers (group plans) Upsell and maintenance of existing Members (evolving) Acquisition of new Members Providers Government lobbying Marketing focus: Patient acquisition Patient retention Community outreach 2

3 MARKET CONCENTRATION AND BRAND EQUITY The payor market is highly concentrated at the national level and even more so at the regional level. Nationally, the two largest commercial insurers (see Table 3); Unitedhealth Group and Wellpoint each provide health insurance coverage to more than 30 million members and together cover approximately 23 percent of insured Americans. At a regional level, the largest five payors together account for 70 to 85 percent of all health plan enrollments. However, the largest players are not always those with the strongest brands (see Table 2) particularly when it comes to the provider side of the market. In 2011, nearly 16 percent of Americans were not covered by any health insurance including private insurance plans or government programs such as Medicare, Medicaid or Veterans benefits. Over the next few years, a large portion of this uninsured population will become prospects for marketers of individual insurance programs. The competition to develop new products and market effectively to this new demographic is having a ripple effect throughout the industry. Market opportunities exist for service providers who can help health care companies to position themselves with this new demographic while retaining business and controlling costs in existing markets. There is increasing need for brand marketing among both payors and providers. TABLE 2. BRAND STRENGTH OF HEALTH CARE COMPANIES SOURCE HARRISINTERACTIVE.COM 3

4 TABLE 3. RANKING OF LARGEST US PAYORS AND PROVIDERS Rank Payor and link to vital statistics Provider RANKING OF LARGEST INSURANCE COMPANIES National Association of Insurance Commissioners Ranking (naic.org) RANKING OF TOP FOR PROFIT HOSPITALS Leading For Profi t Hospitals in the US based on number of hospitals #1 Unitedhealth Group #2 Wellpoint Inc. Group #3 Kaiser Foundation Group Hospital Corporation of America (Nashville, TN) Number of hospitals: revenue: $29.7 billion Community Health Systems (Brentwood, TN). Number of hospitals: revenue: $113.6 billion Health Management Associates (Naples, FL) Number of hospitals: revenue: $5.8 billion #4 #5 Aetna Group (in-plant print facility) Humana Group (in-plant print facility) LifePoint Hospitals (Brentwood, TN) Number of hospitals: revenue: $3.03 billion Tenet Healthcare Corp. (Dallas TX) Number of hospitals: revenue: $9.58 billion #6 HCSC Group Health Care Services Corporation (operates BCBS plans in Illinois, New Mexico, Oklahoma and Texas) Vanguard Health System (Nashville, TN) Number of hospitals: revenue: $4.89 billion #7 #8 Coventry Corp. Group (proposal to merge with Aetna) Highmark Group (Multiple in-plant print facilities) Universal Health Services (King of Prussia, PA) Number of hospitals: 23 (acute care) 2011 revenue: $7.5 billion IASIS Healthcare (Franklin, TN) Number of hospitals: 18 (acute care) 2011 revenue: $2.8 billion #9 Independence Blue Cross Group #10 Blue Shield of CA Group Prime Healthcare Services (Ontario, CA.) Number of hospitals: revenue: Not available National Surgical Hospitals (Chicago, IL) Number of hospitals: 14 (Specialty/surgical) 2011 revenue: Not available See also Top 25 US Health Insurance Companies from US News and World Report (2011) See also 4

5 LEARNING THE NEW RULES Marketing successfully to the health care industry requires at least a basic understanding of the regulatory scrutiny these companies are under. Regulations affect all aspects of the industry from the formation of insurance products to the delivery of care by providers. The health care industry is regulated by an alphabet soup of acronyms both old and new. Regulations, regulators and guidelines affecting healthcare communications include: Centers for Medicare and Medicaid Services Department of Labor ERISA Internal Revenue Service Health and Human Services Securities and Exchange Commission State Insurance Commissions The Family and Medical Leave Act COBRA HIPAA HiTECH ICD-10 Classifications Patient Protection and Affordable Care Act Most recently, the highly debated Patient Protection and Affordable Care Act (ACA) has had a major impact on the industry and that impact will only increase in coming years. The law will require that all Americans have health insurance or pay a tax for not being covered. The law provides for individual states to create health insurance exchanges (HIX) by 2014 where individuals can compare and purchase health insurance plans. States will also have the option of deciding whether to expand Medicaid eligibility to cover additional low income citizens. Many states are currently undecided on whether to expand coverage or have not defined the terms for doing so. This lack of certainty is challenging for health insurers who must develop products for these exchanges on a state by state basis. Health insurance exchanges and a provision known as the Medical Loss Ratio or MLR are also changing the manner in which insurance products are marketed. Health insurance exchanges are a direct-to-consumer, retail format for comparing and purchasing a policy. This is a stark contrast to insurance companies traditional sales method of using brokers and Third-party Administrators (TPAs) to sell group plans to employers. To participate in exchanges, insurers must launch new products geared to individual members and learn to market them to a consumer instead of a business audience. The need to brand themselves for, market to, and compete in the consumer marketplace is creating pressure to control costs and to improve customer experience. Adding further cost pressure, the MLR is a provision of the ACA that requires insurers to spend at least 80 percent of premium dollars on actual medical benefits for insured members (85 percent for large plans.) If plans spend less than this amount, the difference is to be rebated to policy holders on an annual basis. Currently it is estimated that approximately $650 billion of the $2.6 trillion that American s spend on health care goes to overhead. The MLS provision requires payors to trim between $60 and $65 billion, or roughly 10% of current overhead costs from their budgets. A significant part of this overhead is marketing, advertising and sales commissions. Section 1104 of the ACA titled Administrative Simplification is intended to simplify and streamline billing and payment through standardization and encouragement of electronic processing. It is estimated that providers write off up to $60 billion annually in bad debt, primarily from consumers who don t pay their portion of services billed. Providers also experience significant delays in payment due to difficulty with coding services for processing of claims and a lack of accountability on timeliness of payments from payors. Administrative Simplification includes a series of standards for implementation through 2016 impacting the billing and claims process from pointof-sale through payment to providers. It also includes requirements for monitoring how quickly insurance companies are making payments. 5

