HealthLeaders-InterStudy Gateway

Phoenix | Arizona | 2011 | Market Overview (Event Driven)

Wed, 22 Feb 2012 00:00:00 GMT

Report Summary: Leading health systems in the Phoenix market continue to expand existing facilities or open new ones, despite flattening population growth, the dwindling of the physician supply and the imminent expansion of the state’s uninsured population due to Gov. Jan Brewer’s plan to reduce enrollment in Arizona’s Medicaid program by about 136,000. Health systems and other healthcare providers are lobbying Brewer to avoid these cuts by imposing taxes on healthcare providers and health plans that would result in federal matching funds. Managed care plans in the area can expect another underwhelming year for commercial enrollment. The best opportunity for membership gains appears to be in Medicare Advantage plans.

Coventry | 4Q 2011 | Health Plan Earnings Summaries

Wed, 22 Feb 2012 00:00:00 GMT

The HealthLeaders-InterStudy Market Analyst team analyzes major developments at the nation’s publicly held health plans each quarter through their financial releases and conference call transcripts. The summaries focus on state highlights, product news and significant corporate developments.

WellPoint Inc. | National MCO Analyzer | 2011 (Event Driven)

Tue, 21 Feb 2012 00:00:00 GMT

Report Summary: WellPoint is now the second-largest insurer by covered lives in the nation, operating Blue Cross Blue Shield plans in 14 states including California and New York. But as 2014 approaches, the company's singular strength in the commercial segment will come under pressure from new medical loss ratio requirements. It's had little success in its stated goals of expanding its reach in the fast-growing segments of Medicaid and Medicare. Two major 2011 acquisitions hint at some new strategies, however: its purchase of vertically integrated Medicare Advantage carrier CareMore Health Plan and its major stake in Bloom Health, operator of a "private health exchange" system for employer-based plans.

UnitedHealth Group, Inc. | Indiana | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | Maryland | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | Missouri | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | Texas | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | New York | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | Georgia | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | Wisconsin | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | South Carolina | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | Illinois | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | Iowa | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | Arkansas | 2012 | Plan Profile

Fri, 17 Feb 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Centene | 4Q 2011 | Health Plan Earnings Summaries

Fri, 17 Feb 2012 00:00:00 GMT

Boston | Massachusetts | 2012 | Market Overview (Event Driven)

Fri, 17 Feb 2012 00:00:00 GMT

Report Summary: The innovative Boston market is moving rapidly toward global payments led by Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract. All of the market’s elite academic health systems have joined the AQC and the top three health systems have also been chosen as Pioneer accountable care organizations. Economic conditions are improving and the market has the lowest uninsurance rates in the nation. An intense focus on cost-containment has fundamentally changed the dynamics of this market, including movement into health insurance by the top health systems.

Toledo | Ohio | 2012 | Market Overview (Event Driven)

Wed, 15 Feb 2012 00:00:00 GMT

Report Summary: Toledo's healthcare market remains in somewhat of a holding pattern while the merger between the region's last independent hospital and the market's dominant healthcare provider works its way through the courts, though this setback has not diminished the long-standing rivalry between market leaders ProMedica and Mercy. Competition will increase this year over patient-centered medical homes as state funding becomes available to encourage adoption of this model to serve the uninsured and Medicaid populations. And area health insurers will also face greater competition in 2012 as Ohio rebids its Medicaid contracts and decreases the number of managed care regions in the state. Physicians, employers, and patients alike will benefit from the many different pay-for-performance and patient-centered initiatives currently underway in Toledo, a trend that also promotes pharmaceutical sales.

Cigna Corporation | Vermont | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Virginia | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Michigan | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Pennsylvania | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | New York | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Ohio | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | New Jersey | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Missouri | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | New Hampshire | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Florida | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Nevada | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Washington | 2012 | Plan Profile

Wed, 15 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

UnitedHealth Group | National MCO Analyzer | 2011 (Event Driven)

Tue, 14 Feb 2012 00:00:00 GMT

Report Summary: Most developments were favorable for UnitedHealth Group in 2011, except those outside its control such as economic swings and challenges to healthcare reform. The company was at the top of the heap in many ways: it insured more Americans through commercial, Medicaid and Medicare products than any other health benefits company; it was actively expanding its prescription benefit business through OptumRx with plans to shed its long-term relationship with Medco Health; and it was reaching into nearly every corner of healthcare through its technology solutions, ancillary products and financial services. The company continued to be an innovator in product design and care management and supported patient-centered medical homes in multi-payer programs.

Humana | 4Q 2011 | Health Plan Earnings Summaries

Tue, 14 Feb 2012 00:00:00 GMT

News for DC

Fri, 10 Feb 2012 05:00:00 GMT

News for Texas

Fri, 10 Feb 2012 05:00:00 GMT

News for Wisconsin

Fri, 10 Feb 2012 05:00:00 GMT

News for Florida

Fri, 10 Feb 2012 05:00:00 GMT

Cigna Corporation | Iowa | 2012 | Plan Profile

Fri, 10 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Illinois | 2012 | Plan Profile

Fri, 10 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Alabama | 2012 | Plan Profile

Fri, 10 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | California | 2012 | Plan Profile

Fri, 10 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, Medicare Advantage, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Blue Cross and Blue Shield of Florida, Inc. | Florida | 2012 | Plan Profile

Fri, 10 Feb 2012 00:00:00 GMT

Address: 4800 Deerwood Campus Pkwy, DCC 300, 5th FL, Jacksonville, FL 32246
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.bcbsfl.com

Health Net | 4Q 2011 | Health Plan Earnings Summaries

Fri, 10 Feb 2012 00:00:00 GMT

Report Summary: The HealthLeaders-InterStudy Market Analyst team analyzes major developments at the nation’s publicly held health plans each quarter through their financial releases and conference call transcripts. The summaries focus on state highlights, product news and significant corporate developments.

News for Illinois

Thu, 09 Feb 2012 05:00:00 GMT

News for Kansas

Thu, 09 Feb 2012 05:00:00 GMT

News for Massachusetts

Thu, 09 Feb 2012 05:00:00 GMT

News for Louisiana

Thu, 09 Feb 2012 05:00:00 GMT

News for Maine

Thu, 09 Feb 2012 05:00:00 GMT

National News

Thu, 09 Feb 2012 05:00:00 GMT

Louisville | Kentucky | 2011 | Market Overview (Event Driven)

Thu, 09 Feb 2012 00:00:00 GMT

Report Summary: Louisville health systems are preparing for the expected mega-merger of University of Louisville Hospital and Catholic Health Initiatives, which owns the second-largest health system in the area, Jewish Hospital & St. Mary’s HealthCare. This realignment, along with continued integration with local physicians, is already strengthening the position of the provider sector in contract negotiations with health plans. There are also signs of employers becoming interested in direct arrangements with health systems and programs like work-site clinics to focus on preventive care for the purpose of reducing medical cost trends, though the adoption of consumer-driven health plans appears to be waning.

Lexington | Kentucky | 2011 | Market Overview (Event Driven)

Thu, 09 Feb 2012 00:00:00 GMT

Report Summary: The Lexington market is taking its cues from competition among health systems and health plans in Louisville. Both UK HealthCare and Saint Joseph Health System have partnered with health systems in Louisville to address residents’ healthcare needs statewide. Louisville-based Humana remains the Lexington area’s largest managed care organization. Meanwhile, the state transitioned its Medicaid program to managed care, effective November 2011, creating an influx of three national health plans to Lexington and the rest of the Commonwealth.

Cigna | 4Q 2011 | Health Plan Earnings Summaries

Thu, 09 Feb 2012 00:00:00 GMT

News for Maryland

Wed, 08 Feb 2012 05:00:00 GMT

News for New Hampshire

Wed, 08 Feb 2012 05:00:00 GMT

News for New York

Wed, 08 Feb 2012 05:00:00 GMT

News for Michigan

Wed, 08 Feb 2012 05:00:00 GMT

News for Georgia

Wed, 08 Feb 2012 05:00:00 GMT

Independent Care Health Plan | Wisconsin | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 1555 N. RiverCenter Drive Suite 202A, Milwaukee, WI 53212
Products: Medicaid, Medicare Advantage
URL: http://www.icare-wi.org

Health Care Service Corporation | Illinois | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 300 East Randolph Street, Chicago, IL 60601-5099
Products: HMO, POS, PPO, CDHP, Indemnity
URL: http://www.hcsc.com

Health Alliance Medical Plans, Inc. | Illinois | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 301 S. Vine Street, Urbana, IL 61801
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.healthalliance.org

Health Alliance Plan | Michigan | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 2850 W. Grand Blvd., Detroit, MI 48202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.hap.org

Priority Health | Michigan | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 1231 East Beltline NE, Grand Rapids, MI 49525
Products:
URL: http://www.priorityhealth.com

Cigna Corporation | Tennessee | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Colorado | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Kaiser Foundation Health Plans, Inc. | Colorado | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 1800 Harrison Street 8th Floor, Oakland, CA 51098
Products: HMO, PPO, Medicaid, Medicare Advantage, CDHP, Indemnity
URL: http://www.kp.org

Rocky Mountain Health Plans | Colorado | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 2775 Crossroads Blvd., Grand Junction, CO 81506
Products: HMO, PPO, Medicaid, Indemnity
URL: http://www.rmhp.org

Cigna Corporation | North Carolina | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

SCAN Health Plan | California | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 3800 Kilroy Airport Way, Long Beach, CA 90806
Products: Medicaid, Medicare Advantage
URL: http://www.scanhealthplan.com

Cigna Corporation | Texas | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Health First Health Plans, Inc. | Florida | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 6450 US Highway 1, Rockledge, FL 32955
Products: HMO, Medicare Advantage
URL: www.health-first.org/health_plans.com

Cigna Corporation | Connecticut | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Arizona | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, Medicare Advantage, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Health Net, Inc. | Arizona | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 21650 Oxnard Street, Woodland Hills, CA 91367
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.healthnet.com

Coventry Health Care, Inc. | Missouri | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.cvty.com

Essence | Missouri | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 12655 Olive Blvd., 4th Floor, St. Louis, MO 63141
Products: Medicare Advantage
URL: http://www.essencehealthcare.com

Aetna Inc. | Arizona | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Blue Cross and Blue Shield of Kansas City | Missouri | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 2301 Main Street, Kansas City, MO 64108-2428
Products: HMO, PPO, Medicaid
URL: http://www.bluekc.com

Capital Health Plan | Florida | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 2140 Centerville Place, P.O. Box 15349, Tallahassee, FL 32317-5349
Products:
URL: http://capitalhealth.com/

WellCare Group of Companies | Hawaii | 2012 | Plan Profile

Wed, 08 Feb 2012 00:00:00 GMT

Address: 6800 North Dale Mabry Highway Suite 270/299, Tampa, FL 33614
Products: Medicaid, Medicare Advantage
URL: http://www.wellcare.com

Aetna | 4Q 2011 | Health Plan Earnings Summaries

Wed, 08 Feb 2012 00:00:00 GMT

News for Washington

Tue, 07 Feb 2012 05:00:00 GMT

News for Arizona

Tue, 07 Feb 2012 05:00:00 GMT

News for California

Tue, 07 Feb 2012 05:00:00 GMT

News for Kentucky

Tue, 07 Feb 2012 05:00:00 GMT

News for New Jersey

Tue, 07 Feb 2012 05:00:00 GMT

News for Virginia

Mon, 06 Feb 2012 05:00:00 GMT

News for Oregon

Mon, 06 Feb 2012 05:00:00 GMT

National Medicaid Analyzer | 2011 (Event Driven)

Mon, 06 Feb 2012 00:00:00 GMT

Report Summary: The fastest-growing segment of the healthcare industry is Medicaid, and it's scheduled to grow dramatically in 2014, becoming the de facto healthcare safety net for low-income Americans and a partial template for benefit design in the health exchanges. But Medicaid is administered differently in each state, and Medicaid policy changes with the political and budgetary demands of the moment in each state. This report examines the Medicaid market in the 50 states and the District of Columbia, including the major MCO players, their market position, Medicaid pharmacy policy, and recent state actions on Medicaid's future.

News for North Carolina

Fri, 03 Feb 2012 05:00:00 GMT

Cigna | National MCO Analyzer | 2011 (Event Driven)

Fri, 03 Feb 2012 00:00:00 GMT

Report Summary: Cigna, the nation's fifth-largest insurer by covered lives, remains a leader in serving self-insured large employer groups, and has struggled to push into the mid-sized group and individual markets. But the company is an innovator in creating new funding options for employers, and in pursuing care coordination models with large multi-specialty provider groups across the country.

News for Pennsylvania

Thu, 02 Feb 2012 05:00:00 GMT

Detroit | Michigan | 2011 | Market Overview (Event Driven)

Thu, 02 Feb 2012 00:00:00 GMT

Report Summary: The Detroit economy is struggling back from the brink, with renewed economic growth in suburban areas but lingering unemployment and high rates of uninsurance within the city limits of Detroit and Flint. The physician sector in this market is racing to create accountable care organizations, with at least seven physician-led ACOs that are beginning to negotiate with payers. We expect this consolidation and integration to be the overarching theme development for the near term, and it could mean the demise or sale of smaller providers and health plans. The focus on cost and quality may be a boon to both employers and pharmaceutical companies involved in wellness and disease management programs, which aim to keep employees well by encouraging strict compliance with drug therapy.

News for Rhode Island

Wed, 01 Feb 2012 05:00:00 GMT

News for South Carolina

Wed, 01 Feb 2012 05:00:00 GMT

News for Connecticut

Wed, 01 Feb 2012 05:00:00 GMT

Easy Choice Health Plan Inc. | New York | 2012 | Plan Profile

Wed, 01 Feb 2012 00:00:00 GMT

Address: 20411 SW Birch Street Suite 200, Newport Beach, CA 926580
Products:
URL: http://www.easychoicehealthplan.com

Managed Care Landscape | 2012

Tue, 31 Jan 2012 00:00:00 GMT

Report Summary: With commercial enrollment growth stalling over the past two years, national managed care organizations have turned to Medicaid and Medicare Advantage markets while simultaneously making strategic purchases of smaller health plans or provider groups to leverage their positions. This annual report of the Managed Care Landscape examines enrollment, benefit design and care management trends. The PowerPoint presentation looks at the MCO strategies for managing healthcare costs and examines upcoming developments related to healthcare reform. It also highlights the industry's embracing of accountable or coordinated care models. Finally, the major MCOs' strengths, weaknesses, opportunities and threats are compared and contrasted with one another.

WellPoint | 4Q 2011 | Health Plan Earnings Summaries

Tue, 31 Jan 2012 00:00:00 GMT

News for Tennessee

Mon, 30 Jan 2012 05:00:00 GMT

News for Alabama

Fri, 27 Jan 2012 05:00:00 GMT

National Medicare Analyzer | 2011 (Event Driven)

Fri, 27 Jan 2012 00:00:00 GMT

Report Summary: Medicare is big and getting much bigger, largely because of the aging of baby boomers, set to enter the program for the first time in 2011. The double-digit growth in Medicare beneficiary enrollment will be an underlying factor in drug and medical service utilization, provider supply and benefit design over the next decade. 2011 finds Medicare at a crossroads:policymakers are planning for a new care delivery system via accountable care organizations while Medicare Advantage plans work to maintain enrollment among new beneficiaries accustomed to managed care. Health plans, meanwhile, are concerned about bonus payments related to their Star ratings and in keeping members compliant with their drugs through medication therapy management.

