What State Policies Best Foster Insurance Market Competition?

What State Policies Best Foster Insurance Market Competition? | At the intersection of health, health care, and policy.

“It is important to better understand how different regulatory environments may affect the functioning and competitiveness of insurance markets. In the case of rate review, a recent study suggests that pre-ACA premiums were lower in states that took a more active regulatory approach. ACA rate review grants sought to reduce regulatory variation by collectively raising the bar.”

Source: Health Affairs Blog 

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Consolidation Among Managed Care Organizations Seen Heating Up; Aetna and Cigna Licking Their Chops

There has been a wave of mergers and acquisitions in the health insurer marketplace in recent years, our research for the National Directory of Managed Care Organizations has found.

The numbers of MCOs keeps shrinking, according to our research for the database.

Just the other day Humana announced that it was working with advisers at Goldman Sachs Group Inc., according to people familiar with the matter, the Wall Street Journal reported. “Aetna Inc. and Cigna Corp. are among those that have held preliminary discussions with the company,” the WSJ reported.

“We view this step as a trigger event in a managed-care industry overdue for consolidation, the   “analysts at Leerink Partners LLC wrote in a research note Friday afternoon, The WSJ reported.. “We expect the next year will see multiple strategic actions among the major players.”

“It’s sale may trigger consolidation that shrinks the number of large publicly traded health insurers from five down to three, said analyst Ana Gupte, PhD, Leerink’s Managing Director for Healthcare Services.. “It’s a huge push for scale,” she added.

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The National Directory of Managed Care Organizations Database

This unique database provides managed care market business
intelligence on more than 1180 managed care organizations
that offer 5,279 health insurance plan products.

This managed care directory also covers specialty HMOs and PPOs,
and includes details on PBMs, TPAs, PSOs, POSs, EPOs, Medicare,
Medicaid Plans, and Medicare Advantage Health plans.

The National Directory of Managed Care Organizations Database

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Executives from Aetna and Anthem Inc. have said in recent weeks they are interested in doing large deals, Reuters reported. Analysts said on Friday that Anthem may also look at Humana.

“The government has pressured health insurers to cut costs with the new Obamacare exchange plans and in Medicare while employers have also gotten tough on spending for medical procedures and drugs,” reported Reuters.

“Acquiring Humana would vault Cigna to the lead in the market for Medicare Advantage policies, Continue reading

2015 Health Plan Member Satisfaction Study Released by J.D. Power

Health plan overall member satisfaction averages 679, a 10 point improvement from 2014, found a new study by J.D. Power.

The study now in its ninth year measures satisfaction among members of 134 health plans in 18 regions throughout the U.. by examining six key factors: coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service. Satisfaction is calculated on a 1,000-point scale, the firm said..

“Following a year filled with negative news coverage about health insurance, a bumpy start to the launch of the Affordable Care Act, and an atmosphere of fear, member satisfaction with health plans has increased significantly as plan administrators take a customer-centric approach, helping to build member trust and loyalty,” the study revealed.

The increase in satisfaction is driven by improved performance across all factors, most notably in information and communication (+17 points), which is primarily a result of efforts among many of the health plans to retool their approach by refining messaging, adjusting message frequency and upgrading their website. Satisfaction in the customer service factor has increased by 11 points, driven partially by matching communication methods to member preferences, such as mobile and text. Cost satisfaction increases by 13 points while fewer members indicate having experienced an increase in their monthly premium, as well as a decline in overall out-of-pocket expenses for individuals and families.

“Health plans have come a long way since last year as the focus has shifted toward better serving member needs and building trust. However, there is still a lot of work to do,” said Rick Johnson, senior director of the healthcare practice at J.D. Power.

“Health plans need to take a more customer-centric approach and keep their members engaged through regular communications about programs and services available through their plan. When members perceive their plan as a trusted health partner, there is a positive impact on loyalty and advocacy.”

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Now, a Managed Care Directory – Database of Business Information Just For Your State!

No need to buy a directory of managed care for the whole country when
you only need to know about the MCOs in your state. The National Directory
of Managed Care Organizations Database State Edition 
is ready to be rushed to you, on CD-Rom in Excel format.

The database provides key executive contacts and benchmarking business
information on the managed care plans in your state.