6 IMPACT ON BUSINESS COMMUNICATIONS In the model where health insurance is sold by insurers directly to large employers or through Third Party Administrators to small businesses and individuals, insurance premiums are paid by employers or TPAs on behalf of members. Typically, the only communications sent directly to plan members under this scenario are required proof of coverage, ID card, Explanations of Benefit (EOBs) and any required notices of change in coverage. Even the initial Explanations of Coverage EOCs are often delivered by the employer at the time of enrollment. Notable exceptions are the marketing of Medicare Advantage and Medicare Supplement plans which are sold directly by insurers to seniors on Medicare. Implementation of the ACA along with the need to drive down costs, market to individuals and improve member experience is affecting business communications across the product lifecycle. TABLE 4. KEY PAYOR BUSINESS COMMUNICATIONS Product / Application Industry Challenges Marketing Direct marketing open enrollment. Seasonal direct mail and targeted to groups and members during open enrollment for employer sponsored plans and Medicare Advantage and Supplement Plans. Direct marketing individual plans. Non-seasonal multichannel marketing focusing on non-group. Collateral and signage. Static collateral at the corporate and plan level to support partners and retail operations. Enrollment Materials Enrollment Forms. Forms used to gather information to enroll an employee or individual in a health plan. ANOC/EOC. Annual Notice Of Change / Evidence Of Coverage Membership Identification Card. Provided at time of enrollment or as needed or required by plan sponsor post enrollment. Explanations of Coverage. EOC Booklets detailing benefits and exclusions of specific plans. ACA requires EOCs to be updated with standard definitions for insurance and medical terms. Summary Plan Description. The SPD is a legal summary of the plan benefits and overlaps somewhat with the EOC and the SBC. Summary of Benefits and Coverage. The SBC is a new, highly variable document mandated by the ACA intended to help compare plan features in a standardized way. It must be offered at enrollment and at least 60 days in advance of any plan changes. Provider Directory. Plans prefer to deliver information online but many members prefer print. The enrollment period for Medicare plans has been condensed from 6 months to 3 and overlaps group open enrollment. Information that is benefit neutral can be mailed in advance of the enrollment marketing period. The industry has little experience with direct to consumer marketing. As insurance companies establish retail storefronts there is an increased need for high end retail marketing collateral and signage. See details on Medicare Enrollment Materials Group plans are pushing to move enrollment online but print is still required and may need customization at the plan level. Applies to Medicare plans and is highly seasonal. Many plans shifting from paper ID cards to plastic. Trends toward RFID and embedding of additional member data in cards. Timely delivery is critical. There are now multiple documents describing coverage, the EOC, SBC and SPD which must be kept in synch. There are many variations of SPDs to create and manage. The SBC poses a significant challenge and expense to update, manage and distribute to plan participants and beneficiaries and volumes are difficult to forecast. Reduce print by driving members online and tailoring print by member location. Continued on next page 6

7 TABLE 4. KEY PAYOR BUSINESS COMMUNICATIONS CONTINUED Product / Application Industry Challenges Marketing Formulary Directory. A listing of the drugs a health plan will pay for. Usually this information is available online but many group plans require printed formularies to be provided. Providers may also request copies. Pharmacy directory. Similar to physician director, lists participating pharmacies in members region. A printed formulary is required for all Medicare plans. Directory required for all plan sponsors offering a Medicare Part D benefit. Wellness & Disease Management Health Assessments. Survey of individual health plan member health behaviors used to create a group risk profile and to recommend lifestyle changes to the individual. Usually results in an online or printed report to the individual. Wellness Programs. Communications, often personalized, intended to encourage the use of preventative care screenings and adoption of healthy lifestyle changes such as diet and exercise regimens. Disease Management. Ongoing communication on all aspects of dealing with a chronic medical condition such as asthma, diabetes, high-cholesterol or cancer. Communications for the patient, family, caretakers for addressing dietary and mental impacts as well as the disease itself. Program reporting. In addition to materials directed to individual members, there are aggregated reporting requirements at the group plan level to report on the effectiveness of programs and the overall risk profile of the insured population. Effective wellness programs require use of sensitive member data and therefore processes must be highly secure. In many cases, wellness programs may be tied to employee incentives for positive behaviors such as fitness activities or quitting smoking. If such programs are administered by employers they can be considered discriminatory and trigger IRS penalties or plan changes. Plans when offered by insurers are considered a competitive advantage. Coordinating individual campaign execution and reporting aggregated information to employers requires careful coordination and security. Wellness and disease management programs have been shown to significantly increase patient health and reduce health care costs. Billing, Claims and Payment (see Administrative Simplifi cation) EOB. Explanations of Benefit are explanations of claims made against health plans by members for health services. EOP. Explanations of Payments may be sent to providers or members to detail the proportion of a claim that is being paid. They may be accompanied by a check. Monthly Health Statement. In an effort to improve customer experience and track service usage, particularly for Consumer Driven Health (CDH) plans with high deductibles, plans are offering monthly summaries of claim activity. Checks. While payments are increasingly being processed online, insurers still have many check applications for responding to claims as well as normal accounts payable. Correspondence. Insurers have a wide variety of letters and notices to process related to plans for groups and individuals. Moving EOBs from a per claim basis to an aggregated reporting format. Moving EOBs online, improving clarity and augmenting with Monthly Health Statements. The ACA encourages payment activity to move online but some checks are still required. These statements are typically a much more customer friendly document requiring significant reengineering of claims data. Many insures are moving toward dynamic messaging and promotions on these documents but do not have the systems to support messaging and offers. Insurers want to avoid printing checks as a separate processing stream both for mailing efficiency and customer experience reasons. Eliminating pre-printed check stock is a cost cutting opportunity. Security and assurance against fraud is a critical concern. Many letters and notices are one off designs that need to be consolidated and managed more efficiently. Many will require redesign under administrative simplification. Continued on next page 7

8 TABLE 4. KEY PAYOR BUSINESS COMMUNICATIONS CONTINUED Product / Application Industry Challenges Corporate and Internal Communications Compliance Reporting. There is significant increased compliance reporting mandated by the ACA. Most of this information is reported online but printed copies may be requested by investors, stakeholders or for legal purposes. Investor Communications. Prospectuses, Annual reports and corporate filings for publicly traded companies. Human Resources. Payors also must offer benefits communications to their employees as well as training materials. Companies are struggling to interpret and comply with new quality and performance reporting. With all of the changes in operating procedures, management of trainer and trainee materials is a challenge. TABLE 5. KEY PROVIDER BUSINESS COMMUNICATIONS Marketing Direct Marketing Collateral and Signage Information on special program offerings such as cancer, elder care, pre-natal. Keeping information current Periodicals /Newsletters Admissions and Patient Care Forms Labels Wristbands Patient Instructions Service Reminders Disease Management Industry Challenges Hospitals are awash in preprinted forms that are poorly designed and often photocopied in poor quality at higher than necessary expense. Determining the printing technology to use for internal label production and the appropriate source for base labeling stock. Label design, including the introduction of color for enhanced patient safety is also a concern. More and more data is being added to wristbands, including patient photographs and medical alerts to enhance patient care. Patient instructions are often poorly designed and source files are poorly managed. They man entail a combination of preprinted material and form-fill components that are error prone. Service reminders are critical for patient care as well as customer experience and provider marketing success. Providers want patients to return to them for regularly scheduled services. Disease management is an ongoing communications challenge where the cost of communications are more than offset by the impact on patient adherence to treatment guidelines and corresponding health care cost reductions. Billing, Claims and Payment (see Administrative Simplifi cation) Forms Hospitals are awash in preprinted forms that are poorly designed and often photocopied in poor quality at higher than necessary expense. 8

