While the U.S. House and Senate wrangle over the final healthcare bill, health plans aren't sitting idly by waiting for the future to arrive.
While the U.S. House and Senate wrangle over the final healthcare bill, health plans aren’t sitting idly by waiting for the future to arrive. There are a number of trends plans can expect to affect business in 2010 and beyond.
The economy is still a wild card, but is showing signs of recovery. If the economy does improve, and more jobs are created, then health plan membership will also improve. If the economy doesn’t continue to improve, health plans must be prepared to focus even more on retaining and attracting members, according to Tom Epstein, vice president for public affairs, Blue Shield of California.
“Health plans need to develop products that are easy to understand and administer to prepare for the exchange environment,” he says. “We must also take strong action to hold the line on costs while improving care coordination and incentivizing quality care.”
Epstein says health plans will continue to seek partnerships and try new programs and technologies to improve the quality of care and lower costs.
“At Blue Shield we are piloting a new program with a medical group and a hospital where we all share the risk for providing coordinated care at a lower cost for a major customer,” he says. “Health plans will also bring more processes online to provide faster and more accurate service at a lower cost.”
Get the latest industry news, event updates, and more from Managed healthcare Executive.
Conversations with Perry and Friends: Saar Mahna, J.D., MBA
July 7th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the "Conversations with Perry and Friends" podcast. In this episode, Cohen speaks with Saar Mahna, J.D., MBA, CEO and founder of Banjo Health, an artificial intelligence company focused on prior authorization.
Listen
PBM-Offered Genomics Testing Could Reshape Prescribing of Medications
July 25th 2025Two PBMs, True Rx Health Strategies and Capital Rx, are using pharmacogenomics — how a person’s DNA affects their response to medications — to reduce the trial-and-error of prescribing medications, saving employers and patients time and money.
Read More
Conversations With Perry and Friends: Paul Fronstin, Ph.D.
May 9th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the Conversations with Perry and Friends podcast. In this episode, his guest is Paul Fronstin, Ph.D., director of health benefits research at the Employee Benefit Research Institute.
Listen
FDA Accepts Tabelecleucel BLA; Priority Review Granted for Post-Transplant Disease Therapy
July 24th 2025The FDA has accepted the resubmitted BLA for tabelecleucel (tab-cel), intended for the treatment of Epstein-Barr virus positive post-transplant lymphoproliferative disease (EBV+ PTLD).
Read More