Tag Archives: health plans

Positioning for continued growth in public exchanges

With four million people enrolled in public health exchanges as of the end of 2014, most payers competing in federally facilitated marketplaces or state-based exchanges have moved beyond the initial stages of implementation and are envisioning taking their plans to the next level. This “next level” means delivering more consumer-oriented offerings and engagement approaches, with […]
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Plans should take full advantage of technology, operations to manage exchange markets

As Affordable Care Act (ACA) exchange markets evolve, health plans managing these markets face certain realities: many exchanges have not functioned as anticipated, technology has not always panned out, pricing often has been driven by poor data and inadequate risk assessment, and the market has been in a state of flux. However, during the transition […]
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Accelerating the progression toward an integrated clinical model

As we sit post-ACA, it has become apparent that we have entered one of the most dynamic times in all of health care. Risk for all stakeholders has been on an accelerated course since 2010, but managing risk looks different depending where you are in the health care space. Providers — whether hospitals or physician […]
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Health plans expanding risk-based contracting efforts

Are risk-based contracting arrangements between health insurers and providers here to stay? The answer can be summed up in three words: “Follow the money.” Health plans are investing in and paying for an increasing amount of care covered by risk-based contracts. And these contracts aren’t just with the obvious accountable care organizations (ACO) and patient-centered […]
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Navigating existing strategies in the new year

There’s something refreshing and exciting about ushering in a new year. Perhaps it’s the feeling that a new year means a new beginning. After giving pause to reflect on our progress the past 12 months, we feel inspired and optimistic as we envision what lies ahead. But what is often overlooked in the infancy of […]
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Consumer-centric front office uses data and outreach to engage members

Under the Affordable Care Act, health plans have been striving for a business model that shifts away from an employer-centered approach to one that puts consumers at the center of their organization. At this point in time, the health care marketplace still lags behind other industries in this transition. While there isn’t a singular approach […]
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IT strengthens payer–provider partnerships as Value-Based Reimbursement arrangements take hold

With new reimbursement models, changing regulatory dynamics and broad quality initiatives, providers and health plans are feeling the pressure to increase their focus on the value of health care services delivered for premium dollars. Risk is now being transferred from payers to providers, blurring the distinction between the two entities. Increasingly, both groups face the […]
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Leveraging benchmarks to target best opportunities for improving medical cost management

Health plans and risk-bearing providers are under increasing pressure to explore business models that allow for the reduction of medical loss ratios (MLRs), strengthen clinical performance and enhance relationships with providers. New forces at the local, state and federal levels are requiring plans to rethink their business models and identify new approaches to growth, and […]
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The health savings and spending consumer journey

Health care is one of life’s basic necessities, but it’s not the easiest to budget or understand. Ongoing changes in the industry however, have led a growing number of consumers to take greater control of their health care dollars, often through options such as health savings accounts (HSAs), health reimbursement accounts (HRAs) or flexible spending […]
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Payers understanding the provider perspective in a rapidly converging marketplace

As you’ve witnessed, rising medical costs and developing regulations have led to new initiatives to target clinical quality outcomes and manage financial risk. These and other market forces are transforming the way we [payers, providers and consumers] interact: Payers are accelerating risk-contracting efforts. Plan distribution is moving to direct-to-consumer. Care models are increasingly consumer oriented. […]
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