9 HELPING YOUR HEALTH CARE CUSTOMERS In order to gain traction in the health care market, service providers need to understand the challenges that are keeping executives up at night. For every challenge, there is an opportunity for service providers to demonstrate an understanding of the problem and to present solutions for meeting their needs. Since cost control is an overarching theme in the health care market, providers must understand that a key goal of these companies is to reduce print. To succeed in this market, service providers must position themselves to profi t from both print and non-print revenues. The most successful fi rms will be able to offer strategic consulting, multi-channel marketing solutions, printed and electronic transaction communications platforms and robust data analytics. TABLE 6. OPPORTUNITIES TO HELP PAYORS Challenges Faced Opportunities to Serve Reducing ineffi ciencies and implementing standards Improving Customer Experience for Competitive Advantage Increasing Marketing Effectiveness As insurance companies struggle to meet compliance deadlines for Administrative Simplification between now and 2016, there is the risk of creating one off solutions that will drive downstream inefficiencies in managing communications. Help customers to: Reengineer documents to use new standards for language and coding while enhancing production efficiencies. Create standard templates for all document types from campaigns through enrollment and claims. Review content creation and management processes; develop automated workflows for managing templates. Standardizing communications will help customers meet compliance requirements and has the added benefit of improving customer experience. Plan members expect timely and consistent delivery of information across multiple channels. Your services can help: Review communications for brand and content consistency across channels. Provide redesign services. Provide examples from other industries to help insurance companies understand the power of cross-channel consistency including the use of social media and mobile devices. Leverage full color printing to ensure that brand consistency is maintained across channels. Enable faster production and more timely communications. Provide loyalty and wellness marketing solutions that make customers feel valued. Standardization of communications across channels will not only improve customer experience, it can make it easier to market to new customers and retain loyalty with existing customers. Helping insurance companies to embrace the consumer channel while managing existing group markets will require: Support managing and analyzing data starting with existing data sets and migrating to big data solutions. Strategic consulting to identify market segments and triggers for relevant personalization. Creation and management of personalized, multi-channel campaigns for acquisition, enrollment processing, loyalty, wellness and chronic disease management. Encourage innovative use of all channels, including cross-selling and brand marketing on transaction documents. Provide tools for measuring effectiveness and continuous improvement. Help insurers understand how to work within regulatory constraints for example sending benefit neutral educational mailings to Medicare Advantage prospects in advance of the fall marketing period to build trust and brand awareness. Continued on next page 9

10 TABLE 6. OPPORTUNITIES TO HELP PAYORS CONTINUED Challenges Faced Opportunities to Serve Controlling Business Communications Costs Establishing a Retail Environment While striving to be more competitive, serve new markets and implement myriad regulatory measures, insurers are also expected to reduce their overhead. Every aspect of producing communications must be tuned to the highest degree of efficiency without sacrificing effectiveness. Cost control involves: Clean segmented data to allow effective targeting while reducing mail volume. Data services are critical. The ability to consolidate mailings such as EOBs and checks with inline MICR and finishing solutions. The ability to drive member communications to e-presentment and e-payment platforms thereby reducing print. Making sales materials available on ipads and other tablets augmented by print on demand portals to support brokers. Optimizing postal processes through increased postal density, mail consolidation, intelligent use of USPS options and tracking services and piece level integrity. Eliminate costs from preprinting obsolescence and warehousing through digital printing. Personalized wellness and chronic disease management programs measurably reduce health care spending by consumers. Effectively managing these communications for insurers is a competitive differentiator. As health insurance companies begin to establish a retail presence in order to sell insurance direct to the consumer market, they must learn the best-practices of branch management from other industries such as financial services and retail stores. You can help by: Sharing print and procurement tactics used by other branch based clients. Providing guidelines for effective signage and signage rotation. Multi-site distribution of forms and collateral. Portals for branches to track, order and manage sales collateral. 10

11 Service providers who offer templated, web-to-print marketing solutions may fi nd opportunities with smaller providers and independent practices to support appointment reminders and marketing efforts, however, the major opportunities are to be found with big box hospitals and hybrid hospital networks who have a broader base of prospects and larger budgets. TABLE 7. OPPORTUNITIES TO HELP PROVIDERS Challenges Faced Opportunities to Serve Patient Safety Implementation of Administrative Simplifi cation Increased Marketing Demands The primary focus of any health care provider should be the quality of care given to patients. Patient safety is a concern that is increasing addressed through improved workflow and technology including Electronic Medical Records or EMR (also Electronic Health Records EHR) and RFID tagging to help reduce clinical errors and combat the counterfeiting of medicinal products. In addition there are many aspects of print that contribute to patient safety. These include Forms for admissions processing and creation of dynamic, often color-coded wrist-bands for in-patient and outpatient visits. Labels, often color coded, for medications. Patient instructions for follow on care when leaving the provider. These documents are primarily processed at point of care, but there are opportunities for design and production of collateral such as patient instructions. Administrative Simplification will have many benefits for providers including the ability to assess eligibility at the point of service and hopefully, to reduce the amount of bad debt currently faced by the industry. However, these are not tasks that staff is currently trained for and the changes to the work environment will be daunting. Providers will need intensive training of various groups over the next several years which will likely involve the management and distribution of a significant volume of training materials. As more consumers move to Consumer Directed or High-deductible insurance plans, they are more likely to shop around for services. In addition, in order to keep health care costs in line, it is critical that consumers receive standard preventative care and screening. Providers need cost effective solutions for: Community marketing and brand awareness campaigns Patient outreach including appointment reminders, screening reminders, chronic disease management and wellness campaigns. Consumer marketing campaigns highlighting specialty focus areas of large hospital providers. Philanthropic donor campaigns for not-for-profit entities. Providers, even large ones, typically do not have the marketing staff or marketing budget or marketing data that even the smallest health insurer can muster. They need help with all aspects of marketing management from planning through production and measurement. 11

12 SUMMARY The health care market in the US is facing a multi-year period of significant change, and change breeds opportunity. While it is inescapable that the current regulatory environment will force a significant portion of health care communications online, there are still significant opportunities for service providers to sell print and nonprint services. Successful service providers to this market will have a strong understanding of the pain points of health care executives coupled with a robust combination of the following offers: Data cleansing, analytics and segmentation tools. Document design and reengineering services. Strategic consulting to define market segmentation and appropriate marketing approaches. End-to-end management of multi-channel marketing campaigns including print, , web, social media and increasingly, transaction document and mobile channels. Flexible digital printing environments supporting highquality color, MICR, dynamic finishing and high-speed production. Web-2-print portals for supporting print on demand communications for brokers, retail centers and provider locations as well as templated solutions for smaller providers. Sophisticated mail management solutions and consulting to help companies to optimize their postal processes and control spending. E-presentment and archiving solutions to compliment transaction printing offers. While helping health care clients to control costs and increase communications effectiveness, service providers must not overlook the overarching focus on data security. Health care companies will seek business partners who have strong data and site security processes and who have achieved certification. While the opportunities for serving this market are great, the potential liability for exposure of personal information should not be overlooked. When approaching this market, prepare yourself with samples of health care applications you can produce as well as relevant current examples of work you produce for health care or industries that healthcare would like to emulate. Provide guidelines that will help companies to design their own communications in a way that will be compatible with your production environment and that will help them to gain efficiencies through standardization. Build trust by demonstrating that you are willing to cannibalize certain aspects of your services to provide the best solution for their needs, for example reducing print in favor of or helping them to move Explanations of Benefit online. Understand that the health care companies that you meet with today will look very different in a year or two. Gaining and maintaining clients in this industry will require that you learn, grow and change right along with them. 12

Optum TM Consumer Acquisition Platform. A Next-Generation Approach to Acquire, Retain and Engage Members.