Greensboro | North Carolina | 2012 | Market Overview (Event Driven)

Fri, 27 Jan 2012 00:00:00 GMT

Report Summary: High unemployment and high levels of uninsurance do not point to large gains in commercial enrollment in the Greensboro market. To retain membership and improve market share, some managed care organizations have introduced suites of products designed to give small employers greater flexibility in plan design and implementing programs to reduce prescription drug expense by encouraging the use of generics. Meanwhile, providers in the region are showing their willingness to adopt innovative systems of patient care, including patient-centered medical homes and initiatives built on the principles of accountable care organizations.

News for Minnesota

Thu, 26 Jan 2012 05:00:00 GMT

UnitedHealth Group | 4Q 2011 | Health Plan Earnings Summaries

Thu, 26 Jan 2012 00:00:00 GMT

Riverside | California | 2011 | Market Overview (Event Driven)

Wed, 25 Jan 2012 00:00:00 GMT

Report Summary: The two-county Riverside market has proven it can embrace collaborations between hospitals, physicians and health plans. Twenty-first century medicine can’t move forward, however, if there aren’t enough physicians to practice it or enough facilities to house its innovations. Despite the presence of Kaiser Permanente, local resources are somewhat limited and widespread integrated care has a long way to go. The result is a considerable amount of push-pull between stakeholders in the local market, where health system construction is often reduced to a multi-billion-dollar game of catch-up. Employers are also struggling to keep up, in their case with the rising costs of employee healthcare. Narrow- and value-based networks as well as hospital-only plans are developments that could affect all market players—increasing competition among hospitals, hurting local physicians and providing health plans a new revenue stream that will nonetheless need volume to counter recession-based enrollment losses. There are already signs that retirees are emerging as the whipping boy for “easy” cuts. Drug benefits may be among the first to go.

The Regence Group | Oregon | 2012 | Plan Profile

Wed, 25 Jan 2012 00:00:00 GMT

Address: 100 SW Market Street, Portland, OR 97201
Products: PPO, Medicare PDP, Indemnity
URL: http://www.regence.com

Pennsylvania Health Plan Data (HMO Financials)

Tue, 24 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

South Carolina Health Plan Data (HMO Financials)

Tue, 24 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

New Jersey Health Plan Data (HMO Financial)

Tue, 24 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Maryland Health Plan Data (HMO Financials)

Tue, 24 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Massachusetts Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Michigan Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Missouri Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Maine Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Florida Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Georgia Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Indiana Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Nevada Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

New York Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

North Carolina Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Texas Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

California Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

UnitedHealth Group, Inc. | California | 2012 | Plan Profile

Mon, 23 Jan 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Blue Cross & Blue Shield of Rhode Island | Rhode Island | 2012 | Plan Profile

Mon, 23 Jan 2012 00:00:00 GMT

Address: 444 Westminster Street, Providence, RI 02903
Products: PPO, Medicare Advantage, Indemnity
URL: http://www.bcbsri.com

Blue Cross and Blue Shield of Massachusetts, Inc. | Massachusetts | 2012 | Plan Profile

Mon, 23 Jan 2012 00:00:00 GMT

Address: Landmark Center 401 Park Drive, Boston, MA 02115
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.bluecrossma.com

Fallon Community Health Plan | Massachusetts | 2012 | Plan Profile

Mon, 23 Jan 2012 00:00:00 GMT

Address: 10 Chestnut Street, Worcester, MA 01608
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP
URL: http://www.fchp.org

Virginia Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Wisconsin Health Plan Data (HMO Financials)

Mon, 23 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Tufts Associated Health Plans, Inc. (TAHP) | Massachusetts | 2012 | Plan Profile

Mon, 23 Jan 2012 00:00:00 GMT

Address: 333 Wyman Street, Waltham, MA 02454
Products: HMO, PPO, Medicare Advantage
URL: http://www.tuftshealthplan.com

WellPoint, Inc. | Maine | 2012 | Plan Profile

Mon, 23 Jan 2012 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

Oklahoma City | Oklahoma | 2011 | Market Overview (Event Driven)

Mon, 23 Jan 2012 00:00:00 GMT

Report Summary: Health systems in the Oklahoma City market are carving out a name for themselves in cancer care, offering treatments that are only available in only a handful of cities nationally. Employers in the region continue to gravitate toward high-deductible health plans and large employers in the market have shown increased interest in onsite clinics. Some managed care organizations have found increased interest in narrow-network health plans and along with HDHPs we expect enrollment in such plans to grow. Two of the region's largest health systems are developing medical home programs and laying the groundwork for accountable care organizations. As insurers look for initiatives designed to reduce long-term medical costs, such programs should receive a favorable response from managed care organizations.

Richmond | Virginia | 2011 | Market Overview (Event Driven)

Mon, 23 Jan 2012 00:00:00 GMT

Report Summary: Competition among health systems in the Richmond market has heated up as market leaders HCA Virginia and Bon Secours Health System continue to expand facilities and services. Meanwhile, health plans in the area are struggling to keep healthcare costs down by reducing use of hospital emergency departments, encouraging enrollees to use the areaÕs retail and urgent-care clinics. Only one health system in the market, Bon Secours Health System in Virginia, appears to be moving toward development of an accountable care organization. However, the integration of physicians throughout the market could mean a relatively smooth transition to such models of care if hospitals and physician groups choose to take that route.

Cambridge Network Health Plan | Massachusetts | 2012 | Plan Profile

Mon, 23 Jan 2012 00:00:00 GMT

Address: 101 Station Landing, Medford, MA 02155
Products:
URL:

Meridian Health Plan, Inc. | Michigan | 2012 | Plan Profile

Mon, 23 Jan 2012 00:00:00 GMT

Address: 777 Woodward Avenue Suite 600, Detroit, MI 48226
Products:
URL: http://meridianhealthplan.com/

News for Iowa

Sun, 22 Jan 2012 05:00:00 GMT

Orange County | California | 2012 | Market Overview (Event Driven)

Fri, 20 Jan 2012 00:00:00 GMT

Report Summary: Monarch HealthCare's acquisition by UnitedHealth Group subsidiary OptumHealth has ended Monarch’s accountable care organization with Anthem Blue Cross and its relationship with Blue Shield of California. While the result of this acquisition has been clear, the effect of the market's tighter integration and growing consolidation on reform initiatives remains to be seen, particularly as it develops alongside increasing health plan influence and the likely growth of narrow networks in the Orange County market.

News for Missouri

Thu, 19 Jan 2012 05:00:00 GMT

Omaha | Nebraska | 2012 | Market Overview (Event Driven)

Thu, 19 Jan 2012 00:00:00 GMT

Report Summary: The highly consolidated Omaha health system sector wields considerable influence in the market, and efforts by some of the largest systems in the region to adopt coordinated care initiatives designed to improve efficiency and reduce medical costs could have a significant impact on the local healthcare industry. This bodes well for managed care organizations over the long term as such efforts lead to narrow networks and potentially lower medical costs, and for pharma if accountable care organizations and other initiatives boost drug adherence among chronically ill patients. MCOs will see some opportunity for growth as the stateÕs Medicaid program expands managed care statewide. Look for employers to continue turning toward consumer-driven health plans, wellness programs, and possibly narrow provider networks to control employee healthcare costs.

News for Nevada

Wed, 18 Jan 2012 05:00:00 GMT

News for Ohio

Wed, 18 Jan 2012 05:00:00 GMT

Charleston | South Carolina | 2011 | Market Overview (Event Driven)

Wed, 18 Jan 2012 00:00:00 GMT

Report Summary: Charleston’s provider landscape is shifting from one dominated by independent practice groups to a more consolidated market, owing largely to the aggressive acquisition strategy of Roper St. Francis Healthcare. While not as pronounced as in other South Carolina markets, such consolidation could create concern among managed care organizations and employers that it will drive up costs. BlueCross BlueShield of South Carolina retains its stronghold on the Charleston market, but the managed care organization is facing increased competition from national players offering a wide selection of products, including consumer-driven health plans. Meanwhile, South Carolina has made major changes to its Medicaid program by requiring beneficiaries to enroll in managed care, and the program enacted a second round of reimbursement cuts to providers in July 2011.

Pittsburgh | Pennsylvania | 2011 | Market Overview (Event Driven)

Tue, 17 Jan 2012 00:00:00 GMT

Report Summary: The Pittsburgh healthcare market is undergoing dramatic changes that will realign longtime partnerships. A major rift has developed between Highmark, the market’s largest managed care organization, and UPMC, the market’s dominant health system. Highmark has also agreed to purchase West Penn Allegheny Health System, the market’s second-largest health system, while UPMC Health System has agreed to new contracts with a range of MCOs. A big question is how employers will respond to the tough choices they will have to make as Highmark and UPMC Health System threaten to part ways. Choosing one health plan over another now has the potential to greatly impact the providers that are in network, whereas the market has historically aligned in such a way that patients could easily choose from many network hospitals.

Chicago | Illinois | 2011 | Market Overview (Event Driven)

Tue, 17 Jan 2012 00:00:00 GMT

Report Summary: Consolidation, care coordination and cost reduction are central themes for the Chicago healthcare market. The health systems sector has seen a flurry of activity over the past 12 months as two national nonprofit health systems entered the market, regional systems merged, and independent hospitals have consolidated. The market is also seeing an increase in the number of physician groups joining health systems to develop integrated systems of care in response to the changes wrought by healthcare reform and the need to operate more efficiently in a challenging economy. Meanwhile, high unemployment and slow economic recovery point to a challenging market for managed care organizations when it comes to commercial enrollment growth in the Chicago market. As employers in the market continue to demand products that help them rein in healthcare benefit costs, MCOs are responding with plans that embrace reimbursement reform and focus on quality and efficiency, such as bundled payments and products that incentivize members to use preventive services and participate in wellness initiatives.

Indianapolis | Indiana | 2012 | Market Overview (Event Driven)

Tue, 17 Jan 2012 00:00:00 GMT

Report Summary: The Indianapolis healthcare market is becoming more consolidated among its major players—health systems, physician groups, and health plans alike—as they look ahead to healthcare reform. Health systems have almost depleted the supply of independent physicians, smaller community hospitals have merged with the larger systems, and managed care organizations have left the market in the face of healthcare reform requirements. Additionally, collaborative and cost-cutting initiatives such as accountable care organizations, patient-centered medical homes, and onsite medical clinics are on the rise among Indianapolis employers and healthcare providers.

Birmingham | Alabama | 2012 | Market Overview (Event Driven)

Mon, 16 Jan 2012 00:00:00 GMT

Report Summary: A stalled economy, declining reimbursements and a growing uninsured population pose major challenges to Birmingham hospitals and physicians. Yet, despite a surplus of hospital beds and tight capital budgets, health systems and independent physician groups continue to expand in this highly competitive market. While the provider space remains largely fragmented, the managed care sector is consolidated, with dominant insurer Blue Cross and Blue Shield of Alabama controlling more than 70 percent of enrollment. New contracts between largest health system UAB Health System and two large, national insurers should help advance quality and pay-for-performance initiatives in the market, which remains lucrative for pharmaceutical sales due to its poor health status and high prevalence rates of obesity and diabetes.

West Palm Beach | Florida | 2011 | Market Overview (Event Driven)

Mon, 16 Jan 2012 00:00:00 GMT

Report Summary: The local healthcare industry features two dominant health systems, a highly competitive outpatient market, and a moderately consolidated health plan market whose players have a growing interest in vertical integration strategies with hospitals and physicians. Out-of-market competition is a factor because of Palm Beach County’s proximity to Miami and the large presence of snowbirds, who often travel north for the summer. Some local health systems are using hospitalist programs to keep physicians close, a model that poses both threats and opportunities alike to local practices. Health plans are also partnering with physicians, using electronic medical record systems and pay-for-performance programs as bait. Carriers are still coping, however, with commercial enrollment losses. The market’s unemployment rate is higher than the state and national average, and employers are struggling to find healthcare coverage that both they and their employees can afford. Meanwhile, statewide Medicaid reform that would require mandatory managed care enrollment has passed in both the state House and Senate, but it remains to be seen whether the stark differences between the bills can be reconciled.

News for Colorado

Fri, 13 Jan 2012 05:00:00 GMT

Philadelphia | Pennsylvania | 2011 | Market Overview (Event Driven)

Fri, 13 Jan 2012 00:00:00 GMT

Report Summary: The Philadelphia market is a healthcare hub, with many academic facilities and a wide range of specialties and subspecialties that attract top physicians from across the country. There is greater attention among key players to align payments with hospitals and physician organizations in ways that improve quality care and recognize cost savings. Employers are engaged in cost shifting through consumer-driven models, and that should continue as the economy’s recovery remains at a crawling pace. One interesting development is an effort by an influential association of union health, welfare and pension funds to steer members to providers that offer high-quality services. The pilot program is launching in Philadelphia and could expand.

News for Vermont

Thu, 12 Jan 2012 05:00:00 GMT

Aetna Inc. | Virginia | 2012 | Plan Profile

Wed, 11 Jan 2012 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Sentara HealthCare | Virginia | 2012 | Plan Profile

Wed, 11 Jan 2012 00:00:00 GMT

Address: 4417 Corporation Lane, Virginia Beach, VA 23462
Products: HMO, POS, PPO, Medicaid, Medicare PDP, CDHP
URL: http://www.sentara.com

AMERIGROUP Corporation | Texas | 2012 | Plan Profile

Wed, 11 Jan 2012 00:00:00 GMT

Address: 4425 Corporation Lane, Virginia Beach, VA 23462
Products: Medicaid, Medicare Advantage
URL: http://www.amerigroupcorp.com

Health Care Service Corporation | Texas | 2012 | Plan Profile

Wed, 11 Jan 2012 00:00:00 GMT

Address: 300 East Randolph Street, Chicago, IL 60601-5099
Products: HMO, POS, PPO, CDHP, Indemnity
URL: http://www.hcsc.com

AMERIGROUP Corporation | New York | 2012 | Plan Profile

Wed, 11 Jan 2012 00:00:00 GMT

Address: 4425 Corporation Lane, Virginia Beach, VA 23462
Products: Medicaid, Medicare Advantage
URL: http://www.amerigroupcorp.com

HealthPlus, Inc. | New York | 2012 | Plan Profile

Wed, 11 Jan 2012 00:00:00 GMT

Address:
Products: Medicaid, Medicare Advantage
URL: www.healthplus-ny.org

UnitedHealth Group, Inc. | Louisiana | 2012 | Plan Profile

Wed, 11 Jan 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Executive Briefing | Top 10 trends for 2012: Managed care grows up | January 2012

Wed, 11 Jan 2012 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive briefing.

