Health Plan Facts, Trends and Data:  2013-2014

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Publication Details

  • Pub Code: GHPF18-11WEB
  • Pages: 474
  • ISBN: 978-1-936230-56-3
  • Copyright 2013

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Health Plan Facts, Trends and Data: 2013-2014

A best-selling annual book packed with insights into important trends that are re-shaping the health care industry. This one-of-a-kind resource contains reliable data, directories and other valuable resources you can put to work today. Written and organized by AIS's experienced health reporting staff.

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Get the perspective you need to make sense of the state of the health plan industry with Health Plan Facts, Trends and Data

Health Plan Facts, Trends and Data is a comprehensive one-of-a-kind resource on the U.S. health insurance industry. It provides valuable intelligence on a wide range of big-dollar health plan issues — from benefit design and management strategies to corporate financial results and enrollment — that can be of great assistance to you and your management team in the year ahead.

This unique, well-organized resource helps you quickly get up-to-speed on:

  • Management Tactics — such as disease management and wellness initiatives, employer strategies for reducing costs, accountable care organization launches, and the pricing and development of products in both public and private insurance exchanges
  • Strategies and Markets — with in-depth looks at enrollment and market share trends, product launches, and market expansions into managed Medicaid, and the overseas and youth markets, as well as a look at Blue Cross Blue Shield plan trends
  • Industry-wide Trends —including rate-setting practices, network administration, defined-contribution models, communications with consumers, and medical loss ratio rebates
  • Business News — with synopses of mergers and acquisition activity, financial and stock market performance, lobbying activity, executive compensation, and antitrust lawsuits and ‘Most Favored Nation’ clauses

Order your copy of Health Plan Facts, Trends and Data: 2013-2014 today!

Also Available on CD: For an additional $150, you can order the convenient CD version of Health Plan Facts, Trends and Data. The CD contains all of the information in the print version and you’ll find what you need instantly with the user-friendly, searchable PDF format. Plus, all CD purchasers receive a free copy of the print version!

Table of Contents

Chapter 1: Health Plan Enrollment Trends and Market Share

  • Enrollment Trends
  • Medicare Advantage Enrollment Trends
  • Enrollment Data
  • FEHBP, TriCare and Other Federal Programs

Chapter 2: Health Plan Organizational Structure and Leadership

  • Executive Compensation Trends
  • Lobbying and Donations
  • Disaster Planning
  • Layoffs and Other Workforce Developments
  • Leadership Decisions and Appointments

Chapter 3: Health Plan Growth and Consolidation

  • Mergers and Acquisitions
    • Alliances
  • Market Moves and Expansions
  • Contract Awards and Developments
  • Overseas Strategies
  • The Youth Market

Chapter 4: Managed Medicaid Expansion Initiatives

  • Competitive Strategies
  • Contract Developments
  • Dual Eligibles
  • States’ Expansion Initiatives

Chapter 5: Health Plan Product Development and Communication

  • Product Launches and Expansions
  • Retail Insurance Outlets
  • Tiered Networks
  • Ancillary Products
  • Mini-Med Plans
  • Marketing and Communications
    • MA Plans’ Marketing of Star Ratings
    • Communications With Consumers
  • Medical Travel Options

Chapter 6: Health Plan Financial Performance

  • Costs and Profitability
    • MA Payment Rates
  • 2012 and 2013 Annual Results and Projections
  • Second Quarter 2012 Results
  • Third Quarter 2012 Results
  • Fourth Quarter 2012 Results
  • First Quarter 2013 Results
  • Stock Market Performance
  • Medical Loss Ratio Rebates
  • Key Financial Data

Chapter 7: Blue Cross Blue Shield Plan Trends and Data

  • Blue Cross Blue Shield Enrollment and Market Share
  • Market Moves and Competition
  • Blue Cross Blue Shield Conversions and Nonprofit Issues
  • Directory of Blue Cross Blue Shield Organizations

Chapter 8: Rate Setting and Premiums

  • Plans’ Rate Increases
  • Oversight of Rate Increases
  • Premium Trends
  • Age-Rating Provision

Chapter 9: Public Insurance Exchanges

  • Federal Regulations, Guidance and Oversight
  • Pricing and Development of Products
    • Risk Mitigation
  • Essential Health Benefits
  • Impact on Brokers
  • Consumer Operated and Oriented Plans (CO-OP)
  • State Exchange Developments

Chapter 10: Private Exchanges

  • Competition and Participation in Private Exchanges
    • Private Exchange Launches
    • Defined-Contribution Models
  • Case Studies

Chapter 11: Employer Strategies and Challenges

  • Factors Influencing Costs and Savings Strategies
    • Shifting Full-time Employees to Part-time
    • Working Spouse Exclusion
  • Coverage Decisions
    • Coverage of Contraceptives
  • Benefit Design Strategies
    • Defined-Contribution Plans
    • Narrow Networks
  • Taxes and Fees on Employers
    • Cadillac Tax

Chapter 12: Provider/Health Plan Transactions and Developments

  • Network Administration and Reimbursement
  • Mergers and Acquisitions Between Insurers and Providers
  • Affiliations, Joint Ventures and Partnerships Between Health Plans and Providers
    • Highmark-West Penn Affiliation Conflicts
  • Health System Forays Into Insurance Products
  • ICD-10 Compliance
  • Strategies to Improve Outcomes and Quality of Care

Chapter 13: Accountable Care Organizations

  • Health Plan Strategies for ACOs
  • Launches and Expansions
  • Medicare Shared Savings Program (MSSP)
  • State ACO Initiatives

Chapter 14: Health Promotion, Wellness and Disease Management Strategies

  • Strategies for Specific Health Issues
    • Asthma
    • Autism
    • Chiropractic Care
    • Diabetes
    • Infertility
    • Multiple Sclerosis
    • Obesity
    • Oncology
    • Painkiller Abuse
  • Mental and Behavioral Health Coverage
  • Patient-Centered Medical Homes
  • Wellness Initiatives

Chapter 15: Online Tools and Other IT Communications Strategies

  • Online and Interactive Tools for Consumers
  • Applications for Communications Through Mobile Smartphones
  • Social Media Strategies
  • Quality and Cost Data Transparency Tools

Chapter 16: Health Plan Legal and Compliance Challenges

  • Antitrust Lawsuits
  • ‘Most Favored Nation’ Clauses
  • Claims Denials and Other Consumer Violations
  • Coverage-Related Violations
  • Provider Network Legal Cases
  • Pay-for-Delay Deals

Chapter 17: Health Plan Resources and Directories

  • Directory of Federal and Regional Medicare Regulators
  • Directory of Health Plan Trade Associations
  • Directory of Health Plan Accrediting Bodies
  • Directory of State Health Plan Associations
  • Directory of State Insurance Commissioners
  • Directory of State Medicaid Directors
  • State Medicaid Pharmacy Directors
  • State Health Officials

Written By

Health Plan Facts, Trends and Data was written and edited by the editorial staff of Atlantic Information Services.

Written For

  • Managers of HMOs, PPOs, POS plans and PSOs
  • Hospital managers and health system executives
  • Group practice managers
  • Managers of IDSs
  • Insurance executives
  • Employee benefits managers
  • Consultants and attorneys

AIS Guarantee

Order Health Plan Facts, Trends and Data for a 30-day risk-free inspection and test for yourself the value of this highly practical resource. If within 30 days you're not interested in keeping it, just return it to AIS and we will send you a prompt, full refund or credit. For CD purchasers, refunds will not be made once the seal on the CD package has been broken. Please review your copy of the print version prior to breaking the seal.

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Health Plan Facts, Trends and Data: 2013-2014

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