Optum TM Consumer Acquisition Platform. A Next-Generation Approach to Acquire, Retain and Engage Members. Optum TM Consumer Acquisition Platform A Next-Generation Approach to Acquire, Retain and Engage Members. Challenge and opportunity have arrived at the same time for health plans. Millions of consumers

More information

Trends in Healthcare Payments Annual Report: 2012

Trends in Healthcare Payments Annual Report: 2012 Trends in Healthcare Payments Annual Report: 2012 Published: March 2013 CONTENTS 3 Executive Summary 4 Trends in Payer Payments 7 Trends in Patient Payments 9 Provider Sentiment 12 Payer Sentiment 14 Patient

More information

Understanding the ObamaCare Health Insurance Plans in North Carolina Understanding Insurance and Affordable Care Act Terminology: ACA- Marketplace

Understanding the ObamaCare Health Insurance Plans in North Carolina Understanding Insurance and Affordable Care Act Terminology: ACA- Marketplace Understanding the ObamaCare Health Insurance Plans in North Carolina As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with

More information

Preliminary Health Insurance Landscape Analysis

Preliminary Health Insurance Landscape Analysis Preliminary Health Insurance Landscape Analysis Prior to addressing some of the issues listed under Section 3.1 3.5 of the HRSA State Planning Grant report template, here is some of the information available

More information

Ohio Health Plans. Maximizing best practices & leading reform efforts. Search. Ohio Association of Health Plans

Ohio Health Plans. Maximizing best practices & leading reform efforts. Search. Ohio Association of Health Plans Ohio Association of Health Plans File Edit View History Bookmarks Tools Window Help http://www.oahp.com Ohio Health Plans Search Maximizing best practices & leading reform efforts HELPING OHIOANS GET NEEDED

More information

The Implications of Reform on the US Health Insurance Industry

The Implications of Reform on the US Health Insurance Industry WHITE PAPER The Implications of Reform on the US Health Insurance Industry Key Research Findings Table of Contents Executive Summary...1 Research Synopsis...2 Strategic Themes Driving Change...3 1. Shift

More information

Trends in Healthcare Payments Fifth Annual Report: 2014

Trends in Healthcare Payments Fifth Annual Report: 2014 Trends in Healthcare Payments Fifth Annual Report: 2014 Published: May 2015 consumers want to pay healthcare bills online page 23 The U.S. healthcare payments market is expected to reach an estimated $5

More information

Tracking Employment-Based Health Benefits in Changing Times

Tracking Employment-Based Health Benefits in Changing Times Tracking Employment-Based Health Benefits in Changing Times by Brian Mauersberger Bureau of Labor Statistics Originally Posted: January 27, 2012 Most Americans obtain their health care coverage through

More information

Conifer Health Solutions Tenet Investor Webinar

Conifer Health Solutions Tenet Investor Webinar Conifer Health Solutions Tenet Investor Webinar May 16, 2012 Stephen Mooney President, Conifer Health Solutions 1 2012 Conifer Health Solutions, LLC. All Rights Reserved. Forward Looking Statements Certain

More information

HEALTHCARE REFORM SOLUTIONS. Designing a Pharmacy Benefit for the New Public Health Exchange Consumers

HEALTHCARE REFORM SOLUTIONS. Designing a Pharmacy Benefit for the New Public Health Exchange Consumers HEALTHCARE REFORM SOLUTIONS Designing a Pharmacy Benefit for the New Public Health Exchange Consumers FEBRUARY 2013 EXECUTIVE SUMMARY Designing a Pharmacy Benefit for the New Public Health Insurance Exchange

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Healthcare IT Angel Investor Intro Presenter: Saul Richter. sponsored by

Healthcare IT Angel Investor Intro Presenter: Saul Richter. sponsored by Healthcare IT Angel Investor Intro Presenter: Saul Richter sponsored by August 2015 Agenda What is the problem in healthcare? Why is it so hard to solve? Overview of healthcare change Healthcare spending

More information

The Factors Fueling Rising Health Care Costs 2008

The Factors Fueling Rising Health Care Costs 2008 The Factors Fueling Rising Health Care Costs 2008 Prepared for America s Health Insurance Plans, December 2008 2008 America s Health Insurance Plans Table of Contents Executive Summary.............................................................2

More information

Top 10 Issues for Health Plans - Strategic & Operational Priorities

Top 10 Issues for Health Plans - Strategic & Operational Priorities Top 10 Issues for Health Plans - Strategic & Operational Priorities Thomas Carleton, Sr. Director, Health IT & Analytics Mosaic Health Solutions (BCBS NC) Nancy Wise, SVP, Strategic & Regulatory Consulting

More information

The Five Pillars of Population Health Management. Dr. Christopher Mathews Senior Vice President and Chief Medical Officer ZeOmega

The Five Pillars of Population Health Management. Dr. Christopher Mathews Senior Vice President and Chief Medical Officer ZeOmega The Five Pillars of Population Health Management Dr. Christopher Mathews Senior Vice President and Chief Medical Officer ZeOmega ZeOmega a forerunner in Population Health Management Transformation into

More information

Decreasing Costs. Employee Benefits Tax. Medical Device Excise Tax. What It Is

Decreasing Costs. Employee Benefits Tax. Medical Device Excise Tax. What It Is Decreasing Costs Employee Benefits Tax Starting in 2018, the ACA will impose a 40 percent excise tax on high-value plans, where the value of benefits exceeds thresholds of $10,200 for individuals and $27,500

More information

Self-funded Employer s Guide. Transitional Reinsurance Fee and Patient-Centered Outcomes Research Institute Fee

Self-funded Employer s Guide. Transitional Reinsurance Fee and Patient-Centered Outcomes Research Institute Fee Self-funded Employer s Guide Transitional Reinsurance Fee and Patient-Centered Outcomes Research Institute Fee To fund some of the changes mandated by the Affordable Care Act (ACA), several new taxes and

More information

Health insurance exchanges: Jump ball for health plans

Health insurance exchanges: Jump ball for health plans Health insurance exchanges: Jump ball for health plans The advent of mandated government-sponsored health insurance exchanges is expected to create a marketplace disruption larger than that of Medicare

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Managing director, Outlook Senior manager, supply chain strategy Premier, Inc.

