Health Plan Facts, Trends and Data: 2016-2017

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Publication Details

  • Pub Code: GHPF21-11WEB
  • Pages: 436
  • ISBN: 978-1-939721-22-8
  • Copyright 2016

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Health Plan Facts, Trends and Data: 2016-2017

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:

  • Industry-wide Trends. Our in-house editorial and research teams have closely tracked enrollment and market trends over the past year — including Medicare Advantage and Medicaid enrollment, premium rates and integrated health systems.
  • Market Impact of Mergers and Closures. From the controversy surrounding the Anthem-Cigna and Aetna-Humana mergers to myriad CO-OP closures, the industry has seen volatile shifts in the past year.
  • Insurer Strategies. In-depth accounts of health plans’ competitive strategies in public and private exchanges, reimbursement strategies such as value-based care, outcomes-based drug contracting and bundled payments, and pharmacy benefit cost containment.
  • Innovative Partnerships. The shape of the industry continues to evolve as insurers, health systems and providers form partnerships and launch products designed to provide value to customers while cutting costs.
  • Business News. Synopses of mergers, acquisitions and divestitures, financial and stock market performance, personnel decisions and executive compensation trends.
  • Data and Developments on Blues Plans. New for this edition, a chapter is specifically dedicated to data, trends and strategies of Blue Cross and Blue Shield companies.

Order your copy of Health Plan Facts, Trends and Data: 2016-2017 today, so you'll have key health plan business trends at your fingertips!

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 and Market Share

  • Enrollment Data
  • Medicare Advantage Enrollment Data
  • Managed Medicaid Data
  • Dual-Eligibles Data

Chapter 2: Health Plan Organizational Structure and Leadership

  • Executive Compensation Trends
  • AHIP Departures
  • Workforce Developments
  • Leadership Decisions and Appointments

Chapter 3: Health Plan Financial Performance

  • Second-Quarter 2015 Results
  • Third-Quarter 2015 Results
  • Fourth-Quarter 2015 Results
  • Full-Year 2015
  • First-Quarter 2016 Results
  • Stock Market Performance
  • Key Financial Data

Chapter 4: Blue Cross and Blue Shield Plan Trends and Data

  • What Is a Blue Cross Blue Shield Plan?
  • Blue Cross and Blue Shield Plan Enrollment Data
  • Directory of Blue Cross and Blue Shield Organizations

Chapter 5: Market Moves and Expansions

  • Mergers, Acquisitions and Divestitures
    • Aetna-Humana
    • Anthem-Cigna
    • Centene-Health Net
  • Market Expansions and Exits
  • Closures and Exits of CO-OPs and Other Insurers
  • Medicaid Market Developments
  • Start-Ups
  • Overseas Markets

Chapter 6: Health Plan Product Offerings, Marketing and Benefit Design

  • Outreach Efforts
  • Benefit Design and Offerings
    • HDHPs and HSAs
  • Tiered and Narrow Networks
    • OMNIA Tiered Network
  • Short-Term Health Policies
  • Employer Benefit Design Trends

Chapter 7: Private Exchanges

  • Private Exchange Growth Trends
  • Private Exchange Benefit Design and Features
  • Employer Adoption of Private Exchanges

Chapter 8: Insurer Participation and Strategies for Public Exchanges

  • Participation and Competition
  • Marketing Strategies
  • Premium Rate Trends
  • Benefit Design Strategies
    • Network Size
  • IT Challenges
  • Impact on Brokers
  • Reinsurance, Risk Corridors and Risk Adjustment
  • Oversight and Guidance
    • Special Enrollment Periods (SEPs)
    • Standardized Products
    • Basic Health Plan

Chapter 9: Public Exchange Premium Rate and Benefit Design Data

  • Exchange Premium Rate Trends and Data
  • Benefit Design Data on Exchanges

Chapter 10: Provider/Health Plan Transactions and Developments

  • Integrated Health Systems and Payer Collaborations
  • Network Administration and Reimbursement
    • Bundled Payments
    • Medicare Access and CHIP Reauthorization Act (MACRA)
  • Contract Negotiations and Disputes
  • Network Adequacy
  • Provider Directories
  • ICD-10 Transition

Chapter 11: Value-Based Care Initiatives

  • Insurer Strategies for Value-Based Care
  • Launches and Expansions
  • Results From ACOs and Other Value-Based Care Initiatives
  • Medical Homes

Chapter 12: Health Promotion, Wellness and Disease Management Strategies

  • Wellness Initiatives
  • Coverage Policies
  • Care Settings
  • Palliative and End-of-Life Care
  • Strategies and Initiatives for Specific Health Issues

Chapter 13: Health Plan Strategies for Pharmacy Benefit Management

  • Health Plan/PBM Contracts and Disputes
    • Anthem-Express Scripts Lawsuit
  • Pharmacy Benefit Design and Formulary Strategies
  • Use of Generics
  • Performance-Based Deals
  • Drug Pricing
  • E-Prescribing
  • Coverage of Female Viagra
  • Specialty Drug Strategies
    • Hepatitis C Drugs

Chapter 14: IT Strategies, Challenges and Opportunities

  • Telehealth Initiatives
  • Population Health Data
  • Apps and Other Online Consumer Tools
  • Claims Processing and Storage
    • Blue Cloud
  • Data Security and Insurer Breaches

Chapter 15: Health Plan Resources and Directories

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

Click here to see a detailed table of contents.

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

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Health Plan Facts, Trends and Data: 2016-2017

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