AMERIGROUP Corporation | Louisiana | 2012 | Plan Profile

Wed, 11 Jan 2012 00:00:00 GMT

Address: 4425 Corporation Lane, Virginia Beach, VA 23462
Products:
URL: http://www.amerigroupcorp.com

Centene Corporation | Louisiana | 2012 | Plan Profile

Wed, 11 Jan 2012 00:00:00 GMT

Address: 7711 Carondelet Avenue, St. Louis, MO 63105
Products:
URL: http://www.centene.com

AmeriHealth Mercy | Louisiana | 2012 | Plan Profile

Wed, 11 Jan 2012 00:00:00 GMT

Address: 2404 Park Drive, Harrisburg, PA 17110
Products:
URL: http://www.amerihealthmercyhp.com

Centene Corporation | Kentucky | 2012 | Plan Profile

Tue, 10 Jan 2012 00:00:00 GMT

Address: 7711 Carondelet Avenue, St. Louis, MO 63105
Products:
URL: http://www.centene.com

Coventry Health Care, Inc. | Kentucky | 2012 | Plan Profile

Tue, 10 Jan 2012 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, CDHP
URL: http://www.cvty.com

WellCare Group of Companies | Kentucky | 2012 | Plan Profile

Tue, 10 Jan 2012 00:00:00 GMT

Address: 6800 North Dale Mabry Highway Suite 270/299, Tampa, FL 33614
Products:
URL: http://www.wellcare.com

Buffalo | New York | 2012 | Market Overview (Event Driven)

Tue, 10 Jan 2012 00:00:00 GMT

Report Summary: Health systems in the Buffalo market are focusing on specialty services and consolidating operations. Two health systems collaborated to open a new kidney transplant center, their first clinical partnership. State health officials turned down plans for competing cardiac catheterization labs in Niagara County. The Buffalo Niagara Medical Campus in downtown Buffalo is growing a center of healthcare services; Kaleida Health opened a new nursing home there in 2011 and plans to open more facilities in the next several years. The University at Buffalo School of Medicine also plans to move to the campus in several years. Adoption of the medical home model is growing, which is likely to increase efficiency and improve quality of care because of its emphasis on care coordination and evidence-based medicine. An IPA operates a clinical integration program and plans to participate in the Medicare shared savings ACO program in 2012. Managed care plans in New York became responsible for the pharmacy benefit management piece of Medicaid in October 2011, with the flexibility to apply their own formularies and utilization controls. State laws enacted in 2011 overhaul Medicaid, mandate parity for oral cancer drugs and autism coverage, and prohibit health insurers from requiring that members use mail-order pharmacies to buy prescription drugs. In 2012, look for the Legislature to pass amendments to require retailers to accept the same reimbursement rates for 90-day supplies of maintenance drugs if they want customers to use their stores instead of mail-order houses. New York State scaled back premium increases by an average of 4.5 percentage points in the fully insured market for 2012. New union contracts require state employees to pay more of their health insurance premiums.

Community Health Network | Connecticut | 2012 | Plan Profile

Tue, 10 Jan 2012 00:00:00 GMT

Address: 11 Fairfield Boulevard, Wallingford, CT 06492
Products: Medicaid
URL:

Health Net | National MCO Analyzer | 2011 (Event Driven)

Tue, 10 Jan 2012 00:00:00 GMT

Report Summary: Health Net may be focused on just three states, but one of them is the nation's largest, California, and the company is making a name for itself with its successful strategy of offering lower-priced products through the use of narrow provider networks. Health Net's focus is the small to middle-sized employer who opts for fully insured products. At the same time, Health Net is California's largest Medicaid managed care plan, and it's a significant player in the Medicare Advantage market in Arizona and in the Medicare Part D throughout the United States. In addition to commercial, Medicaid and Medicare lines, Health Net also serves TRICARE military members through an administrative-services-only contract with the Department of Defense.

Capital District Physicians' Health Plan, Inc. | New York | 2012 | Plan Profile

Tue, 10 Jan 2012 00:00:00 GMT

Address: 500 Patroon Creek Boulevard, Albany, NY 12206-1057
Products: HMO, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.cdphp.com

EmblemHealth Inc. | New York | 2012 | Plan Profile

Tue, 10 Jan 2012 00:00:00 GMT

Address: 55 Water Street, New York, NY 10041
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.emblemhealth.com

HealthNow New York, Inc. | New York | 2012 | Plan Profile

Tue, 10 Jan 2012 00:00:00 GMT

Address: 1901 Main St., Buffalo, NY 14208
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.bcbswny.com & www.bsneny.com

Alabama Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Colorado Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Connecticut Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Arizona Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

New Hampshire Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Ohio Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Oregon Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Rhode Island Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Iowa Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Kansas Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Kentucky Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Louisiana Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Illinois Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Washington Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Washington, D.C., Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Tennessee Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Vermont Health Plan Data (HMO Financials)

Mon, 09 Jan 2012 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Miami | Florida | 2011 | Market Overview (Event Driven)

Mon, 09 Jan 2012 00:00:00 GMT

Report Summary: Most health systems in the Miami market are financially and strategically sound. But none can afford to weather ongoing uncertainty over Jackson Health System’s role as the primary safety-net provider in Miami-Dade County. Another threat is merger and acquisition activity, which may continue if national forecasts prove true. Meanwhile, physicians are acutely aware of how complicated it has become to practice medicine?with some opting for hospital employment, some joining groups and others selling their practices to local and national buyers. For health plans in Miami-Dade County, the growth of Medicaid managed care is a given. What form it will take is not, with HMOs, provider service networks and medical homes competing for their share. All local players are struggling to understand healthcare reform, particularly quality improvement requirements that may initially weaken their positions. One thing is certain: data is digital gold. How it is aggregated and analyzed to improve care—and by whom—will be a key factor for accountable care and other organizations where power is pooled.

Little Rock | Arkansas | 2012 | Market Overview (Event Driven)

Mon, 09 Jan 2012 00:00:00 GMT

Report Summary: The Little Rock healthcare industry is marked by competition between nonprofit and physician-owned for-profit hospitals, ambulatory surgery and urgent-care centers, and retail clinics. In this entrepreneurial market, managed-care penetration is low and the move to accountable care slow. The state Medicaid program is working on a waiver that would move provider reimbursement to bundled payments rather than fee for service. Spearheaded by the University of Arkansas for Medical Sciences' College of Pharmacy, this market has launched private companies that provide evidence-based pharmaceutical formulary management to public and private employers.

Webinar | Medicaid: The Nation’s Safety Net (Please Knit Faster…)

Fri, 06 Jan 2012 00:00:00 GMT

Recorded Playback Link:
Medicaid: The Nation’s Safety Net (Please Knit Faster…)

Medicaid programs across the United States are facing unprecedented change over the coming year with the confluence of budget problems, preparations for healthcare reform and the intense health needs of their beneficiaries. This presentation covers:

The growing power and influence of managed care organizations who are gaining multiple new contracts with state governments to coordinate care for millions of Americans
New developments within states on prescription drug limits and other cost-cutting moves by states
A look ahead into states’ strategies on the Medicaid expansion included in the Affordable Care Act and where those biggest impacts lie
Who plans are doing business with now that they have more control

UnitedHealth Group, Inc. | Connecticut | 2012 | Plan Profile

Fri, 06 Jan 2012 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Aetna Inc. | Connecticut | 2012 | Plan Profile

Fri, 06 Jan 2012 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Tucson | Arizona | 2011 | Market Overview (Event Driven)

Thu, 05 Jan 2012 00:00:00 GMT

Report Summary: Healthcare in Tucson took center stage in January 2011. The Arizona Legislature proposed cutting 250,000 from the rolls of the Arizona Health Care Cost Containment System, receiving federal approval in March 2011. The repercussions of this cut are deep and long-lasting across all areas of healthcare in the state. Meanwhile, hospitals in the Tucson market are involved in expansions that could increase competition, as there exists some overlap in these new and planned facilities. Health plans have seen potential in Medicare Advantage plans, since the state population skews older than the national average. Meanwhile, Tucson’s employer market, which is made up mostly of small businesses, has been slow to adopt consumer-driven health plans.

Market Overview | 2012 | Product Manual

Sun, 01 Jan 2012 00:00:00 GMT

Market Overview | 2012 | Release Schedule

Sun, 01 Jan 2012 00:00:00 GMT

Southern New Jersey | New Jersey | 2011 | Market Overview (Event Driven)

Wed, 21 Dec 2011 00:00:00 GMT

Report Summary: Southern New Jersey healthcare providers are dabbling in innovative care delivery and payment models that reward efficiency and improved patient outcomes rather than volume of services provided. However, health systems and physicians in the market continue to face a challenging reimbursement environment characterized by a high cost of living, expensive malpractice insurance and low reimbursements from Medicaid and private payers. In an effort to lower costs, some managed care organizations have begun offering insurance products that only allow members to use providers who have in-network contracts with health plans. It remains to be see how such plans will be received by Southern New Jersey employers, who continue to push more costs on to employees, cut benefits or drop coverage altogether.

Louisiana Health Service & Indemnity Company | Louisiana | 2011 | Plan Profile

Wed, 21 Dec 2011 00:00:00 GMT

Address: 5525 Reitz Avenue, Baton Rouge, LA 70809
Products: HMO, PPO, CDHP, Indemnity
URL: http://www.bcbsla.com

Blue Cross and Blue Shield of Alabama | Alabama | 2011 | Plan Profile

Wed, 21 Dec 2011 00:00:00 GMT

Address: 450 Riverchase Parkway East, Birmingham, AL 35298
Products: PPO, Medicare PDP
URL: http://www.bcbsal.com

UnitedHealth Group, Inc. | Alabama | 2011 | Plan Profile

Wed, 21 Dec 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

BlueCross BlueShield of Tennessee | Tennessee | 2011 | Plan Profile

Wed, 21 Dec 2011 00:00:00 GMT

Address: 801 Pine Street, Chattanooga, TN 37402
Products: PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.bcbst.com

Blue Cross and Blue Shield of North Carolina | North Carolina | 2011 | Plan Profile

Wed, 21 Dec 2011 00:00:00 GMT

Address: 5901 Chapel Hill Road, Durham, NC 27707
Products: HMO, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.bcbsnc.com

Blue Cross and Blue Shield of South Carolina | South Carolina | 2011 | Plan Profile

Wed, 21 Dec 2011 00:00:00 GMT

Address: I-20 at Alpine Road, Columbia, SC 29219-0001
Products: HMO, POS, PPO, Medicaid, Medicare PDP, Indemnity
URL: http://www.southcarolinablues.com

Jacksonville | Florida | 2011 | Market Overview (Event Driven)

Tue, 20 Dec 2011 00:00:00 GMT

Report Summary: Awakening from their recession-induced slumber, Jacksonville health systems are moving forward once again with plans for new hospitals, with at least three new hospitals planned for the growing affluent suburbs outside I-295. To make sure these well-insured patients are directed toward their new facilities, area health systems are affiliating with physicians; the largest primary care groups on the First Coast are strongly tied to a health system or owned outright. The integration of physician with hospital also prepares the system for the anticipated transition in reimbursement, from fee-for-service to a model that emphasizes episode outcomes. Commercial MCOs in the area do not yet incentivize the medical home model substantively, and health systems are reticent about making the leap to accountable care organizations, but the groundwork is being built. Not all physicians are onboard with the hospitals’ plans, and independent single specialty supergroups are valuable commodities as health systems want to tap into more highly reimbursed procedures. Watch for these groups to expand their reach while remaining independent. Health plans in the market and the rest of Florida are largely at a standstill, waiting for the impact of 2014, when federal healthcare reform kicks in and the state fully expands its mandatory Medicaid managed care program. Combined, both initiatives will add millions of people to enrollment.

Las Vegas | Nevada | 2011 | Market Overview (Event Driven)

Mon, 19 Dec 2011 00:00:00 GMT

Report Summary: Adoption of quality care initiatives and payment reform has been slow in the Las Vegas market, but providers are moving in that direction with some prodding from the region's largest employer coalition. Meanwhile, physicians in the market will continue to feel downward pressure on reimbursements as managed care organizations in the market look to reduce costs. Look for increased consolidation of the physicians sector as smaller medical groups join their larger counterparts. Given the state of the local economy, employers are increasingly moving to high-deductible health plan options for their employees and MCOs in the market have responded with broader offerings of such plans as well as wellness programs designed to reduce costs.

CareFirst, Inc. | Maryland | 2011 | Plan Profile

Fri, 16 Dec 2011 00:00:00 GMT

Address: 10455 Mill Run Circle, Owings Mills, MD 21117
Products: HMO, POS, PPO, CDHP, Indemnity
URL: http://www.carefirst.com

St. Louis | Missouri | 2011 | Market Overview (Event Driven)

Wed, 14 Dec 2011 00:00:00 GMT

Report Summary: The St. Louis healthcare market is not as collaborative as some of its Midwest neighbors, but it has strong academic medical centers and select providers are advancing in the formation of accountable care organizations. Employers in the market are hungry for information about hospital pricing and quality so they can work to bend the cost curve. Local health systems are making a play for patients in key specialties and luring medical practices, although some smaller hospitals are struggling from declining Medicaid payments and closures could be on the way. A certificate-of-need dispute in the market has sparked heated debate in the legislature over the necessity of the law with physicians for repeal and hospitals against it.

Tulsa | Oklahoma | 2011 | Market Overview (Event Driven)

Tue, 13 Dec 2011 00:00:00 GMT

Report Summary: The Tulsa healthcare market is slowly testing the waters of some of the more innovative payment and healthcare structures being implemented across the country, such as bundling Medicare payments, medical homes and accountable care organizations. While consumer-directed health plans have yet to catch on in the Tulsa market, narrow-network PPO plans offered by the two largest managed care organizations have proven to be popular among employers. To get medical costs under control, large employers in the market are showing increased interest in worksite clinics and wellness initiatives, and this trend will likely continue. Meanwhile health systems in the market continue to expand facilities and services.

Syracuse | New York | 2011 | Market Overview (Event Driven)

Tue, 13 Dec 2011 00:00:00 GMT

Report Summary: Upstate University Health System became the dominant health system in the Syracuse market after it purchased a smaller hospital in mid-2011. The acquisition is shaking up the market, resulting in new affiliations for some physicians and greater bargaining power for the health system in contract negotiations with health insurers. Local hospitals are hiring more physicians, who are opting for employment because of challenges with low reimbursement and high costs. Because of the state’s prior approval process for premiums in community-rated plans, health insurers cannot raise premiums as much as they requested. At the same time, the state enacted new mandates for autism coverage and oral cancer drug therapy. As a result, look for health plans to include fewer choices in small-group coverage. Expect more employers to shift health insurance costs to employees after the state’s tough negotiating stance with two public employee unions.

News for Indiana

Mon, 12 Dec 2011 05:00:00 GMT

Baton Rouge | Louisiana | 2011 | Market Overview (Event Driven)

Mon, 12 Dec 2011 00:00:00 GMT

Report Summary: Baton Rouge's healthcare system is reinventing itself by closing its charity-care hospital and expanding the market's largest hospital to take on uninsured care in a public-private partnership. The deal means the market will get its first Level 1 Trauma Center. Physician shortages continue to plague Louisiana, and one local health plan has decided to purchase a physician group in order to ensure access to primary care. A high uninsured rate and cuts to Medicaid reimbursement rates continue to trouble providers in the market; meanwhile, the state will transition to managed Medicaid for the first time in 2012.

Executive Briefing | Bricks, Mortar and Benefit Design in the Age of Payment Bundling | December 2011

Mon, 12 Dec 2011 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive briefing.