Managing director, Outlook Senior manager, supply chain strategy Premier, Inc. Care Coordination and the Supply Chain October 21, 2015 Kayla Sutton, MPH Managing director, Outlook Senior manager, supply chain strategy Premier, Inc. Premier s Outlook publication series Published semiannually,

More information

Frequently Asked Questions: How Health Reform Law Protects Patients

Frequently Asked Questions: How Health Reform Law Protects Patients Frequently Asked Questions: How Health Reform Law Protects Patients In this section: Grandfathered Health Plans Patient Protections Medical Loss Ratio (MLR) Summary of Benefits and Coverage Grandfathered

More information

MEDICAL LOSS RATIO ADJUSTMENT REQUEST North Carolina Individual Health Insurance Market

MEDICAL LOSS RATIO ADJUSTMENT REQUEST North Carolina Individual Health Insurance Market North Carolina Department of Insurance MEDICAL LOSS RATIO ADJUSTMENT REQUEST North Carolina Individual Health Insurance Market September 6, 2011 BACKGROUND The Patient Protection and Affordable Care Act

More information

2015 Employee. Outlook A year of continued evolution. National Employee Benefits Practice

2015 Employee. Outlook A year of continued evolution. National Employee Benefits Practice 2015 Employee Benefits Outlook A year of continued evolution National Employee Benefits Practice Introduction The 2015 employee benefits outlook provides insights from the practice leaders at Wells Fargo

More information

Health Research Institute 2014 June. Medical cost trend: Behind the numbers 2015 Chart pack

Health Research Institute 2014 June. Medical cost trend: Behind the numbers 2015 Chart pack Health Research Institute 2014 June Medical cost trend: Behind the numbers 2015 Chart pack HRI projects 2015 s medical cost trend to be 6.8% a modest increase over our 2014 projection of 6.5%. As more

More information

UNITED STATES OFFICE OF PERSONNEL MANAGEMENT

UNITED STATES OFFICE OF PERSONNEL MANAGEMENT UNITED STATES OFFICE OF PERSONNEL MANAGEMENT STATEMENT OF JONATHAN FOLEY DIRECTOR, PLANNING AND POLICY ANALYSIS U.S. OFFICE OF PERSONNEL MANAGEMENT before the SUBCOMMITTEE ON FEDERAL WORKFORCE, U.S. POSTAL

More information

December 2014. Federal Employees Health Benefits (FEHB) Program Report on Health Information Technology (HIT) and Transparency

December 2014. Federal Employees Health Benefits (FEHB) Program Report on Health Information Technology (HIT) and Transparency December 2014 Federal Employees Health Benefits (FEHB) Program Report on Health Information Technology (HIT) and Transparency I. Background Federal Employees Health Benefits (FEHB) Program Report on Health

More information

reinventing health insurance brings challenges for hospitals

reinventing health insurance brings challenges for hospitals reinventing health insurance brings challenges for hospitals 1 3 Introduction 4 01 / Containing costs while increasing access and quality 5 02 / Coordinating patient care 6 03 / Boosting training and development

More information

The 80/20 Rule: How Insurers Spend Your Health Insurance Premiums

The 80/20 Rule: How Insurers Spend Your Health Insurance Premiums SUMMARY The 80/20 Rule: How Insurers Spend Your Health Insurance Premiums The Affordable Care Act holds health insurers accountable to consumers and ensures that American families receive value for their

More information

Health Information Technology (IT) Simplified

Health Information Technology (IT) Simplified Health Information Technology (IT) Simplified A glossary of all things Health IT Accountable Care Organizations (ACO) - A group of health care providers who give coordinated care, chronic disease management,

More information

as the only company focused on campus health, we make it possible for health centers, counseling centers and athletic departments

as the only company focused on campus health, we make it possible for health centers, counseling centers and athletic departments over 300 campuses already understand why we re so successful. as the only company focused on campus health, we make it possible for health centers, counseling centers and athletic departments to bill insurance

More information

Response to Serving the Medi Cal SPD Population in Alameda County

Response to Serving the Medi Cal SPD Population in Alameda County Expanding Health Coverage and Increasing Access to High Quality Care Response to Serving the Medi Cal SPD Population in Alameda County As the State has acknowledged in the 1115 waiver concept paper, the

More information

Advanced Forms Automation and the Link to Revenue Cycle Management

Advanced Forms Automation and the Link to Revenue Cycle Management Advanced Forms Automation and the Link to Revenue Cycle Management Chris Joyce Director of Healthcare Solutions Engineering Today s healthcare providers are facing growing financial pressures that can

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Analysis of National Sales Data of Individual and Family Health Insurance

Analysis of National Sales Data of Individual and Family Health Insurance Analysis of National Sales Data of Individual and Family Health Insurance Implications for Policymakers and the Effectiveness of Health Insurance Tax Credits Vip Patel, Chairman ehealthinsurance June 2001

More information

A Guide to Health Insurance

A Guide to Health Insurance A Guide to Health Insurance Your health matters. A healthier you makes a healthier Cleveland! Healthy Cleveland Insurance Guide Dial Dial Acknowledgements On behalf of the City of Cleveland Department

More information

The Patient Protection and Affordable Care Act. Implementation Timeline

The Patient Protection and Affordable Care Act. Implementation Timeline The Patient Protection and Affordable Care Act Implementation Timeline 2009 Credit to Encourage Investment in New Therapies: A two year temporary credit subject to an overall cap of $1 billion to encourage

More information

VIRTUAL CARDS: Healthcare s New Electronic Payment Revolution

VIRTUAL CARDS: Healthcare s New Electronic Payment Revolution VIRTUAL CARDS: Healthcare s New Electronic Payment Revolution Healthcare is truly an 800-pound gorilla. Accounting for approximately one-sixth of the entire U.S. economy, industry spending totals more

More information

Program Objectives 9/2/2014. Affordable Care Act: Smooth or White Waters Ahead? History of Healthcare Reform

Program Objectives 9/2/2014. Affordable Care Act: Smooth or White Waters Ahead? History of Healthcare Reform Affordable Care Act: Smooth or White Waters Ahead? Kathleen Bradbury-Golas, DNP, RN, NP-C, ACNS-BC Assistant Professor, Felician College Family Nurse Practitioner, Virtua Atlantic Shore Family Practice

More information

White Paper. Workflow Automation: Why It s Key to your Success. August 2014. In-plant/Corporate Printers. Service Areas. Comments or Questions?