This is MCO business information that you need to successfully do business
with the managed care industry.

Starting at $195 with free shipping. Pricing for this practical and
affordable version of the database is based on the number of managed care
organizations – health insurers in a state.

For more information and to order now, visit:
The National Directory of Managed Care Organizations Database State Edition

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The study found that overall satisfaction is significantly higher among the 19 percent of members who strongly agree their health plan is a trusted partner in managing their health. Among members who say they “strongly agree” that their health plan is a trusted partner, satisfaction increases by 201 points.

 KEY FINDINGS

  • Members who say they “strongly agree” that their health plan is a trusted advisor are less likely to switch health plan providers.
  • Within information and communication, satisfaction ratings have improved from 2014 in the factor’s four attributes: ease of understanding your plan’s benefits and services (6.4 vs. 6.2, respectively, on a 10-point scale); frequency of communications (6.3 vs. 6.1, respectively); usefulness of information (6.4 vs. 6.2, respectively); and variety of communications (6.3 vs. 6.1, respectively).
  • Similarly, satisfaction ratings have also improved year over year in the attributes within the cost factor: premiums (5.9 vs. 5.7, respectively); deductible amount (5.8 vs. 5.7, respectively); co-pays for prescription medication (6.4 vs. 6.2, respectively); and co-pays for doctor visits (6.3 vs. 6.2, respectively).
  • Overall member satisfaction is 108 points higher among members who have contacted their plan via mobile app at least once in the past 12 months than among those who haven’t.  While members under 40 years old contact their plan via text and mobile app at a significantly higher rate than older members, the telephone is still the most frequently used contact method across all age cohorts.

Study Rankings

Satisfaction is highest among health plan members in the California (695), Northwest (693), IllinoisIndiana (689), Michigan (688) and Mountain (686) regions. Satisfaction is lowest among members in the New England (664) and the Southwest and MinnesotaWisconsin regions at a tie (665).

In a related development, J.D. Power plans to release a Health Insurance Marketplace Exchange Shopper and Re-enrollment Study (HIX), focused on member satisfaction with health plans purchased through public exchanges, as well as the shopping experience on those exchanges, this month. In October 2015, J.D. Power will also release a Medicare Advantage Study, focused on member satisfaction with Medicare Advantage plans.

The 2015 Member Health Plan Study is based on responses from more than 31,000 members of 134 commercial health plans across 18 regions in the United States. The study was fielded in November and December 2014. For more comprehensive health plan rankings for all 18 U.S. regions, please visit www.jdpower.com.

Following Are Member Satisfaction Index Rankings :

US Hospitals Could Save Billions If They Took This Lesson from the VA – Defense One

healthcarereimagined

Most hospitals don’t have good ways of measuring the complex costs associated with an individual patient’s stay in the hospital. The VA is one surprising exception.

The success of health reform in the US depends on finding ways to control the growth of costs. Hospital care is expensive. And when patients have to be readmitted unexpectedly after discharge, it can really crank up spending.

As we strive to keep health care costs in line, reducing hospital readmissions is drawing a lot of attention. Reducing preventable readmissions could reduce health care spending and improve quality of care at the same time.

But very little research on readmission costs has been done. An exception is a study that found that one in five elderly Medicare patients is readmitted to the hospital within 30 days of being discharged, at an estimated cost of $17.4 billion in 2004.

Most hospitals don’t…

View original post 616 more words

Trends That We Are Reporting On Our Facebook Page

Almost 70 percent of Americans now have access to an accountable care organization for their health needs

Although growth slowed the number of ACOs still rose by about 16 percent; number of patients served rose 6 percent, said consultant Oliver Wyman.

Almost 70 percent of the U.S. population now lives in localities served by accountable care organizations, and 44 percent live in areas served by two or more, found new research by the Oliver Wyman consulting firm.

The total number of ACOs participating in Medicare programs has increased to 426, up from 368 in January 2014, the study found.

About 5.6 million Medicare beneficiaries, or about 11 percent of total Medicare beneficiaries, now receive their healthcare from ACOs participating in Medicare’s ACO programs.  https://www.facebook.com/TheMCIC

Source:  Oliver Wyman Study  http://www.oliverwyman.com/

What ‪‎Physicians‬ Earned in 2014 – New Results

“On average, specialists earned $284,000 a year while primary care physicians earned about $195,000, according to a new survey, which polled 19,500 physicians across 25 specialties.”