Neighborhood Health Plan of Rhode Island | Rhode Island | 2011 | Plan Profile

Fri, 09 Dec 2011 00:00:00 GMT

Address: 299 Promenade Street, Providence, RI 02908
Products: Medicaid
URL: http://www.nhpri.org

Tufts Associated Health Plans, Inc. (TAHP) | Rhode Island | 2011 | Plan Profile

Fri, 09 Dec 2011 00:00:00 GMT

Address: 333 Wyman Street, Waltham, MA 02454
Products: HMO, PPO
URL: http://www.tuftshealthplan.com

UnitedHealth Group, Inc. | Rhode Island | 2011 | Plan Profile

Fri, 09 Dec 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

WellPoint, Inc. | Colorado | 2011 | Plan Profile

Fri, 09 Dec 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

Aetna Inc. | Ohio | 2011 | Plan Profile

Fri, 09 Dec 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Aetna Inc. | Texas | 2011 | Plan Profile

Fri, 09 Dec 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Catholic Healthcare West | Nevada | 2011 | Plan Profile

Fri, 09 Dec 2011 00:00:00 GMT

Address: 185 Berry Street Suite 300, San Francisco, CA 94107
Products: HMO, POS, PPO
URL: http://www.chwhealth.org

UnitedHealth Group, Inc. | Nevada | 2011 | Plan Profile

Fri, 09 Dec 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Pharmacy Benefit Evaluator 2.0 | Data | July 2011

Wed, 07 Dec 2011 00:00:00 GMT

The Regence Group | Washington | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 100 SW Market Street, Portland, OR 97201
Products: POS, PPO, Medicaid, Medicare PDP, CDHP, Indemnity
URL: http://www.regence.com

Group Health Cooperative (WA) | Washington | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 320 Westlake Ave N, Seattle, WA 98109
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.ghc.org

Highmark, Inc. | West Virginia | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 120 Fifth Avenue Suite 105, Pittsburgh, PA 15222-3099
Products: POS, PPO, Medicare PDP, Indemnity
URL: http://www.highmark.com

Cigna Corporation | Arkansas | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Mississippi | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Montana | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Blue Cross and Blue Shield of Nebraska | Nebraska | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: P.O. Box 3248, Omaha, NE 68124
Products: PPO, CDHP, Indemnity
URL: http://www.bcbsne.com

Presbyterian Healthcare Services | New Mexico | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 2501 Buena Vista SE, Albuquerque, NM 87106
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.phs.org

Lovelace Health System | New Mexico | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 3801 Southern Blvd SE, Rio Rancho, NM 87124
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, CDHP, Rental Network
URL: http://www.lovelace.com

BlueCross and BlueShield of Oklahoma | Oklahoma | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 1400 S. Boston Ave., Tulsa, OK 74119
Products:
URL: http://www.bcbsok.com

DAKOTACARE | South Dakota | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 2600 W. 49th Street PO Box 7406, Sioux Falls, SD 57117-7406
Products: HMO
URL: http://www.dakotacare.com

Sanford Health Plan | South Dakota | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 1305 West 18th Street, Sioux Falls, SD 57117
Products: HMO, CDHP
URL: http://www.siouxvalley.org

Avera Health Plans | South Dakota | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 3900 West Avera Drive Suite 100, Sioux Falls, SD 57108
Products: HMO, PPO
URL: http://www.averahealthplans.com

Blue Cross Blue Shield of Wyoming | Wyoming | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 4000 House Avenue, Cheyenne, WY 82001
Products: PPO, Indemnity, Rental Network
URL:

UnitedHealth Group, Inc. | Utah | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

The Regence Group | Utah | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 100 SW Market Street, Portland, OR 97201
Products: HMO, PPO, Medicare PDP, CDHP, Indemnity
URL: http://www.regence.com

Intermountain HealthCare | Utah | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 4646 W. Lake Park Boulevard P.O. Box 30192, Salt Lake City, UT 84130
Products: HMO, PPO, Medicaid, CDHP
URL: http://www.selecthealth.org

Wellmark, Inc. | South Dakota | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 636 Grand Avenue, Des Moines, IA 50309
Products: PPO, Indemnity
URL: http://www.wellmark.com

Triple-S Management Corporation | Puerto Rico | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 1441 Franklin D. Roosevelt Avenue, San Juan, PR 00922
Products: PPO, Medicaid, Medicare Advantage, Medicare PDP
URL: http://www.triplesmanagement.com

MCS Health Management Options | Puerto Rico | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 255 Ponce de Leon Avenue, San Juan, PR 00918
Products: PPO, Medicaid, Medicare Advantage
URL:

Humana, Inc. | Puerto Rico | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

Health Care Service Corporation | New Mexico | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 300 East Randolph Street, Chicago, IL 60601-5099
Products: HMO, POS, PPO, Medicaid, CDHP, Indemnity
URL: http://www.hcsc.com

UnitedHealth Group, Inc. | Nebraska | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Aetna Inc. | Delaware | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Aetna Inc. | North Dakota | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Indemnity
URL: http://www.aetna.com

UnitedHealth Group, Inc. | Mississippi | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Group Health Cooperative (WA) | Idaho | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 320 Westlake Ave N, Seattle, WA 98109
Products: HMO, POS, PPO
URL: http://www.ghc.org

Aetna Inc. | Alaska | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

Blue Cross and Blue Shield of Montana | Montana | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: PO Box 4309 560 N Park, Helena, MT 59604
Products: HMO, POS, PPO, Indemnity
URL: http://www.bluecrossmontana.com

New West Health Services | Montana | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 130 Neill Avenue, Helena, MT 59601
Products: HMO, POS, Medicare PDP, Indemnity
URL: http://www.newwesthealth.com

Blue Cross and Blue Shield of North Dakota | North Dakota | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 4510 13th Avenue Southwest, Fargo, ND 58121
Products: POS, PPO, Medicaid, Indemnity
URL:

Coventry Health Care, Inc. | Nebraska | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.cvty.com

Premera Blue Cross | Alaska | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 7001 220th St. SW Building 1, Mountlake Terrace, WA 98043
Products: PPO
URL: http://www.premera.com

QCA Health Plan, Inc. | Arkansas | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 10800 Financial Centre Parkway, Suite 540, Little Rock, AR 72211
Products: HMO, POS
URL: http://www.qcark.com

BlueCross BlueShield of Delaware | Delaware | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: P.O. Box 1991 One Brandywine Gateway, Wilmington, DE 19899-1991
Products: HMO, POS, PPO, CDHP, Indemnity
URL: http://www.bcbsde.com/

Hawaii Medical Service Association (HMSA) | Hawaii | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 818 Keeaumoku Road, Honolulu, HI 96814
Products: HMO, PPO, Medicaid, Medicare PDP, CDHP
URL:

Kaiser Foundation Health Plans, Inc. | Hawaii | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 1800 Harrison Street 8th Floor, Oakland, CA 51098
Products: HMO, PPO, Medicaid, Medicare Advantage, CDHP
URL: http://www.kp.org

AlohaCare | Hawaii | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 1357 Kapiolani Blvd #1250, Honolulu, HI 96814
Products: Medicaid, Medicare Advantage
URL:

The Regence Group | Idaho | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 100 SW Market Street, Portland, OR 97201
Products: PPO, Medicare PDP, Indemnity
URL: http://www.regence.com

Blue Cross of Idaho Health Service, Inc. | Idaho | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 3000 E. Pine Avenue, Meridian, ID 83642
Products: POS, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.bcidaho.com

Blue Cross & Blue Shield of Mississippi | Mississippi | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 3545 Lakeland Drive, Flowood, MS 39232
Products: PPO, Indemnity
URL:

Cigna Corporation | Wyoming | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

The ODS Companies | Washington | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 601 S.W. Second Avenue, Portland, OR 97204
Products: PPO
URL: http://www.odscompanies.com

Independence Blue Cross | New Jersey | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 1901 Market Street, Philadelphia, PA 19103-1480
Products: HMO, POS, PPO, Medicare Advantage, Indemnity
URL: http://www.amerihealth.com

WellPoint, Inc. | New York | 2011 | Plan Profile

Mon, 05 Dec 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

Worcester | Massachusetts | 2011 | Market Overview (Event Driven)

Fri, 02 Dec 2011 00:00:00 GMT

Report Summary: The Worcester economy continues to stabilize and health system financial margins in the local market are better than elsewhere in the state. As is the case with the state as a whole, uninsurance is nearly nonexistent, and this will continue to create a steady market for providers, managed care organizations and should mean steady sales volume for prescription drugs. Health systems in the market are feeling increased pressure to reduce medical costs and we predict there will be considerable focus in the near term on formation of accountable care organizations and on delivering high-quality, low-cost care. Unable to significantly improve top line revenue, managed care organizations are focusing their attention on expenses and using a variety of strategies to reduce costs and improve margins.

Market Overview | 2011 | Product Manual

Fri, 02 Dec 2011 00:00:00 GMT

Des Moines | Iowa | 2011 | Market Overview (Event Driven)

Wed, 30 Nov 2011 00:00:00 GMT

Report Summary: Des Moines is a highly consolidated market, with locally-based insurer Wellmark BlueCross BlueShield as the top MCO in the market and Iowa. The top two health systems, Iowa Health-Des Moines and Mercy Health, account for the vast majority of inpatient discharges and have nearly equal market shares. Traditionally a low reimbursed state for Medicare, Iowa should see a noteworthy change as federal healthcare reform addresses the geographical disparities in Medicare and works to even out payments received by providers. High healthcare costs have employers in the Hawkeye state looking for new ways to curb spending, which includes consumer driven health plans and shifting the cost of benefits onto employees.

Albuquerque | New Mexico | 2011 | Market Overview (Event Driven)

Wed, 30 Nov 2011 00:00:00 GMT

Report Summary: Each of the region's three health systems is expanding facilities and services in the Rio Rancho area relatively affluent area where most residents are commercially insured in the hope of offsetting declining revenue resulting from higher uninsurance and the cost of uncompensated care. Throughout the market, a growing Medicare population, which generally represents higher demand for medical services and prescription drugs, will help stabilize all sectors within the healthcare industry. Meanwhile, health systems in the market, two of which are linked to the top managed care organizations in the market, are moving forward with payment reform initiatives. With the high level of integration between health systems, physicians and payers, development of coordinated care programs that base reimbursements on quality of care could be a relatively easy transition in Albuquerque.

New Orleans | Louisiana | 2011 | Market Overview (Event Driven)

Wed, 30 Nov 2011 00:00:00 GMT

Report Summary: Louisiana has approved construction of an academic medical center to replace New Orleans’ Charity Hospital, which closed after Hurricane Katrina. Officials envision the new $1 billion medical center as a destination research facility that will attract patients from across the region. The poor and uninsured will again have a large safety net hospital when it opens in 2015, but local hospitals expect it will also siphon privately insured patients away if its new destination business model works. Louisiana is implementing managed Medicaid for the first time in 2012, and a high uninsured rate continues to plague the state.

Minneapolis | Minnesota | 2011 | Market Overview (Event Driven)

Wed, 30 Nov 2011 00:00:00 GMT

Report Summary: Minneapolis is a highly consolidated market and is ahead of the curve on integrating providers into accountable care organizations and transforming pay models away from fee for service. The market is exploring pay for quality, bundled payments, and total cost of care initiatives. The state’s largest insurer has signed pay-for-performance contracts with major health systems. The second-largest health system is basing half of physician pay on external quality measures. The state has implemented a Medicaid expansion as well as a cap of 1 percent on public health plans' operating margins.

Centene Corp. | National MCO Analyzer | 2011 (Event Driven)

Wed, 30 Nov 2011 00:00:00 GMT

Report Summary: Centene Corp. is on a roll, posting ever-higher enrollment, revenues and earnings as it takes advantage of the nationwide trend of moving Medicaid members to managed care. The Fortune 500 company has had more success than any other Medicaid HMO in winning this new business, scoring contracts in each of its last seven bids. Wall Street analysts report that the past 28 Medicaid requests for proposals have put more than 10 million lives up for bid, and Centene has been awarded 1.4 million lives. By the end of 2012, Centene will add more than 1 million new pharmacy lives through new state contracts and as states reverse the trend of carving pharmacy benefits out of managed care.

Executive Briefing | Is Insurance Strife In NYC A Sign Of Reform Future? | November 2011

Tue, 29 Nov 2011 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive briefing.

Austin | Texas | 2011 | Market Overview (Event Driven)

Tue, 29 Nov 2011 00:00:00 GMT

Report Summary: The Austin healthcare market is dominated by St. David’s HealthCare, which is partially owned by Nashville, Tenn.-based HCA, and Seton Family of Hospitals, part of Ascension Health. Together, they command 89 percent of inpatient discharges. One of the strongest trends in the Austin area is an increase in employment of physicians by health systems. Expansion of healthcare facilities, including construction of two new hospitals, continues as the population grows at a rate of 3 percent annually. The area’s uninsurance rate is 23 percent, but two new programs help small businesses afford health insurance coverage.

Springfield | Massachusetts | 2011 | Market Overview (Event Driven)

Tue, 29 Nov 2011 00:00:00 GMT

Report Summary: The Springfield healthcare market is innovative and consolidating rather rapidly. While healthcare providers are watching developments in the state legislature closely to see what happens with the governor's payment reform initiative, providers in western Massachusetts are moving ahead with establishing patient-centered medical homes, wellness programs and expansion plans despite the uncertainty. For pharmaceutical companies, the outcome of payment reform is critically important because global payment will raise the importance of disease management, where compliance with prescription drug regimens will be closely monitored. At the same time, bundled payment will force providers to squeeze every excess penny of out of the system, which may affect sales of branded drugs. Whatever the outcome, we expect drug companies will find a space within accountable care organizations to advise and advocate for the efficacy and value of their products.

Cleveland | Ohio | 2011 | Market Overview (Event Driven)

Tue, 29 Nov 2011 00:00:00 GMT

Report Summary: Cleveland healthcare is based on the bedrock of health systems, particularly the Cleveland Clinic. The Clinic and historical rival University Hospitals are winding down large capital investments that include new hospitals and major outpatient facilities. Health systems in the market have also invested in electronic medical records and clinical integration with physicians. Whether or not accountable care organizations eventually deliver on promises of better quality care with more efficient cost, the pending reform has touched every aspect of the northeast Ohio healthcare market. These actions could precipitate a renewed competition among Greater Cleveland's major players and more consolidation. Moving beyond leveraging better contracts and more referrals, ACOs promise to give high-performing healthcare entities financial incentive for providing quality, integrated care. With northeast Ohio settling into a quasi-permanent recession, the opportunity for an enhanced revenue stream is not one that can be passed up.

Baltimore | Maryland | 2011 | Market Overview (Event Driven)

Tue, 29 Nov 2011 00:00:00 GMT

Report Summary: Although it's still feeling the effects of recession, the Baltimore market's healthcare industry is showing signs of growth. Hospitals in the region's health systems sector, which is dominated by large academic medical centers and is home to the highly regarded Johns Hopkins Medicine, continue to add services and facilities while increasing the size of their physician networks. Health plans in the Baltimore region have faced an uphill climb when it comes to overall commercial health plan enrollment, but insurers have seen growth in consumer-directed health plan enrollment. Such lower-cost options are likely to remain popular among an employer sector reeling from higher premiums. Look for coordinated patient care initiatives, such as patient-centered medical homes, to gain traction in Baltimore and statewide, boosted by a new legislation designed to foster the creation of PCMHs and the need for health plans to lower medical costs.

