White Papers, Studies and Surveys

Recent research findings, data and survey results from leading health care organizations

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Reference Pricing: A Small Piece of the Health Care Price and Quality Puzzle

National Institute for Health Care Reform

As purchasers seek strategies to reduce high health care provider prices, interest in reference pricing—or capping payment for a particular medical service—has grown significantly. But potential savings to payers from reference pricing for medical services are modest. When considering reference pricing, employers and health plans should weigh potential savings against increased plan complexity and financial risk to enrollees. Read more

Analysis: How Any Willing Provider Makes Health Care More Expensive

America’s Health Insurance Plans

Any Willing Provider (AWP) law permit providers who are willing to agree to an insurer’s terms and condition for inclusion in a network to demand inclusion in that network. At present, 17 states have AWP laws that apply to either hospitals, physicians, or both. The potential for AWP laws to become more disruptive to health care financing in the future will likely spur greater efforts by providers to pass such laws. But if they succeed, the costs to consumers, employers and taxpayers could be even larger than we have seen in the past. Read more

Health and Financial Well-Being: How Strong is the Link?

Cigna Corp.

Cigna Corp.’s survey of U.S. consumers reveals the link between health care costs and financial well-being. Consumers draw a strong connection between their health care costs and what they perceive to be their ability to finance future needs. While 54% of consumers report they have a favorable outlook on health care affordability, more than 4 in 10 consumers are worried that health care costs will rise faster than their household income. Companies like Cigna can play in understanding consumers’ needs and working together with them, all the way. Read more

Think Inside the Box: How to Reduce Costs of Specialty Pharmacy Shipments and Increase Patient Satisfaction

Daniel Kus RPh and Bill Bailey RPh

The specialty pharmacy industry could reduce costs by $27.5 million annually (product and call center staff costs only) if visual temperature indicators were used as decision-making tools to determine if medicine should be used or returned when patients suspect heat damage. In addition, 97% of patients surveyed, who received medicine from specialty pharmacies with a visual temperature indicator included in the package, agree that they would want an indicator in all shipments and 95% agree the indicator increased their confidence in the medicines received. Read more

Meet the New Health Care Consumer: Reluctant. Anxious. Looking for help.

Media Logic

The ACA has left health care consumers feeling anxious, confused and reluctant—anything but empowered. What’s that mean for health care marketers? Opportunity. In this white paper payers and providers will learn surprising trends related to the ACA’s impact, and specific steps they can take to earn consumer trust and attract new business by embracing price and quality transparency and optimizing the customer experience. Read more

3 Elements of Medicare Advantage You Don’t Want to Tackle Alone

TMG Health

TMG Health’s white paper, “3 Elements of Medicare Advantage You Don’t Want to Tackle Alone” outlines the significant burden payers shoulder to understand and meet the ever-changing requirements for reporting, tracking, and member communication that flow from CMS. The paper offers advice and outlines best practices for meeting the challenge while providing a superb member experience, remaining compliant and maximizing revenue. Insight and recommendations are provided by TMG Health’s operational subject matter experts and several industry sources. Read more

Population Health Management: A Key Addition to Your Electronic Health Record

i2i Systems

This white paper defines population health management and examines how it can be used to engage patients to take action, secure and increase pay-for-performance (P4P) revenue, help practices differentiate themselves to compete effectively in a modern health care delivery environment, and more. Read more

Compliance Challenges and Opportunities in Medicare Advantage

HighRoads and Leavitt Partners

Medicare Advantage is one of the fastest growing public sector programs in the country, presenting an opportunity for commercial payers. But with opportunity comes challenges, like meeting compliance requirements and securing a four-star rating. In this white paper, Leavitt Partners and HighRoads articulate why payers need to execute on a sound data management strategy to build or expand their Medicare Advantage business. Read more

ACA and Self-Insurance for Small Employers: A White Paper for Employers and Their Brokers

HPM Institute

In response to major uncertainties in the commercial insurance market due to the sweeping new health reform law, many mid-sized and smaller employers — as well as their brokers and consultants — are seriously considering a shift to self-insurance even before the new law’s costly benefit mandates become effective. The aggregate impact of the Affordable Care Act (ACA) on the insurance market; including, impending yet undefined large premium increases; delays in issuing implementing regulations; a congressional focus on ACA amendments; and possible changes in the national political landscape, have left plan sponsors, insurers, regulators and consumers with few clear answers about ACA’s future implementation. This report discusses ACA’s new federal benefit mandates and distinguishes their impact on insured vs. self-insured plans, tracks positive trends in self-insurance for employers of all sizes and outlines a new model for data-driven self-funding programs. Read more

The new marketplaces: Private Health Insurance Exchange Survey Report

Array Health

This summer with the October 1 launch of public health exchanges looming, Array Health surveyed health insurance executives to get their perspective on the changing marketplace. Read this report to discover their opinions on key questions surrounding exchanges including: What percentage of insurers will participate in both private and public exchanges? How aware are employers of the defined contribution funding model? How many “young invincibles” will comply with the ACA individual coverage mandate? Read more

CMS 2013 Short Cycle Dispensing/CMS 2014 Daily Cost Sharing Rate Effective: January 1, 2013, and January 1, 2014 Respectively

Gorman Health Group

In an effort to contain costs and reduce waste associated with the Medicare prescription drug benefit, CMS established a trial supply program that would require Part D sponsors to provide, in certain cases, the option of a daily prorated cost-sharing rate for prescriptions for fewer than 30 days. This white paper outlines the program requirements and compliance action steps. Read more

Centralized Benefits Plan Management: A Health Care Payer’s Foundation for Success under Health Care Reform

HighRoads

Health care payers face intense pressure to implement the provisions of the Affordable Care Act (ACA) and must meet aggressive timelines to address reform mandates through 2014. The ever increasing pressure on profit margins combined with medical loss ratio (MLR) restrictions are forcing payers to focus on reducing costs and improving efficiency in all areas of their business. There are several market trends and government regulations that will significantly change how health care payers design and distribute products in the years to come. Read more

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