Health Plan Facts, Trends and Data: 2012-2013

Table of Contents

Chapter 1: Health Plan Enrollment Trends and Market Share

• Health Plan Enrollment Trends
• Health Plan Enrollment Data
• Employer-Sponsored Enrollment Data
• FEHBP, TriCare and Other Federal Programs

Chapter 2: Health Plan Organizational Structure and Leadership

• Executive Compensation Trends and Developments
• Lobbying and Donations
• Leadership Changes and Appointments

Chapter 3: Health Plan Growth and Consolidation

• Mergers, Acquisitions and Divestitures
  • Affiliations and Partnerships
• Market Moves, Expansions and Contract Awards
• The Overseas Market
• Product Launches and Coverage Expansions
• Uninsured and Underinsured Populations
• Marketing Strategies (Shift to Retail Market, Rebranding)
• Retail Insurance Outlets

Chapter 4: Health Plan Financial Performance

• Costs and Profitability
• 2011 and 2012 Annual Results and Projections
• Q2-Q4 2011 and Q1 2012 Results
• Stock Market Performance
• Key Financial Data

Chapter 5: Health Reform Decisions and Impact

Chapter 6: Medical Loss Ratios

• Regulations and Oversight
• Broker Compensation
• Rebates
• State Waivers
• Medical Loss Ratios and MLR Factors of Selected Companies for 2011
  • 2011 Medical Loss Ratios by Market for 10 Large Health Insurers
  • Analysis of Components of 2011 MLR Calculations

Chapter 7: Rate Setting and Premiums

• Causes of Rate Increases
• Increases, Decreases, Denials and Delays
• Oversight of Rate Increases
• Premium Trends

Chapter 8: Insurance Exchanges

• Effect of Exchanges on Health Plans and Other Stakeholders
• Consumer Operated and Oriented Plans (CO-OPs)
• Essential Health Benefits
• Private Insurance Exchanges
• State Exchanges
• HHS Initiatives

Chapter 9: Benefit Design

• Design Strategies
• Value-Based Design
• Limited-Benefit Plans/Mini-Meds
• HSAs, Debit Cards and Other Financial Products

Chapter 10: Employer Strategies and Challenges

• Coverage Costs and Trends
• Benefit Design Strategies
• Defined-Contribution Plans
• Narrow Networks

Chapter 11: Pharmacy Strategies for Health Plans and Employers

• PBM Market Moves
• Pharmacy Cost Concerns
• Coupons and Copay Programs
• Pricing Disputes
• Generics Use
• Genetic Testing
• Narrow Pharmacy Networks
• Outcomes-Based Research
• Medication Therapy Management (MTM)

Chapter 12: Provider Network Administration, Reimbursement and Contracting Issues

• Network Administration and Reimbursement
  • Health Information Exchanges
• Affiliations Between Health Plans and Providers
• Quality Initiatives

Chapter 13: Accountable Care Organizations

• ACO Pilots and Programs
• Health Plan Participation
• Regulations and Legal Concerns
• Care Coordination Through ACOs

Chapter 14: Health Promotion, Wellness and Disease Management Strategies and Challenges

• Health Management and Utilization
• Strategies for Specific Health Issues
  • Autism
  • Diabetes
  • Flu
  • Obesity
  • Painkiller Abuse
• Patient-Centered Medical Homes
• Wellness Initiatives

Chapter 15: Social Media Tools and Other IT Communications Strategies

• Online and Interactive Tools for Consumers
• Applications for Communications Through Mobile Smartphones
• Social Media Strategies
• Telemedicine

Chapter 16: Records Security, Coding and Data Protection Issues

• Data Management and Claims Processing
• Data Security Challenges and Breaches
• Electronic Health Records
• ICD-10 Compliance

Chapter 17: Health Plan Legal Challenges

• False Claims and Fraud and Abuse Issues
• Health Plan Liability and Legal Actions
  • ‘Most Favored Nation’ Clauses
• Consumer-Related Violations
• Explanation of Benefit (EOB) Forms
• Coverage of Same-Sex Spouses
• State-Level Legislation

Chapter 18: 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
• Directory of State Medicaid Pharmacy Directors
• Directory of 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

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