White Papers, Studies and Surveys

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

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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

Health Insurance Exchanges: The Mandate for Data-Driven Strategies to Drive Quality Improvement and Financial Outcomes

IDC Health Insights and Inovalon

The Health Insurance Exchange (HIX) Marketplace creates significant opportunities and challenges for participating health insurance carriers and their Qualified Health Plan offerings, necessitating innovation to ensure financial performance, market share growth, and a positive impact on quality and outcomes. This industry brief provides insights into the HIX Marketplace and how to meet challenges with risk score accuracy and planning. Read more

Navigate Edge Server Requirements: Strategies for Complying with HHS’ HIX Edge Server Requirements


Qualified Health Plans preparing to participate in the Health Insurance Exchange (HIX) Marketplace must provide Health and Human Services de-identified claims information through a secure system, or Edge Server, operating on the “edge” of the health plan’s data environment. The crucial challenge for health plans is to attain compliance with evolving Edge Server requirements. This paper examines steps health plans and supporting vendors can consider for Edge Server readiness. Read more

The Florida Long-Term Care Managed Care Program – One State’s Approach to an Integrated Care Model

Gorman Health Group

While comprehensive plans serving Medicare Advantage dual eligibles present a market opportunity, there are a number of issues that demand careful consideration and can present great risk. Using Florida as a case study, this white paper outlines issues that Medicare Advantage plans considering participating in any statewide initiatives or dual demonstration programs should examine, including network capacity, complex case management needs and data management and reporting. Read more

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


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

The Accountable Care Paradigm: More than Just Managed Care 2.0

Leavitt Partners Center for Accountable Care Intelligence

The Accountable Care Paradigm: More than Just Managed Care 2.0 is an in-depth look at how ACO leadership around the country understands their role in the accountable care movement. The authors offer qualitative insights from their numerous interactions with ACO leadership to show how this movement differs from the failed managed care efforts of the past and how the market is defining what it means to provide accountable care. Read more

The Role of Text Messaging in Modern Healthcare


Smartphones and tablets are becoming standard equipment for healthcare professionals, putting a wide range of tools at their fingertips, including reference documents, patient management software and communication applications. But smart devices also represent a fast-growing, high-risk aspect of health care that is not well regulated. Texting in particular is a popular practice but one which exposes electronic data to a variety of risks. This paper will examine the impact of text messaging in healthcare today and the different solutions available to ensure that ePHI remains protected. Read more

Meeting the Nation's Primary Care Needs: Current and Prospective Roles of Doctors of Chiropractic and Naturopathic Medicine, Practitioners of Acupuncture and Oriental Medicine, and Direct-Entry Midwives

The Primary Care Project of the Academic Consortium for Complementary and Alternative Health Care

The white paper is intended to assist policy makers, regulators, third-party payers, delivery system administrators, practitioners, and other concerned parties as well as the disciplines themselves in considering the optimal use of certain non-medical doctor practitioners — doctors of chiropractic and naturopathic medicine, practitioners and doctors of acupuncture and Oriental medicine, and direct-entry midwives —as part of the nation’s primary care matrix, in the face of the growing shortage of primary care providers. Read more

Global Pricing Data and Advanced Analytics for Better Decisions and Competitor Edge

Alliance Life Sciences Consulting Group

This article is the first in a three part series looking at how pricing data and analytics form an integral part of informed decision making for pharmaceutical companies. Read more

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