Portland | Maine | 2011 | Market Overview (Event Driven)

Mon, 28 Nov 2011 00:00:00 GMT

Report Summary: Portland, the most urban region of Maine, has higher incomes and greater access to healthcare than other parts of the state. Overall economic growth is improving, although household incomes are lagging. Every segment of this healthcare market is highly consolidated, from health systems to physicians and health plans. We expect the market’s dense integration to provide a fertile environment for creation of accountable care organizations, with employers and providers coming together to focus on improving quality and outcomes while controlling costs.

Formulary Advantages in Type 2 Diabetes:Rebates and discounts dictate the formulary position of branded therapies among some U.S. health plans.

Tue, 22 Nov 2011 00:00:00 GMT

Report Summary: According to the Centers for Disease Control and Prevention (CDC), an estimated 25.8 million people in the United States have diabetes. Diabetes is the leading cause of kidney failure, nontraumatic lower-limb amputation, and new cases of blindness. Although health plans are mostly eager to offer wide formulary access to therapies for diabetes as a result of this huge need, greater inter-brand competition both within and across drug classes and the generic entry of several key brands will allow health plans more opportunities to design formularies for type 2 diabetes with a focus on drug cost.

Fresno | California | 2011 | Market Overview (Event Driven)

Tue, 22 Nov 2011 00:00:00 GMT

Report Summary: The Fresno market, with its agrarian economy and large low-income and unemployed populations, continues to stand on the sidelines as its more innovative peers throughout California prepare for healthcare reform. In fairness, Medicare beneficiaries who are the primary targets of accountable care organizations and other reform initiatives represent only eight percent of the market’s population. Fresno is the only county in the state that has indicated it may reject about $60 million in federal grants to expand coverage for the uninsured. Hospitals in the San Joaquin Valley are affected by the area’s physician shortage. They report that it has affected their ability to coordinate post-discharge follow-up patient care—a factor that could increase preventable readmissions and run counter to healthcare reform efforts to reduce those numbers. Medicaid reimbursements for physicians in California are among the lowest in the nation and that will worsen as 10 percent cuts to provider reimbursements are implemented January 2012 unless advocacy groups are successful in blocking those cuts. Given the concentration of Medi-Cal enrollees in the Fresno market, the cuts will make a challenging business environment for physicians even more difficult.

Columbus | Ohio | 2011 | Market Overview (Event Driven)

Tue, 22 Nov 2011 00:00:00 GMT

Report Summary: Already highly consolidated in the health system sector, the Columbus market is seeing increased alliances between health systems and physicians. The trend should give these providers greater leverage when negotiating contracts with managed care organizations, especially in the Columbus market where no one health plan dominates. Numerous hospital construction projects are either planned or under way as health systems broaden their footprints into more affluent suburban areas. An expansion of managed Medicaid should create opportunities for MCOs at a time when commercial enrollment is slipping.

New York City | New York | 2011 | Market Overview (Event Driven)

Tue, 22 Nov 2011 00:00:00 GMT

Report Summary: Consolidation and affiliations are increasing among health systems in the New York City market, which includes a high concentration of academic medical centers. Leading health systems are hiring many physicians. A new state budget law limits Medicaid spending and transfers management of the Medicaid pharmacy benefit to managed care organizations. The law also provides financial support for patient-centered medical homes. Employers are shifting more costs to workers and limiting coverage choices.

Dayton | Ohio | 2011 | Market Overview (Event Driven)

Tue, 22 Nov 2011 00:00:00 GMT

Report Summary: After several years of rapid consolidation, the only major health systems in Dayton are Premier Health Partners and Kettering Health Network, and local healthcare largely revolves around the movements of these two entities. Within the Dayton market, both are expanding their existing facilities with new construction, and Kettering is building a new hospital, scheduled to open in 2012, in the suburb of Bea¬vercreek. As construction winds down, the hospitals will work on streamlining operations and tightening alignments with physicians. The largest health plans in Dayton are UnitedHealth Group and WellPoint’s Anthem Blue Cross and Blue Shield in Ohio, but the insurer with momentum is locally based CareSource, which specializes in Medicaid plans, a growth industry in the current economic climate. Gov. John Kasich’s proposed 2012-2013 budget includes a modest expansion of the state’s already robust managed Medicaid program. But the governor’s proposal also includes billion-dollar cuts in Medicaid reimbursements for hospitals, health plans and nursing homes.

Health Care Service Corp. | National MCO Analyzer | 2011 (Event Driven)

Mon, 21 Nov 2011 00:00:00 GMT

Report Summary: Health Care Service Corp. is the big insurance carrier nobody knows, operating as four Blue Cross Blue Shield Plans (Texas, Illinois, Oklahoma, New Mexico) with 12 million members nationwide. Although the company’s growth potential is limited by its four-state footprint, its national accounts business is growing because of its aggressive courting of firms with a national footprint and its use of the Blue Card network , which allows it to service group accounts with members throughout the United States. In addition, HCSC has acquired ancillary companies, such as MEDecision, the disease management software company.

Aetna | National MCO Analyzer | 2011 (Event Driven)

Thu, 17 Nov 2011 00:00:00 GMT

Report Summary: With 17.6 million members nationwide, Aetna is the nation's third-largest health carrier behind UnitedHealth Group and WellPoint Inc. But Aetna does not dominate any large local markets, and is working to become a player in the fast-growing Medicaid segment, which is set to expand by at least 16 million covered lives beginning in 2014. In 2011, Aetna has done a massive transformation of its plan designs, moving to high-deductible plans and heavy cost-sharing designs that incentivize in-network utilization. It is moving toward creation of commercial accountable care organizations by contracting with key providers rather than buying them outright.

Memphis | Tennessee | 2011 | Market Overview (Event Driven)

Wed, 16 Nov 2011 00:00:00 GMT

Report Summary: Memphis is a hotbed of physician-acquisition activity, with health systems using their newly employed physician groups as building blocks for accountable care organizations. While such coordinated care initiatives could prove effective in reducing medical utilization and improving outcomes, the market’s socio-economics and high rates of obesity and diabetes present challenges for providers and health plans alike. Faced with double-digit premium hikes, several Memphis employers have implemented wellness programs, but adoption of consumer-driven health plans remains low.

Dallas | Texas | 2011 | Market Overview (Event Driven)

Wed, 16 Nov 2011 00:00:00 GMT

Report Summary: Health systems in the Dallas market are in expansion mode as they build new hospitals in suburban areas, expand a variety of facilities and develop specialty centers to compete for patients in the growing Metroplex. Health systems also are employing more physicians through affiliated nonprofit organizations as they prepare to form accountable care organizations. The state has proposed moving most fee-for-service Medicaid members into managed care, while a large reduction in Medicaid reimbursement rates for providers is likely in 2011 as the Texas Legislature attempts to solve a budget crisis. The uninsured rate of 25 percent in the Dallas market reflects the unaffordability of health insurance coverage for many small employers. Large, cost-conscious employers are shifting more health insurance costs to workers and showing interest in value-based health benefits.

Hartford | Connecticut | 2011 | Market Overview (Event Driven)

Sun, 13 Nov 2011 00:00:00 GMT

Report Summary: The Hartford market began to consolidate rapidly in 2011 with the merger of Hartford Healthcare and Central Connecticut Health Alliance. We predict that state and federal healthcare reform will accelerate the consolidation of health systems and physicians, giving providers more clout in contract negotiations with payers. The state's budget crisis doomed creation of a public health insurance option for private employers in 2011, but the state employees' health plan will be opened to municipal and other public employees in 2012 and to nonprofit state contractors in 2013—if state employees vote in fall 2011 to approve the change. The governor also has signed a bill that authorizes the establishment of a health insurance exchange, which will launch in 2014.

Albany | New York | 2011 | Market Overview (Event Driven)

Fri, 11 Nov 2011 00:00:00 GMT

Report Summary: A merger of three health systems into one large system is changing the dynamics of the Albany healthcare market. In October 2011, St. Peter’s Health Partners became the dominant health system, surpassing Albany Medical Center in the percentage of inpatient discharges. While total integration of the system is expected to take three years, look for the new system to reduce costs through more efficient, coordinated healthcare. More physician practices are adopting the patient-centered medical home model, which has generated positive results in a pilot program. A relatively low unemployment rate reflects a stable local economy, but state leaders are threatening layoffs of state workers in union negotiations. Employers are likely to see some relief in health insurance premium increases for 2012 because utilization of healthcare has decreased, but look for continued interest in ways to shift more costs to employees.

CIGNA | 3Q 2011 | Health Plan Earnings Summaries

Fri, 11 Nov 2011 00:00:00 GMT

Arkansas Blue Cross and Blue Shield | Arkansas | 2011 | Plan Profile

Fri, 11 Nov 2011 00:00:00 GMT

Address: 601 Gaines Street, Little Rock, AR 72201
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://arkbluecross.abcbs.net/

WellCare | 3Q 2011 | Health Plan Earnings Summaries

Thu, 10 Nov 2011 00:00:00 GMT

Health Net | 3Q 2011 | Health Plan Earnings Summaries

Wed, 09 Nov 2011 00:00:00 GMT

Humana | 3Q 2011 | Health Plan Earnings Summaries

Tue, 08 Nov 2011 00:00:00 GMT

Cigna Corporation | Oregon | 2011 | Plan Profile

Mon, 07 Nov 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | South Carolina | 2011 | Plan Profile

Mon, 07 Nov 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Amerigroup | 3Q 2011 | Health Plan Earnings Summaries

Fri, 04 Nov 2011 00:00:00 GMT

Coventry | 3Q 2011 | Health Plan Earnings Summaries

Fri, 04 Nov 2011 00:00:00 GMT

Houston | Texas | 2011 | Market Overview (Event Driven)

Fri, 04 Nov 2011 00:00:00 GMT

Report Summary: Rapid growth in affluent areas of Houston is fueling the construction of new medical facilities. The Texas Medical Center is still the hub of medical care, but leading health systems are building networks of suburban community hospitals and outpatient centers while the Harris County Hospital District emphasizes ambulatory care. Employment of physicians is increasing, but many physicians remain in small practices and clinical integration with hospitals is expected. If the Texas Legislature approves a large Medicaid reimbursement cut to providers, the event could have a cascading effect on commercial insurance premiums as fewer physicians accept Medicaid patients and more beneficiaries seek low-reimbursed care in emergency rooms, causing hospitals to raise prices. The new Healthy Texas reinsurance program is likely to help some small businesses afford health insurance, but a high uninsurance rate will continue in 2011.

Atlanta | Georgia | 2011 | Market Overview (Event Driven)

Thu, 03 Nov 2011 00:00:00 GMT

Report Summary: While Atlanta has high unemployment, the economy is showing signs of growth, and that bodes well for all facets of the healthcare industry. The health systems sector is in expansion mode as systems look to tap into high-growth areas of the market. While competition between health systems remains heated, there are signs of consolidation, and we expect this to continue as economic pressure on smaller systems increases. The market has been slow to adopt medical homes and other coordinated patient care delivery models, but there is some movement in that direction. Health plans in the market continue to benefit from a favorable regulatory environment, and employer desire to shift additional healthcare costs to employees indicates continued growth in high-deductible health plans. While WellPoint's Blue Cross and Blue Shield of Georgia and UnitedHealthcare continue to dominate the market in terms of enrollment, Kaiser Foundation Health Plans is making a sizeable investment in the region, looking to increase its share of the market.

WellPoint | 3Q 2011 | Health Plan Earnings Summaries

Thu, 03 Nov 2011 00:00:00 GMT

Aetna | 3Q 2011 | Health Plan Earnings Summaries

Thu, 03 Nov 2011 00:00:00 GMT

Executive Briefing | Benefits Exchanges: Put Your Money On Private Developments | November 2011

Thu, 03 Nov 2011 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive briefing.

Nashville | Tennessee | 2011 | Market Overview (Event Driven)

Thu, 03 Nov 2011 00:00:00 GMT

Report Summary: Although the Nashville economy is still struggling, the local job market has improved and the region has fared better than many similarly sized metropolitan areas nationally. That bodes well for stability of commercial enrollment, and product offerings designed to slow the growth of premiums are likely to gain in popularity. Meanwhile, health systems in the market continue to expand facilities and services, including some large projects to expand cardiovascular and oncology services. Although there has been slow movement toward coordinated care in the market, one of the largest health systems is putting significant resources into an effort to establish an integrated care delivery system built upon the principles of the accountable care organization model. As the demand for programs and strategies to slow the growth of benefit costs increases, we expect more providers in the market to embrace reimbursement reform and coordinated patient care.

Cigna Corporation | Kansas | 2011 | Plan Profile

Thu, 03 Nov 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Maryland | 2011 | Plan Profile

Thu, 03 Nov 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Louisiana | 2011 | Plan Profile

Thu, 03 Nov 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Minnesota | 2011 | Plan Profile

Thu, 03 Nov 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Indiana | 2011 | Plan Profile

Thu, 03 Nov 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Massachusetts | 2011 | Plan Profile

Thu, 03 Nov 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Kentucky | 2011 | Plan Profile

Thu, 03 Nov 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Cigna Corporation | Maine | 2011 | Plan Profile

Thu, 03 Nov 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Kaiser Permanente | National MCO Analyzer | 2011 (Event Driven)

Mon, 31 Oct 2011 00:00:00 GMT

Report Summary: With 9 million members, nonprofit health insurer Kaiser Permanente has a structure unlike any other national carrier. With commercial populations in nine states, Californians make up 75 percent of its membership. Kaiser is investing heavily in new medical offices and medical centers throughout its footprint, and particularly in its underperforming markets of the Mid-Atlantic and Georgia. Kaiser's integrated structure is complemented by its HealthConnect electronic medical records system, and is years ahead of its competitors in its ability to track members' care. It now offers PPOs, POS plans and self-insured plans as those models gained favor among Americans, but most Kaiser members remain sold on the HMO.

Molina | 3Q 2011 | Health Plan Earnings Summaries

Mon, 31 Oct 2011 00:00:00 GMT

Centene | 3Q 2011 | Health Plan Earnings Summaries

Fri, 28 Oct 2011 00:00:00 GMT

Cincinnati | Ohio | 2011 | Market Overview (Event Driven)

Fri, 28 Oct 2011 00:00:00 GMT

Report Summary: Text The Cincinnati market was forced to restructure itself after the breakup of the Health Alliance of Greater Cincinnati in 2010, and this year saw significant growth for health systems, including a huge push to purchase the most and best doctors. This trend has made Cincinnati’s largest health systems even larger. The increase in health systems’ employment of physicians has made independent physician practices few and far between, and this consolidation is likely to continue as the smaller doctor groups face the impact of healthcare reform. Cincinnati’s employer sector has a positive outlook, with a number of businesses on the list of America’s Healthiest companies, and area employers attempting to decrease costs in a variety of ways, including wellness initiatives and cost-shifting to employees via high-deductible health plans. These trends among area employers may curb spending on pharmaceuticals, but Cincinnati’s relatively unhealthy population, low uninsured rate, and abundant supply of both primary-care and specialty physicians bode well for pharmaceutical sales.

