Business Strategy

Medicare Advantage could set a precedent for plan switching

The provider and payer will develop a suite of health plans and an accountable care model with fully insured, self-insured and Medicare products

The 21 to 27 age group will see net costs increase $470, and that's the worst of it

The comprehensive context of PPACA continues to change as more information comes to light

Some plans must increase benefits and premiums to meet requirements

The marketing tools include bilingual websites and printed materials that partners can co-brand

The 32 Pioneers asked CMS to delay the move to pay for performance in 2013

Early response bodes well for new plans

Infrastructure needed to ensure organizations live up to the promise of ACOs

New care models and federal requirements motivate HIE stakeholders

FDA committees are examining DTC genetic tests that make medical claims

Medicare Advantage plans must comply with CMS regulations

With their unique roles, pharmacists are moving away from being drug dispensers to becoming consultants in ACO models

Plans will see the most cost reductions on the medical side of the ledger, but there are still opportunities to reduce administrative waste

Differentiate between products and offer guidance to compare costs

Aetna believes its new fertility program will improve the chances of conception for infertile couples, while controlling costs

Several Republican governors are going to expand Medicaid eligibility under PPACA

Some repeat imaging might occur within the parameters of acceptable practices and medical necessity and shouldn’t be identified as waste

Payers struggle against market headwinds

Stakeholders must influence individuals to become more responsible for their choices.

Benefits of ICD-10 migrations can be significant for payers.

According to AHIP, more claims are being received by payers in electronic formats, and payers are processing those claims at a faster rate than before.

A think-tank report calls for national agenda to hold spending down to the growth in GDP per capita

The new middle class represents an opportunity to sell health insurance products outside the United States

Among the list of changes that consumers simply are not ready to face is value-based purchasing and reduced care based on evidence