Orthopedists‬ earn an average of $450,000 a year. Cardiologists were earning a average total of $395,000 a year, the survey found.

On the lower end, pediatrics showed the lowest total compensation at $196,000, though exactly half said they felt fairly compensated. Also, 50 percent of pediatricians polled were women.

The average compensation for a self-employed male physician was $324,000, compared to $259,000 for female physicians.  https://www.facebook.com/TheMCIC

Source: Health Care Finance  http://www.healthcarefinancenews.com/

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Directories of Healthcare Payers and Provider Organizations From the Managed Care Information Center

Searching for contact information about managed care organizations, health systems and hospitals or such physician organizations as independent practice associations or physician hospital organizations visit our Directories of Health Insurers and Providers page at Health Resources Online.

https://www.healthresourcesonline.com/directories-of-health-insurers-and-providers.html
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“A small percentage of patients are responsible for the majority of healthcare spending in the United States,” study finds.

The top three percent of patients categorized as persistent high users accounted for 21 percent of total annual healthcare expenditure for a typical large business in Pennsylvania, found the study published this week in the American Journal of Managed Care.

Persistent high users incurred annual expenses of more than $38,000 compared to just $2201 for patients who never crossed the “high use” threshold, the study researchers said. While some patients experiencing acute issues or hospitalizations temporarily incurred high expenses, patients experiencing a higher burden of sustained chronic conditions were significantly more likely to be frequent users of healthcare services. https://www.facebook.com/TheMCIC

Source: Healthcare IT Analytics  www.http://healthitanalytics.com/

 

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

From collaboration and consolidation to the inevitable acceptance of
a value-based system, the state of healthcare continues to stimulate
health plans,  providers and employers.

“Healthcare Trends & Forecasts in 2015: Performance Expectations for
the  Healthcare Industry,” HIN’s eleventh annual industry forecast,
examines the  factors challenging healthcare players and suggests
strategies for organizations  to distinguish themselves in the steadily
evolving marketplace.

For more information or to reserve your copy today please click on
this link: “Healthcare Trends And Forecasts in 2015”

In this yearly strategy playbook, Steven T. Valentine, president of
The Camden  Group, returns to give the industry outlook for healthcare
providers. Beginning  with his “pyramid of success” for population health
management, Valentine  outlines key impacts for physicians and
hospitals, including increasing  transparency in quality and pricing data;
emerging business roles for  physicians; shifting locus of care; and the
empowered and tech-savvy  healthcare consumer.

Offering the payor perspective is Dorothy Moller, managing director,
Navigant, who outlines industry “winds of change” and “seeds of
transformation” impacting health plans in the form of new roles for
existing stakeholders, mobile health and technology, and new players
on the healthcare field.

Now in its eleventh year of providing healthcare executives with a look
ahead to help shape strategic plans, “Healthcare Trends & Forecasts in
2015: Performance Expectations for the Healthcare Industry” covers
the following:

* Snapshot of provider trends, including inpatient utilization, pricing
and  quality transparency, and population health management;

* Provider milestones along the road to fee for value, including
accountable care and clinical integration;

* Report card on accountable care organization (ACO) performance;

* 15 key ACO infrastructure elements;

* Expectations for the patient-centered primary care delivery model;

* Impact of Medicare Chronic Care Management reimbursement in 2015;

* 16 factors in health system transition to a value-based reimbursement
system, including time frame, delivery systems and payment models;

* Responding to changes in locus of care, telehealth, retail health,
and direct primary care;

* Five payor strategies mirroring provider initiatives;

* 15 transformative payor challenges signaling a fundamental change
in the industry;

* Five questions payors must answer before negotiating the path to
value-based care;

* A dozen companies to watch that are introducing new technologies,
care delivery vehicles, care payment structures and consumer
engagement models;

* Eight payor survival strategies for weathering the ‘disruptive winds’
in the industry; and much more.

Reserve your copy today and please click here now: Healthcare Trends
And Forecasts in 2015