Sacramento | California | 2011 | Market Overview (Event Driven)

Thu, 27 Oct 2011 00:00:00 GMT

Report Summary: The innovativeness of the Sacramento market positions large health systems and physician groups well for the demands of healthcare reform. Major initiatives in the region are being shaped by large health systems and physician groups who wield considerable influence throughout the market. Small physician groups, meanwhile, could feel increased pressure to join larger organizations. Sutter Emergency Medical Associates recently joined CEP America, a national physician management company and one of three such organizations with a presence in the region. Meanwhile health plans in the Sacramento market are using a variety of strategies to control costs, including ACOs, value-based purchasing, pay-for-performance programs and narrow networks.

HealthSpring | National MCO Analyzer | 2011 (Event Driven)

Thu, 27 Oct 2011 00:00:00 GMT

Report Summary: HealthSpring, a carrier of Medicare Advantage and Part D plans, is now the largest national carrier whose entire focus is the senior population. With major operations in eleven states, the acquisition-driven company has recently completed its largest purchase to date, that of Baltimore-based Bravo Health, and its leaders are promising to expand its company-owned or exclusively-contracted clinics, in addition to expanding its footprint contiguous to its major market centers. It is actively on the hunt for other regional provider-based MA plans, and is also making a foray into serving those dually eligible for Medicaid and Medicare.

Kansas City | Missouri | 2011 | Market Overview (Event Driven)

Thu, 27 Oct 2011 00:00:00 GMT

Report Summary: The Kansas City healthcare market is an unconsolidated market where no one sector seems to call the shots. After helping employers implement value-based insurance design, the local business coalition is developing a report card that would companies evaluate and address chronic health risks among their workers. Adoption of consumer-directed health plans is higher in Kansas City than the national average, and narrow provider networks could emerge as the next cost-saving option in this market. As healthcare reform plays out, Kansas City will likely see continued mergers and acquisitions among its provider entities.

UnitedHealth Group | 3Q 2011 | Health Plan Earnings Summaries

Fri, 21 Oct 2011 00:00:00 GMT

Executive Briefing | Managed Medicare 2012: Rising Stars, Drug Management And More | October 2011

Thu, 20 Oct 2011 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive briefing.

Coventry Health Care | National MCO Analyzer | 2011 (Event Driven)

Thu, 20 Oct 2011 00:00:00 GMT

Report Summary: Coventry Health Care continues to grow through acquisitions of smaller regional health plans, and is looking for more acquisition targets. It's also working to expand its Medicaid presence and has announced a new suite of national Medicare Part D products with Wal-Mart, Walgreens and Target Stores as network providers. But it faces stiff challenges with healthcare reform, which will inhibit its ability to underwrite and to raise premium rates.

Citrus Health Care, Inc. | Florida | 2011 | Plan Profile

Thu, 20 Oct 2011 00:00:00 GMT

Address: 5420 Bay Center Drive, Suite 250, Tampa, FL 33609
Products: HMO, Medicare Advantage
URL:

HealthSpring, Inc. | Florida | 2011 | Plan Profile

Thu, 20 Oct 2011 00:00:00 GMT

Address: 9009 Carothers Parkway, Suite 501, Franklin, TN 37067
Products: Medicare Advantage
URL: http://www.healthspring.com

Independent Health | New York | 2011 | Plan Profile

Thu, 20 Oct 2011 00:00:00 GMT

Address: 511 Farber Lakes Drive, Buffalo, NY 14221
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.independenthealth.com

Humana, Inc. | Ohio | 2011 | Plan Profile

Wed, 19 Oct 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

CareSource Management Group Co. | Ohio | 2011 | Plan Profile

Wed, 19 Oct 2011 00:00:00 GMT

Address: One Dayton Centre One South Main Street, Dayton, OH 45402
Products: Medicaid, Medicare Advantage
URL: http://www.csmg-online.com

Coventry Health Care, Inc. | Maryland | 2011 | Plan Profile

Mon, 17 Oct 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicaid, CDHP
URL: http://www.cvty.com

Welborn Health Plans | Indiana | 2011 | Plan Profile

Mon, 17 Oct 2011 00:00:00 GMT

Address: 101 S.E. Third Street, Evansville, IN 47713
Products: HMO, POS, Medicare Advantage
URL: http://www.welbornhealthplans.com

Aetna Inc. | Indiana | 2011 | Plan Profile

Mon, 17 Oct 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

Madison | Wisconsin | 2011 | Market Overview (Event Driven)

Mon, 17 Oct 2011 00:00:00 GMT

Report Summary: Madison’s healthcare market is truly unique with all three of its health systems having hospitals, physicians and health plans aligned together, fostering quality healthcare at low cost. But even here, the need for health systems to have their own physicians and clinics has taken hold, creating more competition in a market that has until this point been highly collaborative in its approach to delivering medical care. At the same time, providers are seeking new payment models that will reward them for quality care, and employers are implementing a pilot to steer their workers toward cost-effective providers.

Horizon Blue Cross Blue Shield of New Jersey | New Jersey | 2011 | Plan Profile

Mon, 17 Oct 2011 00:00:00 GMT

Address: 3 Penn Plaza East, Newark, NJ 07105-2200
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, CDHP, Indemnity
URL: http://www.horizonblue.com

Coventry Health Care, Inc. | Virginia | 2011 | Plan Profile

Mon, 17 Oct 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicaid, CDHP
URL: http://www.cvty.com

New York State Catholic Health Plan | New York | 2011 | Plan Profile

Mon, 17 Oct 2011 00:00:00 GMT

Address: 95-25 Queens Blvd., Rego Park, NY 11374
Products:
URL:

Valley Baptist Insurance Company, Inc. | Texas | 2011 | Plan Profile

Mon, 17 Oct 2011 00:00:00 GMT

Address: 2005 Ed Carey Drive, Harlingen, TX 78550
Products: HMO, POS, PPO
URL: http://www.valleybaptisthealthplans.com

WellCare | National MCO Analyzer | 2011 (Event Driven)

Fri, 14 Oct 2011 00:00:00 GMT

Report Summary: WellCare is finally emerging from the long legal aftermath of the 2007 federal raid and investigations for Medicaid fraud, having paid out multi-million-dollar settlements to the government and to whistleblowers. It's hoping for a financial turnaround in 2011, with a new Medicaid contract in Kentucky to add to its stable of business. WellCare is focused solely on Medicaid and Medicare, both Part D and Medicare Advantage. But its two largest Medicaid contracts, in Georgia and Florida, are up for bids in 2012, putting a huge portion of WellCare's revenues at risk.

Formulary Advantages in Atrial Fibrillation: How Will MCO Size Affect the Design of Factor Xa Formularies?

Tue, 11 Oct 2011 00:00:00 GMT

Report Summary: In the coming years, atrial fibrillation (AF) patients will increasingly have more choice for anticoagulation therapy. Although Boehringer Ingelheim’s Pradaxa (dabigatran etexilate) and emerging factor Xa inhibitors will offer clinical advantages over warfarin, their high prices will likely be the greatest obstacle to patient access. Using tiering and restrictions data from Fingertip Formulary and insight from 50 pharmacy directors, we discuss the key trends in reimbursement of AF therapies, the drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to beat the competition.

Cape Coral | Florida | 2011 | Market Overview (Event Driven)

Mon, 10 Oct 2011 00:00:00 GMT

Report Summary: The Cape Coral market continues to suffer economic doldrums, with its two biggest industries—tourism and real estate—showing signs of a slow recovery. High rates of uninsurance and unemployment continue to drag on the bottom lines of hospitals and health insurers. The largest force in the local healthcare industry, Lee Memorial Health System, has moved from consolidating facilities in previous years to actively pursuing growth in mental healthcare services and physician group affiliations. A governor-approved plan to transition most of Florida's Medicaid patients to managed care awaits approval.

El Paso | Texas | 2011 | Market Overview (Event Driven)

Thu, 06 Oct 2011 00:00:00 GMT

Report Summary: El Paso's population is booming at an annual rate of 6 percent because of a major expansion of Fort Bliss near El Paso and an exodus of Juarez, Mexico, residents across the border to escape violence. Many small companies cannot afford health insurance, as reflected in the 31 percent uninsured rate. As more uninsured residents seek treatment, private insurance rates are likely to increase to cover the cost of uncompensated care. New state laws slash Medicaid reimbursement rates for hospitals, overhaul managed Medicaid, and create parity for oral cancer drugs in health insurance plans. A new children's hospital, scheduled to open in 2012, is bringing pediatric specialists to El Paso, and two health systems are offering new air ambulance services.

San Diego | California | 2011 | Market Overview (Event Driven)

Thu, 29 Sep 2011 00:00:00 GMT

Report Summary: San Diego is well positioned for healthcare reform changes that aim to place more emphasis on efficiency and improved outcomes. Leading hospitals are affiliated with many of the market's largest physician groups, and accountable care organizations, payment bundling and value-based contracting are emerging trends in the San Diego area. Health systems in the market continue to expand services and facilities, with competition in cancer services and cardiovascular medicine is likely to intensify. Meanwhile, managed care organizations in California face intense scrutiny from state officials over premium increases, administrative expenditures, delayed patient access, and late payments to providers. MCOs are, however, responding to employer demands for lower-cost employee coverage. While the popularity of consumer-directed health plans in the region may be waning, narrow-network plans are becoming even more popular in the region.

MVP Health Authority | Oregon | 2011 | Plan Profile

Thu, 29 Sep 2011 00:00:00 GMT

Address: 245 Commercial St. SE Suite 220, Salem, OR 97301
Products: Medicaid, Medicare Advantage, Medicare PDP
URL: http://www.mvipa.org

The ODS Companies | Oregon | 2011 | Plan Profile

Thu, 29 Sep 2011 00:00:00 GMT

Address: 601 S.W. Second Avenue, Portland, OR 97204
Products: POS, PPO, Medicaid, Medicare PDP, CDHP, Indemnity
URL: http://www.odscompanies.com

Texas Children's Hospital | Texas | 2011 | Plan Profile

Thu, 29 Sep 2011 00:00:00 GMT

Address: 2450 Holcombe, Ste. 34L, Houston, TX 77021
Products: Medicaid
URL: http://www.texaschildrenshospital.org/HealthCoverage

Cook Children's Health Care System | Texas | 2011 | Plan Profile

Thu, 29 Sep 2011 00:00:00 GMT

Address: 801 Seventh Avenue, Fort Worth, TX 76104
Products: Medicaid
URL: http://www.cookchildrens.org

Aultman Health Foundation | Ohio | 2011 | Plan Profile

Thu, 29 Sep 2011 00:00:00 GMT

Address: 2600 6th Street SW , Canton, OH 44710
Products: HMO, PPO, Medicare Advantage, Medicare PDP
URL: http://www.aultman.com

Gateway Health Plan | Pennsylvania | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: US Steel Tower 600 Grant Street, Pittsburgh, PA 15219
Products:
URL: http://www.gatewayhealthplan.com

Humana, Inc. | Pennsylvania | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: Medicare Advantage, Medicare PDP
URL: http://www.humana.com

Health Partners, Inc. (PA) | Pennsylvania | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 901 Market Street Suite 500, Philadelphia, PA 19107
Products: Medicaid
URL: http://www.healthpart.com

HealthSpring, Inc. | Tennessee | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 9009 Carothers Parkway, Suite 501, Franklin, TN 37067
Products: Medicare Advantage
URL: http://www.healthspring.com

Humana, Inc. | Tennessee | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

UnitedHealth Group, Inc. | Tennessee | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Windsor Health Group | Tennessee | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 7100 Commerce Way, Suite 285, Brentwood, TN 37027
Products:
URL: http://www.windsorhealthgroup.com

Aetna Inc. | Tennessee | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

AMERIGROUP Corporation | Tennessee | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 4425 Corporation Lane, Virginia Beach, VA 23462
Products: Medicaid, Medicare Advantage
URL: http://www.amerigroupcorp.com

Humana, Inc. | Virginia | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

Community Care Organization, Inc | Wisconsin | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 1555 South Layton Blvd, Milwaukee, WI 53215
Products: Medicaid, Medicare Advantage
URL: http://www.communitycareorganization.com

Virginia Premier Health Plan, Inc. | Virginia | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 600 East Broad Street, Suite 400, Richmond, VA 23219
Products: Medicaid
URL: http://www.virginiapremier.com

UnitedHealth Group, Inc. | Michigan | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Coventry Health Care, Inc. | Indiana | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, CDHP
URL: http://www.cvty.com

Coventry Health Care, Inc. | South Carolina | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, CDHP
URL: http://www.cvty.com

Medical Mutual of Ohio | South Carolina | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 2060 East 9th Street, Cleveland, OH 44115
Products: HMO, POS, PPO, Rental Network
URL: http://www.MedMutual.com

Centene Corporation | South Carolina | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 7711 Carondelet Avenue, St. Louis, MO 63105
Products: Medicaid
URL: http://www.centene.com

Aetna Inc. | South Carolina | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

AmeriHealth Mercy | South Carolina | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 2404 Park Drive, Harrisburg, PA 17110
Products: Medicaid
URL: http://www.amerihealthmercyhp.com

MercyCare Insurance Company | Wisconsin | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 3430 Palmer Drive P.O. Box 2770, Janesville, WI 53547
Products: HMO, POS, PPO, Medicaid
URL: http://www.mercycarehealthplans.com

Partnership Health Plan, Inc. | Wisconsin | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 2240 EastRidge Center, Eau Claire, WI 54701
Products: Medicaid, Medicare Advantage
URL: http://www.communityhealthpartnership.com

Centene Corporation | Wisconsin | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 7711 Carondelet Avenue, St. Louis, MO 63105
Products: Medicaid
URL: http://www.centene.com

Children's Community Health Plan, Inc. | Wisconsin | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: P.O. Box 56099, Madison, WI 53705
Products: Medicaid
URL: http://www.childrenschp.com

Group Health Cooperative of Eau Claire | Wisconsin | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 2503 North Hillcrest Parkway, Altoona, WI 54720
Products: HMO, Medicaid
URL: http://www.grouphealth.com

Group Health Cooperative of South Central Wisconsin | Wisconsin | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 1265 John Q Hammons Drive P.O. Box 44971, Madison, WI 53744-4971
Products: HMO, POS, PPO, Medicaid, CDHP
URL: http://www.grouphealth.com

Gundersen Lutheran Health Plan, Inc. | Wisconsin | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 1900 South Avenue. NCA2-01, La Crosse, WI 54601
Products: HMO, POS, Medicaid, Medicare Advantage
URL: http://www.glhealthplan.org

Health Tradition Health Plan | Wisconsin | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 1808 E. Main St., Onalaska, WI 54650
Products: HMO, POS, Medicaid, CDHP, Rental Network
URL: http://www.healthtradition.com

Covenant Health System | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 3615 19th Street, Lubbock, TX 79410
Products: HMO, PPO, Medicaid, Medicare Advantage, Indemnity
URL: http://www.covenanthealth.org

Driscoll Children's Health Plan | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 615 North Upper Broadway, Suite 1621, Corpus Christi, TX 78477
Products: Medicaid
URL: http://www.dchpkids.com

El Paso First Health Network | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 2501 North Mesa, El Paso, TX 79902
Products: Medicaid
URL: http://www.epfirst.com

HealthSpring, Inc. | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 9009 Carothers Parkway, Suite 501, Franklin, TN 37067
Products: Medicare Advantage, Medicare PDP
URL: http://www.healthspring.com

KS Plan Administrators, LLC | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 2727 West Holcombe 4th Floor, Admin., Houston, TX 77025
Products: Medicare Advantage
URL: http://www.kelseycareadvantage.com