White Paper. Workflow Automation: Why It s Key to your Success. August 2014. In-plant/Corporate Printers. Service Areas. Comments or Questions? White Paper August 2014 Workflow Automation: Why It s Key to your Success In-plant/Corporate Printers Service Areas On Demand Printing & Publishing Production Workflow & Customized Communication Solutions

More information

The Health Insurance Marketplace Brings Needed Changes

The Health Insurance Marketplace Brings Needed Changes The Health Insurance Marketplace Brings Needed Changes Healthcare Reform is showing early returns. The Health Insurance Marketplace can help it work even better. The U.S. Department of Health and Human

More information

The Rising Tide of Pharmacy Benefit Cost and Complexity: A health plans roadmap to optimizing pharmacy services relationships

The Rising Tide of Pharmacy Benefit Cost and Complexity: A health plans roadmap to optimizing pharmacy services relationships The Rising Tide of Pharmacy Benefit Cost and Complexity: A health plans roadmap to optimizing pharmacy services relationships New pharmacy benefit challenges After several years of manageable pharmacy

More information

Big Data Analytics in Healthcare In pursuit of the Triple Aim with Analytics. David Wiggin, Director, Industry Marketing, Teradata 20 November, 2014

Big Data Analytics in Healthcare In pursuit of the Triple Aim with Analytics. David Wiggin, Director, Industry Marketing, Teradata 20 November, 2014 Big Data Analytics in Healthcare In pursuit of the Triple Aim with Analytics David Wiggin, Director, Industry Marketing, Teradata 20 November, 2014 Agenda The Triple Aim Population Health in Russia The

More information

Customer Segmentation and Profitability

Customer Segmentation and Profitability Customer Segmentation and Profitability Building Loyal, Profitable Customers S O L U T I O N P A P E R : FINANCIAL SERVICES SOLUTION PAPER: FINANCIAL SERVICES Customer Segmentation and Profitability Building

More information

Health Care Reform Management Alert Series Roadmap of Plan Changes Needed For Upcoming Plan Years

Health Care Reform Management Alert Series Roadmap of Plan Changes Needed For Upcoming Plan Years Health Care Reform Management Alert Series Roadmap of Plan Changes Needed For Upcoming Plan Years Seyfarth Shaw has generously given permission to Lawyers Alliance for New York to circulate this chart

More information

This is a licensed product of AM Mindpower Solutions and should not be copied

This is a licensed product of AM Mindpower Solutions and should not be copied 1 TABLE OF CONTENTS 1. The US Health Insurance Industry Introduction 2. The US Health Insurance Industry Value Chain Government Health Programs Private Health Programs. 3. The US Regulations Pertaining

More information

AETNA TO ACQUIRE COVENTRY HEALTH CARE, INC.

AETNA TO ACQUIRE COVENTRY HEALTH CARE, INC. AETNA TO ACQUIRE COVENTRY HEALTH CARE, INC. Companies Description www.aetna.com Aetna (NYSE: ΑET) is one of the nation's leaders in health care, dental, pharmacy, group life and disability insurance, and

More information

Old Law, New Impact: The Mental Health Benefit Parity Requirement

Old Law, New Impact: The Mental Health Benefit Parity Requirement Old Law, New Impact: The Mental Health Benefit Parity Requirement The Mental Health Parity and Addiction Equity Act (MHPAEA) has been on the books for years. Yet some employers are about to feel the law's

More information

Get Plugged in: Defining Your Connectivity Strategy. CHIME College Live 17 April 2013

Get Plugged in: Defining Your Connectivity Strategy. CHIME College Live 17 April 2013 Get Plugged in: Defining Your Connectivity Strategy CHIME College Live 17 April 2013 Topics Introductions Drivers Strategies Imperatives Discussion Page 2 Copyright Kurt Salmon 2013 All Rights Reserved

More information

Targeted Messaging Emerges as an Essential Service in Post-Reform Health Care

Targeted Messaging Emerges as an Essential Service in Post-Reform Health Care Targeted Messaging Emerges as an Essential Service in Post-Reform Health Care Turning Messages into Positive Action What to Look for in a Messaging Platform How a Messaging Platform Works Conclusion About

More information

Presentation for Licensed Producers The Affordable Care Act

Presentation for Licensed Producers The Affordable Care Act Presentation for Licensed Producers The Affordable Care Act Bruce Donaldson, CHC Producer & Stakeholder Specialist Arkansas Insurance Department Affordable Care Act The ACA was passed by Congress and signed

More information

to Health Care Reform

to Health Care Reform The Employer s Guide to Health Care Reform What you need to know now to: Consider your choices Decide what s best for you Follow the rules 2013-2014 Health care reform is the law of the land. Some don

More information

Using targeted marketing strategies to optimize healthcare plans

Using targeted marketing strategies to optimize healthcare plans Using targeted marketing strategies to optimize healthcare plans Targeted benefits communications can improve member health and lower program costs WHITE PAPER Introduction Today, organizations are finding

More information

Strategies for Success in the CMS Medicare Advantage Star Quality Ratings

Strategies for Success in the CMS Medicare Advantage Star Quality Ratings Strategies for Success in the CMS Medicare Advantage Star Quality Ratings The National Pay for Performance Summit February 20, 2013, San Francisco, CA Theresa C. Carnegie Mintz, Levin, Cohn, Ferris, Glovsky

More information

Ohio Health Benefits LLC. Your health insurance partner!!

Ohio Health Benefits LLC. Your health insurance partner!! December 16, 2014 Presented by Steve Clark & Scott Prior Patient Protection and Affordable Care Act of 2010 Obamacare or ACA or PPACA or Health Care Reform (HCR) Signed in to law on March 23, 2010 The

More information

continued on page 26 REINSURANCE NEWS AUGUST 2008 25

continued on page 26 REINSURANCE NEWS AUGUST 2008 25 Limited Medical Benefit Plans What Insurance Companies, Employers and Reinsurers Need to Know by Michael L. Frank for new products to provide lower cost solutions. Benefit offerings are focused either

More information

Health Plan Enrollment Shifting Toward Government-Sponsored Programs

Health Plan Enrollment Shifting Toward Government-Sponsored Programs 1 of 6 2/4/2013 11:36 PM Health Plan Enrollment Shifting Toward Government-Sponsored Programs 1/25/2013 by Debra A. Donahue Medical membership for the leading U.S. health insurance plans increased 2.6%

More information

Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs. Today s Discussion

Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs. Today s Discussion Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs Ohio Association of Community Health Centers June 2014 Contact Us Andrew Principe PO Box 410221, Cambridge, MA 02141 P.

