White Papers, Studies and Surveys

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

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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

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

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