Arcadian Health Plan, Inc. | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 825 Washington Street Suite 300, Oakland, CA 94607
Products: Medicare Advantage
URL: http://www.arcadianhp.com

Bexar County Hospital District, dba University Health System | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 4502 Medical Drive, San Antonio, TX 78229
Products: HMO, Medicaid
URL: http://www.universityhealthsystem.com

Community Health Choice, Inc. | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 2636 South West Loop Suite 700, Houston, TX 77054
Products: Medicaid
URL: http://www.communityhealthchoice.org

Atlantis Health Plan, Inc. | New York | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 39 Broadway Suite 1240, New York, NY 10006
Products: HMO
URL: http://www.atlantishp.com

Hudson Health Plan | New York | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 303 South Broadway #321, Tarrytown, NY 10591
Products: Medicaid
URL: www.hudsonhealthplan.org

Seton Healthcare Network | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 7715 Chevy Chase Drive, Austin, TX 78752
Products: Medicaid
URL: http://www.setonhealthplan.com

Parkland Community Health Plan, Inc. | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 2777 N. Stemmons Freeway Suite 1750, Dallas, TX 75207
Products: Medicaid
URL: http://www.parklandhmo.org

Physicians Health Choice | Texas | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 8637 Fredericksburg, Suite 400, San Antonio, TX 78240
Products: Medicare Advantage
URL:

SCHC Total Care, Inc. | New York | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 819 South Salina Street, Syracuse, NY 13202
Products: Medicaid
URL: www.totalcareny.com

Touchstone Health | New York | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 14 Wall St, New York, NY 10005
Products: Medicare Advantage
URL: www.touchstone-health.com

Metropolitan Jewish Health System | New York | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 6323 Seventh Ave, Brooklyn, NY 11220
Products: Medicare Advantage
URL: www.mjhs.org

MetroPlus Health Plan | New York | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 160 Water Street, 3rd Floor, New York, NY 10038
Products: Medicaid, Medicare Advantage
URL: www.metroplus.org

Affinity Health Plan | New York | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: One Fordham Plaza Suite E-220, Bronx, NY 10458
Products: Medicaid, Medicare Advantage
URL: www.affinityplan.org

Neighborhood Health Providers | New York | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 521 Fifth Avenue, New York, NY 10175
Products: Medicaid
URL: www.getnhp.com

PacificSource Health Plans | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 110 International Way, Springfield, OR 97477
Products: PPO, Medicaid, Medicare Advantage, Medicare PDP
URL: http://www.pacificsource.com

Premera Blue Cross | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 7001 220th St. SW Building 1, Mountlake Terrace, WA 98043
Products: PPO
URL: http://www.premera.com

Providence Health System | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 506 Second Avenue Suite 1200, Seattle, WA 98104
Products: HMO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.providence.org

Samaritan Health Services | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 3600 NW Samaritan Drive, Corvallis, OR 97330
Products: Medicaid, Medicare Advantage
URL: http://www.samhealth.org/ihn/

Tuality Health Alliance | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: PO Box 925, Hillsboro, OR 97123-0925
Products: Medicaid
URL: http://www.tualityhealthalliance.org

Aetna Inc. | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

CareOregon | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 315 SW Fifth Avenue Suite 900, Portland, OR 97204
Products: Medicaid, Medicare Advantage
URL: http://www.careoregon.org

Douglas County IPA | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 1813 W. Harvard Ave., Suite 431, Roseburg, OR 97470
Products: Medicaid
URL:

FamilyCare, Inc. | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 2121 SW Broadway, Suite 300, Portland, OR 97201
Products: Medicaid, Medicare Advantage
URL: http://www.familycareinc.org

Health Net, Inc. | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 21650 Oxnard Street, Woodland Hills, CA 91367
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.healthnet.com

Mid Rogue Community Health Plan | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 820 N.E. 7th Street, Grants Pass, OR 97526
Products: Medicaid, Medicare Advantage
URL: http://www.mripa.org

UnitedHealth Group, Inc. | Washington | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Aetna Inc. | Washington | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

Columbia United Providers | Washington | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 19120 SE 34TH Street Suite 201, Vancouver, WA 98683
Products: Medicaid
URL: http://www.cuphealth.com

Community Health Plan (WA) | Washington | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 720 Olive Way Suite 300, Seattle, WA 98101
Products: Medicaid, Medicare Advantage
URL: http://www.chpw.org

Jai Medical Systems Managed Care Organization, Inc. | Maryland | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 5010 York Road, Baltimore, MD 21212
Products: Medicaid
URL: http://www.jaimedical.com

Kaiser Foundation Health Plans, Inc. | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 1800 Harrison Street 8th Floor, Oakland, CA 51098
Products: HMO, PPO, Medicaid, Medicare Advantage, CDHP, Indemnity
URL: http://www.kp.org

Oregon Health Management Services | Oregon | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 3455 S.W. U.S. Veterans Hospital Road SN-4N, Portland, OR 97239-2941
Products: Medicaid
URL: http://www.ohsu.edu/hms

HealthFirst PHSP, Inc. | New York | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 25 Broadway, New York, NY 10004
Products:N/A
URL: N/A

Formulary Advantages in Asthma and COPD Therapies: Formulary Advantages in Asthma and COPD TherapiesÑ Abstract

Wed, 28 Sep 2011 00:00:00 GMT

Report Summary: The market for asthma and chronic obstructive pulmonary disease (COPD) has grown notably in recent years because of increasing prevalence and diagnosis rates for both conditions as well as the greater use of higher-cost combination therapies. Blockbuster drugs like GlaxoSmithKlineÕs Advair (salmeterol + fluticasone propionate), Boehringer Ingelheim/PfizerÕs Spiriva (tiotropium), and MerckÕs Singulair (montelukast) lead the $13.7 billion U.S. asthma and COPD market, with numerous other brands vying for share among the various classes. Tiering data from Fingertip Formulary show that commercial and Medicare plans offer advantaged tier coverage (Tier 1 or 2 placement) to a few number of therapies, and survey responses from pharmacy directors suggest that these decisions are based on clinical advantage over other therapies or lower prices. In some cases, surveyed plans are exclusively covering a single short-acting beta2 agonist in exchange for richer reimbursements. Between 2010 and 2019, the overall size of the inhaler market for asthma and COPD will increase to an estimated $18.3 billion with the arrival of newer combination therapies such as long-acting beta2 agonist/long-acting muscarinic antagonist drugs. Therapies expected to launch over the next several years will face a crowded market and the desire by plans to limit cost increases for asthma and COPD therapies. Because of the arrival of newer therapies as well as generic versions of popular current drugs, marketers of branded asthma and COPD therapies must think creatively to ensure advantaged tier formulary access to their drugs over the next several years. Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of therapies for psychiatric disorders, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Amerigroup Corp. | National MCO Analyzer | 2011 (Event Driven)

Wed, 28 Sep 2011 00:00:00 GMT

Report Summary: Amerigroup had a banner year in 2010, growing revenue to a level that launched it into the Fortune 500, and it continued the momentum in 2011 by winning major new Medicaid contracts. Investment analysts expect the company to double revenue between 2011 and 2014, when federal healthcare reform kicks in and Amerigroup gains up to 1 million new members from the expansion of Medicaid. Amerigroup is particularly strong in serving the aged, blind and disabled population, which is where much of the near-term growth in managed Medicaid will come from as states begin to move this population to managed care. Pharmacy lives are another growth arena, with Texas and New York about to move management of pharmacy benefits to Amerigroup and other managed care organizations.

Abrazo Advantage Health Plan | Arizona | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 7878 North 16th Street, Suite 105, Phoenix, AZ 85020
Products: Medicare Advantage
URL: http://www.abrazohealth.com

Humana, Inc. | New York | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: Medicare Advantage, Medicare PDP
URL: http://www.humana.com

HealthSpring, Inc. | Pennsylvania | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 9009 Carothers Parkway, Suite 501, Franklin, TN 37067
Products: Medicare Advantage
URL: http://www.healthspring.com

Molina Healthcare, Inc. | Wisconsin | 2011 | Plan Profile

Wed, 28 Sep 2011 00:00:00 GMT

Address: 200 Oceangate Suite 100, Long Beach, CA 90802
Products: Medicaid
URL: http://www.molinahealthcare.com

Knoxville | Tennessee | 2011 | Market Overview (Event Driven)

Tue, 27 Sep 2011 00:00:00 GMT

Report Summary: The Knoxville region’s economy has fared better than other metropolitan areas in Tennessee, and while unemployment remains a concern, slight job growth bodes well for the healthcare industry as the pool of insured residents grows. The highly consolidated health systems sector continues to expand facilities and services while physicians in the market are partnering with managed care organizations on coordinated patient care systems. As providers and MCOs adjust to meet the demands of healthcare reform and increased pressure from employers looking to control healthcare benefit expense, look for further development of coordinated patient care models and reimbursement reform. Adoption of consumer-directed health plans has been strong in the Knoxville market, and such plans will continue to grow. However, the enrollment growth rate of CDHPs has slowed.

Portland | Oregon | 2011 | Market Overview (Event Driven)

Mon, 26 Sep 2011 00:00:00 GMT

Report Summary: The Portland market is characterized by a sizable uninsured population, a diffuse and slumping managed care market, and health systems looking to the state for financial help as Medicaid and uncompensated care cases increase. Lawmakers in both Oregon and Washington have passed bills calling for the creation of a health insurance exchange by 2014. Small businesses make up the vast bulk of business in Oregon, and these employers are finding it difficult to counter big rises in health plan premiums.

Milwaukee | Wisconsin | 2011 | Market Overview (Event Driven)

Mon, 26 Sep 2011 00:00:00 GMT

Report Summary: Dominant health system Aurora Health Care’s two new hospitals in Milwaukee’s affluent suburbs have saturated the market, resulting in low admissions and layoffs for both Aurora and its competitors. Health systems are forming accountable care organizations and innovative new cost-saving models that could benefit large employers the most. These new models could also shift the power balance to healthcare systems in contract negotiations and affect pharma by emphasizing use of the most cost-effective drugs. At the same time, a new governmental administration is bringing major changes to state programs that include Medicaid and the healthcare plan for state employees.

Tampa | Florida | 2011 | Market Overview (Event Driven)

Thu, 22 Sep 2011 00:00:00 GMT

Report Summary: With medical reimbursements and the true impact of federal healthcare reform both wild cards, health systems in the Tampa market are employing several strategies to prepare for the changing landscape. The region is keenly competitive, and multiple hospitals are expanding existing facilities and building new ones. Competition is heating up in areas of trauma care, neonatal services and physician acquisition. Most major hospital systems will likely continue to hire physicians and acquire group practices to both further integrate care and strengthen their networks. Economic improvement is slow going in the region. Unemployment is significantly higher than the national average, job growth is anemic, and uncompensated care remains an issue. Hospitals and health plans are closely monitoring Medicaid reform efforts at the state level, which are coupled with budget cuts and expected drops in reimbursements.

Scott and White Health Plan | Texas | 2011 | Plan Profile

Thu, 22 Sep 2011 00:00:00 GMT

Address: 2401 S. 31st St., Temple, TX 76508
Products: HMO, PPO, CDHP, Indemnity
URL: http://www.swhp.org

Centene Corporation | Texas | 2011 | Plan Profile

Thu, 22 Sep 2011 00:00:00 GMT

Address: 7711 Carondelet Avenue, St. Louis, MO 63105
Products: Medicaid, Medicare Advantage
URL: http://www.centene.com

Molina Healthcare, Inc. | Texas | 2011 | Plan Profile

Thu, 22 Sep 2011 00:00:00 GMT

Address: 200 Oceangate Suite 100, Long Beach, CA 90802
Products: Medicaid, Medicare Advantage
URL: http://www.molinahealthcare.com

Humana, Inc. | Texas | 2011 | Plan Profile

Thu, 22 Sep 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

AmeriHealth Mercy | Pennsylvania | 2011 | Plan Profile

Thu, 22 Sep 2011 00:00:00 GMT

Address: 2404 Park Drive, Harrisburg, PA 17110
Products: Medicaid
URL: http://www.amerihealthmercyhp.com

Centene Corporation | Ohio | 2011 | Plan Profile

Thu, 22 Sep 2011 00:00:00 GMT

Address: 7711 Carondelet Avenue, St. Louis, MO 63105
Products: Medicaid, Medicare Advantage
URL: http://www.centene.com

WellCare Group of Companies | Ohio | 2011 | Plan Profile

Thu, 22 Sep 2011 00:00:00 GMT

Address: 6800 North Dale Mabry Highway Suite 270/299, Tampa, FL 33614
Products: Medicaid, Medicare Advantage
URL: http://www.wellcare.com

Mount Carmel Health Plan, Inc. | Ohio | 2011 | Plan Profile

Thu, 22 Sep 2011 00:00:00 GMT

Address: 495 Cooper Road Suite 200, Westerville, OH 43081
Products: Medicare Advantage, Medicare PDP
URL: http://www.medigold.com

Washington, D.C. | 2011 | Market Overview (Event Driven)

Tue, 20 Sep 2011 00:00:00 GMT

Report Summary: The Washington, D.C., metropolitan area’s healthcare market is characterized by its lack of consolidation with several large systems and health plans, but none have enough leverage to dictate shifts in plan design or reimbursements. The District of Columbia, Maryland and Virginia portions of the market each have their large health systems, while small, independent practices scattered throughout the area make up the physician sector. CareFirst Blue Cross Blue Shield is the dominant plan in the area, and behind it are a number of national plans jockeying for a larger share of enrollment. Several health systems in the market are expanding and looking to add to their physician networks, seeking to bolster referrals to facilities and to build the foundation for coordinated patient care systems. Health plans, meanwhile, are trying to exert more control over costs through medical homes and other programs that aim to increase care efficiency and outcomes.

Lansing | Michigan | 2011 | Market Overview (Event Driven)

Mon, 19 Sep 2011 00:00:00 GMT

Report Summary: The Lansing market is showing signs of economic improvement in 2011, including a decrease in unemployment, increased revenues for its major health systems, and expected job growth for the healthcare industry in the future. Competition is increasing between Lansing’s two largest health systems, Sparrow Health System and McLaren Health Care Corp. (Ingham Regional Medical Center), including increasing physician alignment and quality initiatives as the health systems vie for market share. The popularity of high-deductible health plans and wellness programs is growing in Lansing as cost becomes the major driving factor in local residents’ healthcare decisions.