More information

hospitals within a hospital system for other payment purposes and could easily do so for this program as well.

hospitals within a hospital system for other payment purposes and could easily do so for this program as well. Statement by Phyllis Teater on Health Information Technology and the Electronic Health Records Incentive Program submitted to the Committee on Ways and Means United States House of Representatives July

More information

Colorado Small Business Enrollment Guide A BETTER WAY to take care of business

Colorado Small Business Enrollment Guide A BETTER WAY to take care of business 2015 SMALL BUSINESS HEALTH Colorado Small Business Enrollment Guide A BETTER WAY to take care of business Choose BETTER. 31 Important deadline Open enrollment begins on November 15, 2014 for coverage beginning

More information

Health Care Reform Basics

Health Care Reform Basics Health Care Reform Basics You may be asking yourself what health care reform is all about. Don t worry, you re not alone many people are asking the same question! This booklet will give you the basics

More information

One marketplace for public and private health and benefits exchanges

One marketplace for public and private health and benefits exchanges One marketplace for public and private health and benefits exchanges Your Sales and Distribution Supermarket Think of PlanSource OneMarket as your health and benefits supermarket with a goal of keeping

More information

Early Lessons learned from strong revenue cycle performers

Early Lessons learned from strong revenue cycle performers Healthcare Informatics June 2012 Accountable Care Organizations Early Lessons learned from strong revenue cycle performers Healthcare Informatics Accountable Care Organizations Early Lessons learned from

More information

SPD Benefits. October 29th through November 19th, 2014 at Noon EST

SPD Benefits. October 29th through November 19th, 2014 at Noon EST SPD Benefits October 29th through November 19th, 2014 at Noon EST 2015 Overview What stays the same in 2015? No plan design changes for Dental and Vision. No premium changes for Dental and Vision. No changes

More information

Countdown to Healthcare Reform

Countdown to Healthcare Reform Newtek Insurance Agency & Town of North Hempstead Business & Tourism Development Corp Countdown to Healthcare Reform Presented by: Kyle Sloane Senior Vice President Newtek Insurance Agency Newtek Insurance

More information

Accountable Care Organization Workgroup Glossary

Accountable Care Organization Workgroup Glossary Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.

More information

Natalie Pons, Senior Vice President, Assistant General Counsel, Health Care Services. CVS Caremark Corporation

Natalie Pons, Senior Vice President, Assistant General Counsel, Health Care Services. CVS Caremark Corporation Prepared Statement of Natalie Pons, Senior Vice President, Assistant General Counsel, Health Care Services CVS Caremark Corporation Before the Subcommittee on Regulatory Reform, Commercial and Antitrust

More information

A PRESENTATION FOR THE STATE & PUBLIC SCHOOL LIFE & HEALTH INSURANCE TASK FORCE

A PRESENTATION FOR THE STATE & PUBLIC SCHOOL LIFE & HEALTH INSURANCE TASK FORCE A PRESENTATION FOR THE STATE & PUBLIC SCHOOL LIFE & HEALTH INSURANCE TASK FORCE Presented By: Mark Meadors & Brian Davidson BancorpSouth Insurance Services, Inc. Consultants for EBD since 02/01/2014 TABLE

More information

Increasing efficiency and customer satisfaction, while decreasing lapse rates

Increasing efficiency and customer satisfaction, while decreasing lapse rates Increasing efficiency and customer satisfaction, while decreasing lapse rates Electronic and Aggregated Premium Billing Passage of the Patient Protection and Affordable Care Act of 2010 is driving sweeping

More information

Preventive Treatment for the Provider s Back-office

Preventive Treatment for the Provider s Back-office Preventive Treatment for the Provider s Back-office A Closer Look at Administrative Simplification and the Key Strategies Healthcare Providers Can Take to Prepare By some estimates, nearly a third of every

More information

Introduction. By Santhosh Patil, Infogix Inc.

Introduction. By Santhosh Patil, Infogix Inc. Enterprise Health Information Management Framework: Charting the path to bring efficiency in business operations and reduce administrative costs for healthcare payer organizations. By Santhosh Patil, Infogix

More information

Las Vegas Chamber of Commerce Group Health Benefits Program LVCC

Las Vegas Chamber of Commerce Group Health Benefits Program LVCC Las Vegas Chamber of Commerce Group Health Benefits Program LVCC The LVCC Group Health Benefits Program Adds Value to Chamber Membership Providing quality and affordable health insurance has never been

More information

PHASE II CORE 260 ELIGIBILITY & BENEFITS (270/271) DATA CONTENT RULE VERSION 2.1.0 SECTION 6.2 APPENDIX 2: GLOSSARY OF DATA CONTENT TERMS MARCH 2011

PHASE II CORE 260 ELIGIBILITY & BENEFITS (270/271) DATA CONTENT RULE VERSION 2.1.0 SECTION 6.2 APPENDIX 2: GLOSSARY OF DATA CONTENT TERMS MARCH 2011 PHASE II CORE 260 ELIGIBILITY & BENEFITS (270/271) DATA CONTENT RULE VERSION 2.1.0 SECTION 6.2 APPENDIX 2: GLOSSARY OF DATA CONTENT TERMS MARCH 2011 CAQH 2008-2011. All rights reserved. 1 Table of Contents

More information

Transforming Healthcare Communications An Expense Reduction Strategy and New Business Model

Transforming Healthcare Communications An Expense Reduction Strategy and New Business Model Transforming Healthcare Communications An Expense Reduction Strategy and New Business Model Healthcare Communication Services Business Brief For Healthcare Payers, outbound constituent communications (checks,

More information

7/31/2014. Medicare Advantage: Time to Re-examine Your Engagement Strategy. Avalere Health. Eric Hammelman, CFA. Overview

7/31/2014. Medicare Advantage: Time to Re-examine Your Engagement Strategy. Avalere Health. Eric Hammelman, CFA. Overview Medicare Advantage: Time to Re-examine Your Engagement Strategy July 2014 avalerehealth.net Avalere Health Avalere Health delivers research, analysis, insight & strategy to leaders in healthcare policy

More information

Health Plan Funding Options: An Employer s Decision Guide

Health Plan Funding Options: An Employer s Decision Guide Health Plan Funding Options: An Employer s Decision Guide A White Paper by Manning & Napier www.manning-napier.com Unless otherwise noted, all figures are based in USD. 1 Introduction Health plan costs

More information

Wisconsin typically ranks among the states with the highest level of health

Wisconsin typically ranks among the states with the highest level of health Health Insurance Marketplace in Wisconsin by Wisconsin Office of the Commissioner of Insurance Staff Wisconsin typically ranks among the states with the highest level of health care coverage for its citizens.

More information

Office of Personnel Management

Office of Personnel Management United States Office of Personnel Management The Federal Government s Human Resources Agency Multi-State Plan Program Issuer Letter Number: 2014-002 Date: February 4, 2014 Subject: Multi-State Plan Program

More information

Rising Health Care Costs What Factors are Driving Increases?

Rising Health Care Costs What Factors are Driving Increases? Rising Health Care Costs What Factors are Driving Increases? Rising health care costs and access to affordable coverage are prominent issues for Washington employers, health care providers, purchasers,

More information

Optum Health Payment Solutions

Optum Health Payment Solutions Optum Health Payment Solutions Today s competitive health care market demands that payers like you meet cost containment objectives and administrative simplification goals set out in the Affordable Care

More information

Presenters. How to Maximize Technology to Improve Care and Reduce Cost 9/17/2015

Presenters. How to Maximize Technology to Improve Care and Reduce Cost 9/17/2015 How to Maximize Technology to Improve Care and Reduce Cost Presenters Justin Miller Director of Synergy Jordan Health services Dallas, TX jmiller@jhsi.com Justine Garcia Director of Software Solutions

More information

Health Insurance / Learning Targets

Health Insurance / Learning Targets Health Insurance / Learning Targets Compare the basic principles of at least four different health insurance plans Define key terms pertaining to health insurance Health Insurance I have a hospital bill

More information

How to select a practice management system

How to select a practice management system How to select a practice management system New challenges and opportunities are impacting your practice today The physician practice environment is changing dramatically. The transition to ICD-10-CM and

More information

Colorado Choice Health Plans

Colorado Choice Health Plans Quality Overview Colorado Choice Health Plans Accreditation Exchange Product Accrediting Organization: Accreditation Status: URAC Health Plan Accreditation (Marketplace HMO) Provisional Accreditation Commercial

More information

How Do Key Stakeholders View Transparency?

How Do Key Stakeholders View Transparency? How Do Key Stakeholders View Transparency? Given the clear need for transparency, and the gaps towards achieving the level needed to create full accountability to drive lower costs and improved quality

More information

2019 Healthcare That Works for All

2019 Healthcare That Works for All 2019 Healthcare That Works for All This paper is one of a series describing what a decade of successful change in healthcare could look like in 2019. Each paper focuses on one aspect of healthcare. To

More information

The Changing Face of Employer-Sponsored Retiree Prescription Benefits. Long-term strategies for a rapidly evolving market

The Changing Face of Employer-Sponsored Retiree Prescription Benefits. Long-term strategies for a rapidly evolving market The Changing Face of Employer-Sponsored Retiree Prescription Benefits Long-term strategies for a rapidly evolving market February 2015 Executive Summary The past decade has seen fundamental changes in

More information

Software as a Service Flexible Service Delivery for Your Health Insurance Exchange

Software as a Service Flexible Service Delivery for Your Health Insurance Exchange Software as a Service Flexible Service Delivery for Your Health Insurance Exchange SaaS Health Insurance Exchanges Improving Services through More Cost-Efficient Delivery States are charged with making

More information

Maureen Mangotich, MD, MPH Medical Director

Maureen Mangotich, MD, MPH Medical Director Maureen Mangotich, MD, MPH Medical Director Prepared for the National Governors Association Healthy America: State Policy Leaders Meeting, December 2005 Delivering value from the center of healthcare Pharmaceutical

More information

A Health Analytics Framework

A Health Analytics Framework ABSTRACT Paper SAS1900-2015 A Health Analytics Framework Krisa Tailor, Jeremy Racine, SAS Institute Inc. As the big data wave continues to magnify in the healthcare industry, health data available to organizations

More information

Vermont s Health Services Enterprise (HSE)

Vermont s Health Services Enterprise (HSE) Vermont s Health Services Enterprise (HSE) Where People are at the Center of a Health & Human Services Vision that is Supported by an Integrated Health Information Technology (HIT) Platform December, 2013

More information

N E W S R E L E A S E

N E W S R E L E A S E N E W S R E L E A S E Investors: Brett Manderfeld John S. Penshorn Media: Don Nathan Tyler Mason Vice President Senior Vice President Senior Vice President Vice President 952-936-7216 952-936-7214 952-936-1885

More information

Healthcare Payer. To improve the health of your business, simplify the processes that run it.

Healthcare Payer. To improve the health of your business, simplify the processes that run it. Healthcare Payer To improve the health of your business, simplify the processes that run it. 2 Reform has created complexity. But transformation is breeding simplicity. Healthcare reform is here. With

More information

GOING PAPERLESS: BEST PRACTICES TO ACCELERATE YOUR EMR TRANSITION

GOING PAPERLESS: BEST PRACTICES TO ACCELERATE YOUR EMR TRANSITION WHITE PAPER HEALTHCARE GOING PAPERLESS: BEST PRACTICES TO ACCELERATE YOUR EMR TRANSITION Contents 2 Introduction 3 The Changing Role of HIM 4 EMR Reality Check 5 Best Practices in Accelerating the EMR

More information

The Blue Spectrum of Services. Factors Impacting Health Care Affordability

The Blue Spectrum of Services. Factors Impacting Health Care Affordability The Blue Spectrum of Services Factors Impacting Health Care Affordability Information about the drivers of health care costs from Anthem Blue Cross and Blue Shield for New Hampshire customers, accounts,

More information

OUR EXPERTISE. We were awarded Technology Innovation of the Year by Xplor

OUR EXPERTISE. We were awarded Technology Innovation of the Year by Xplor Suite OUR EXPERTISE Merrill Corporation serves the leading names in managed healthcare with our integrated chain of custody, integrity manufacturing and robust reporting. Since 1968, Merrill has been in

More information

ELECTRONIC MEDICAL RECORDS. Selecting and Utilizing an Electronic Medical Records Solution. A WHITE PAPER by CureMD.

ELECTRONIC MEDICAL RECORDS. Selecting and Utilizing an Electronic Medical Records Solution. A WHITE PAPER by CureMD. ELECTRONIC MEDICAL RECORDS Selecting and Utilizing an Electronic Medical Records Solution A WHITE PAPER by CureMD CureMD Healthcare 55 Broad Street New York, NY 10004 Overview United States of America

More information

2015 ANNUAL BENEFITS ENROLLMENT FOR PRE-65 RETIREES

2015 ANNUAL BENEFITS ENROLLMENT FOR PRE-65 RETIREES Phillips 66 2015 ANNUAL BENEFITS ENROLLMENT FOR PRE-65 RETIREES 2015 ANNUAL BENEFITS ENROLLMENT FOR PRE-65 RETIREES October 31 November 21, 2014 your HEALTH. Living well means different things to different

More information

2014 New York Small Group (1-50) Health Plan Portfolio (Oxford Product Offerings) Robust Benefits, Broad Network, Innovative Online Tools

2014 New York Small Group (1-50) Health Plan Portfolio (Oxford Product Offerings) Robust Benefits, Broad Network, Innovative Online Tools 2014 New York Small Group (1-50) Health Plan Portfolio ( Product Offerings) Robust Benefits, Broad Network, Innovative Online Tools Offering a variety of plan designs, ranging from open access to primary

More information

Best practices for migrating healthcare payments to ACH

Best practices for migrating healthcare payments to ACH Best practices for migrating healthcare payments to ACH Member FDIC Member FDIC Matt Brodis, MBA, MHA Adventist Health System, Inc. June St. John, SVP, CTP Wells Fargo Treasury Management Member FDIC Healthcare

More information