The Lifetime Healthcare Companies | New York | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 165 Court Street, Rochester, NY 14647
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.lifethc.com

Kaiser Foundation Health Plans, Inc. | Washington | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 1800 Harrison Street 8th Floor, Oakland, CA 51098
Products: HMO, PPO, Medicaid, Medicare Advantage, CDHP, Indemnity
URL: http://www.kp.org

Molina Healthcare, Inc. | Washington | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 200 Oceangate Suite 100, Long Beach, CA 90802
Products: Medicaid, Medicare Advantage
URL: http://www.molinahealthcare.com

Premera Blue Cross | Washington | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 7001 220th St. SW Building 1, Mountlake Terrace, WA 98043
Products: PPO
URL: http://www.premera.com

Providence Health System | Washington | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 506 Second Avenue Suite 1200, Seattle, WA 98104
Products: HMO, Medicare Advantage, CDHP, Rental Network
URL: http://www.providence.org

ProMedica Health System | Ohio | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 1901 Indian Wood Circle, Maumee, OH 43537
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, CDHP, Indemnity, Rental Network
URL: http://www.paramounthealthcare.com

Summa Health System | Ohio | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 10 North Main Street, Akron, OH 44308
Products: HMO, POS, PPO, Medicare Advantage, Indemnity
URL:

UnitedHealth Group, Inc. | Ohio | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

WellPoint, Inc. | Ohio | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

Kaiser Foundation Health Plans, Inc. | Ohio | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 1800 Harrison Street 8th Floor, Oakland, CA 51098
Products: HMO, PPO, Medicare Advantage, CDHP, Indemnity
URL: http://www.kp.org

Medical Mutual of Ohio | Ohio | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 2060 East 9th Street, Cleveland, OH 44115
Products: HMO, POS, PPO, Indemnity, Rental Network
URL: http://www.MedMutual.com

AMERIGROUP Corporation | Ohio | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 4425 Corporation Lane, Virginia Beach, VA 23462
Products: Medicaid
URL: http://www.amerigroupcorp.com

UnitedHealth Group, Inc. | North Carolina | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

WellPoint, Inc. | Virginia | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

UnitedHealth Group, Inc. | Virginia | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Kaiser Foundation Health Plans, Inc. | Virginia | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 1800 Harrison Street 8th Floor, Oakland, CA 51098
Products: HMO, PPO, Medicare Advantage, CDHP, Indemnity
URL: http://www.kp.org

AMERIGROUP Corporation | Virginia | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 4425 Corporation Lane, Virginia Beach, VA 23462
Products: Medicaid
URL: http://www.amerigroupcorp.com

CareFirst, Inc. | Virginia | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 10455 Mill Run Circle, Owings Mills, MD 21117
Products: HMO, POS, PPO, CDHP, Indemnity
URL: http://www.carefirst.com

Aetna Inc. | New York | 2011 | Plan Profile

Mon, 19 Sep 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

San Antonio | Texas | 2011 | Market Overview (Event Driven)

Fri, 16 Sep 2011 00:00:00 GMT

Report Summary: San Antonio has a large military presence, a strong healthcare and biomedicine industry, and a moderately growing population. Two for-profit health systems are acquiring or building new facilities. Two nonprofit health systems are planning to open a freestanding children’s hospital. Health systems are aligning more closely with physicians by using affiliated nonprofit organizations to employ them, and the trend is likely to continue as providers prepare to form accountable care organizations. After opening clinics in three local grocery stores, a retail clinic chain plans to expand in the area. Health insurers are emphasizing care coordination, disease management and preventive medicine in an effort to reduce costs. The state is evaluating whether it should continue to carve out pharmacy benefits from managed care Medicaid contracts. Look for the Texas Legislature to cut the Medicaid reimbursement rate for providers as they face a $27 billion state budget deficit. Many employers cannot afford to provide health insurance coverage for workers as evidenced by a 22 percent uninsured rate. Expect a new state-sponsored reinsurance program to provide some relief for small businesses.

Aetna Inc. | New Hampshire | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

Aetna Inc. | Nevada | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

MVP Health Care | New York | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 625 State Street PO Box 2207, Schenectady, NY 12305
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.mvphealthcare.com

WellCare Group of Companies | New York | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 6800 North Dale Mabry Highway Suite 270/299, Tampa, FL 33614
Products: Medicaid, Medicare Advantage
URL: http://www.wellcare.com

Dean Health Plan, Inc. | Wisconsin | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 1277 Deming Way, Madison, WI 53717
Products: HMO, PPO, Medicaid
URL: http://www.deancare.com

Humana, Inc. | Wisconsin | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

Affinity Health System | Wisconsin | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 1570 Midway Place, Menasha, WI 54952
Products: HMO, POS, Medicaid, Medicare PDP
URL: http//www.affinityhealthplans.com

Physicians Plus Insurance Corporation | Wisconsin | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 22 East Mifflin Street, Suite 200, Madison, WI 53703
Products: HMO, POS, PPO, Medicaid, CDHP
URL: http://www.pplusic.com

Security Health Plan of Wisconsin, Inc. | Wisconsin | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 1515 St. Joesph's Avenue P.O. Box 8000, Marshfield, WI 54449
Products: HMO, Medicaid, Medicare Advantage
URL: http://www.securityhealth.org

Unity Health Plans Insurance Corporation | Wisconsin | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 840 Carolina Street, Sauk City, WI 53583
Products: HMO, POS, PPO, Medicaid
URL: http://www.unityhealth.com

WellPoint, Inc. | Wisconsin | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

UnitedHealth Group, Inc. | New Jersey | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Aetna Inc. | New Jersey | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

AMERIGROUP Corporation | New Jersey | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 4425 Corporation Lane, Virginia Beach, VA 23462
Products: Medicaid, Medicare Advantage
URL: http://www.amerigroupcorp.com

Highmark, Inc. | Pennsylvania | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 120 Fifth Avenue Suite 105, Pittsburgh, PA 15222-3099
Products: HMO, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.highmark.com

Independence Blue Cross | Pennsylvania | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 1901 Market Street, Philadelphia, PA 19103-1480
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.amerihealth.com

UnitedHealth Group, Inc. | Pennsylvania | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UPMC Health System | Pennsylvania | 2011 | Plan Profile

Wed, 14 Sep 2011 00:00:00 GMT

Address: One Chatham Center 112 Washington Place, Pittsburgh, PA 15219
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP
URL:

Southern Connecticut | Connecticut | 2011 | Market Overview (Event Driven)

Mon, 12 Sep 2011 00:00:00 GMT

Report Summary: The southern Connecticut healthcare market has been stable and conservative, but in 2011 signs of change appeared. Mergers are in the works or have been completed as the pressure of state and federal healthcare reform builds. We look for more consolidation of health systems and physicians and a greater push from health plans for accountability measures. Pessimistic employers likely to continue cost-shifting or even dropping of health benefits as the advent of health exchanges in 2014 draws nearer.

Oregon & Washington | Summer | 2011 | Health Plan Analysis

Thu, 08 Sep 2011 00:00:00 GMT

Report Summary: Health insurers in Oregon and Washington are trying to meet demand for more cost-effective products as the economy struggles and healthcare costs rise. In Washington, Blue Cross and Blue Shield of Illinois won a lucrative employer contract from Boeing, whose previous insurer was Regence BlueShield. In Oregon, state officials are in the beginning stages of transforming the state's Medicaid program, while in Washington, the State Hospital Association has sued the state because of a disagreement over hospital taxes being diverted to the general fund instead of Medicaid. Also in Washington, the governor signed legislation that requires insurers to cover oral oncology drugs at a rate that is comparable to injected or intravenous oncology drugs. Health plans across the region are using medical home projects to help coordinate care, improve healthcare outcomes and decrease costs.

Oregon & Washington | Summer | 2011 | Health Plan Analysis

Thu, 08 Sep 2011 00:00:00 GMT

Coventry Health Care, Inc. | Pennsylvania | 2011 | Plan Profile

Thu, 01 Sep 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.cvty.com

WellPoint, Inc. | Missouri | 2011 | Plan Profile

Thu, 01 Sep 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, Indemnity, Rental Network
URL: http://www.wellpoint.com

Geisinger Health System Foundation | Pennsylvania | 2011 | Plan Profile

Thu, 01 Sep 2011 00:00:00 GMT

Address: 100 N. Academy Avenue, Danville, PA 17822
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.thehealthplan.com

Blue Cross and Blue Shield of Vermont | Vermont | 2011 | Plan Profile

Thu, 01 Sep 2011 00:00:00 GMT

Address: 445 Industrial Lane, Berlin, VT 05601
Products: HMO, POS, PPO, CDHP, Indemnity
URL: http://www.bcbsvt.com

MVP Health Care | Vermont | 2011 | Plan Profile

Thu, 01 Sep 2011 00:00:00 GMT

Address: 625 State Street PO Box 2207, Schenectady, NY 12305
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.mvphealthcare.com

Carolinas | Summer | 2011 | Health Plan Analysis

Wed, 31 Aug 2011 00:00:00 GMT

Report Summary: Commercial enrollment in North Carolina and South Carolina increased slightly between January 2010 and January 2010. However, a lagging economy continues to make increased market share a difficult prospect for managed care organizations in both states. Meanwhile, employers in the market are showing increased interest in high-deductible health plans and other products that shift more of the healthcare benefit cost to employees. MCOs could find enrollment growth through health plans that offer employers greater flexibility in plan design. Budget woes in North Carolina and South Carolina are driving deeper cuts to the Medicaid programs in both states. In North Carolina, the legislature cut $350 million from the state’s $12.8 billion Medicaid budget in 2011. In July 2011, South Carolina lawmakers implemented another round of Medicaid provider reimbursement cuts. Given the reimbursement cuts implemented in April 2011, some providers will see a total reimbursement cut of 7 percent for 2011.

Carolinas | Summer | 2011 | Health Plan Analysis

Wed, 31 Aug 2011 00:00:00 GMT

San Francisco | California | 2011 | Market Overview (Event Driven)

Tue, 30 Aug 2011 00:00:00 GMT

Report Summary: In San Francisco, the healthcare cost curve is so high that stakeholders must use every tool at their disposal to bend it without breaking it. Accountable care organizations, bundled payments and value-based contracting are all taking place within the market, with Blue Shield of California being a common denominator in each of these efforts. While large medical groups such as Hill Physicians and Brown & Toland Physicians are likely to benefit from these pilots, smaller groups will continue to face threats of consolidations. Things look similarly grim for pharmaceutical sales. Employers, as well as the state’s Medicaid program, are turning to increased member cost sharing, which could restrict patient utilization in a market where unemployment still hovers at or above the national average.

Seattle | Washington | 2011 | Market Overview (Event Driven)

Mon, 29 Aug 2011 00:00:00 GMT

Report Summary: Providers in the Seattle market have often been among the vanguard when it comes to coordinated patient care. With federal healthcare reform driving the healthcare industry toward coordination and integration, local providers should be well positioned to capitalize on their experience. The largest health systems in the Seattle market continue to expand inpatient and outpatient facilities while seeking out partnerships with smaller systems in a bid to increase referrals to their flagship hospitals. Likewise, independent physicians in the market are gravitating to health systems or larger physician organizations, seeking the benefits that economies of scale bring through lower overhead and increased leverage with payers. These factors point to further integration of an already integrated provider sector and such consolidation could pose challenges for managed care organizations when it comes to provider reimbursement contracts. However, such integration also points to development of patient care programs designed to reduce medical and prescription drug utilization and that could benefit MCOs.

FirstCarolinaCare Insurance Company, Inc. | North Carolina | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 42 Memorial Drive, Pinehurst, NC 28374
Products: HMO, PPO
URL:

WellCare Group of Companies | Florida | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 6800 North Dale Mabry Highway Suite 270/299, Tampa, FL 33614
Products: Medicaid, Medicare Advantage
URL: http://www.wellcare.com

Harvard Pilgrim Health Care, Inc. | New Hampshire | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 93 Worcester Street, Wellesley, MA 02481-9181
Products: HMO, PPO, Medicaid, CDHP
URL: http://www.harvardpilgrim.org

WellPoint, Inc. | New Hampshire | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

Humana, Inc. | Missouri | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

WellPoint, Inc. | Nevada | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

Renown Health | Nevada | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 830 Harvard Way, Reno, NV 89502
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Rental Network
URL: http://www.hometownhealth.com

Blue Cross Blue Shield of Michigan | Michigan | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 600 E. Lafayette, Detroit, MI 48226
Products: HMO, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.bcbsm.com

Blue Cross of Northeastern Pennsylvania | Pennsylvania | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 19 North Main St., Wilkes-Barre, PA 18711
Products: HMO, POS, PPO, Medicaid, CDHP, Indemnity
URL: http://www.bcnepa.com

Capital BlueCross | Pennsylvania | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 2500 Elmerton Avenue, Harrisburg, PA 17110
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.capbluecross.com

Aetna Inc. | Pennsylvania | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Coventry Health Care, Inc. | North Carolina | 2011 | Plan Profile

Wed, 24 Aug 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicare PDP, CDHP
URL: http://www.cvty.com

UnitedHealth Group, Inc. | Arizona | 2011 | Plan Profile

Mon, 22 Aug 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Molina Healthcare, Inc. | Missouri | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 200 Oceangate Suite 100, Long Beach, CA 90802
Products: Medicaid
URL: http://www.molinahealthcare.com

Family Health Partners | Kansas | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 215 West Pershing Road Suite 600, Kansas City, MO 64108
Products: Medicaid
URL: http://www.fhp.org

UnitedHealth Group, Inc. | Kansas | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Family Health Partners | Missouri | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 215 West Pershing Road Suite 600, Kansas City, MO 64108
Products: Medicaid
URL: http://www.fhp.org

UnitedHealth Group, Inc. | Florida | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Humana, Inc. | Florida | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

ConnectiCare, Inc. | Connecticut | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 175 Scott Swamp Road, Farmington, CT 06032
Products:
URL:

Rochester | New York | 2011 | Market Overview (Event Driven)

Thu, 18 Aug 2011 00:00:00 GMT

Report Summary: Care coordination, efficiency and quality improvement are top priorities for health systems, physician groups and insurers in the Rochester market, which has a history of collaboration among tech-savvy healthcare providers. Health systems are reducing readmissions by coaching patients to manage chronic diseases and implementing new coordinated discharge procedures. Physician practices, with support from the top two managed care organizations, are adopting the patient-centered medical home model, which focuses on care coordination. A local IPA’s clinical integration program has signed contracts with two more self-insured employers. A regional health information organization connects hospitals, physicians, labs, insurers and radiology practices. A new state law will move management of Medicaid pharmacy benefits from the state to managed care plans, which will apply their formularies to the Medicaid program to control drug utilization. Double-digit premium increases are driving a greater acceptance of high deductible health plans and wellness programs among employers in the Rochester area.

CareSource Management Group Co. | Michigan | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: One Dayton Centre One South Main Street, Dayton, OH 45402
Products: Medicaid, Medicare Advantage
URL: http://www.csmg-online.com

Harmony Health Plan of IL, Inc. | Missouri | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 125 S. Wacker Dr., Ste. 2600, Chicago, IL 60606
Products:
URL:

Aetna Inc. | Massachusetts | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

HealthSpring, Inc. | Alabama | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 9009 Carothers Parkway, Suite 501, Franklin, TN 37067
Products: HMO, Medicare Advantage
URL: http://www.healthspring.com

Coventry Health Care, Inc. | Michigan | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicaid, CDHP
URL: http://www.cvty.com

Aetna Inc. | Michigan | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity, Rental Network
URL: http://www.aetna.com

Upper Peninsula Health Plan, Inc. | Michigan | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 228 W. Washington St., Marquette, MI 49855
Products: Medicaid
URL: http://www.uphp.com

Health Plan of Michigan, Inc. | Michigan | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 17515 W. Nine Mile Rd. Suite 500, Southfield, MI 48075
Products: Medicaid
URL: http://www.hpmich.com

HealthPlus of Michigan, Inc. | Michigan | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 2050 South Linden Road, Flint, MI 48501
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP
URL: http://www.healthplus.org

Humana, Inc. | Michigan | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

McLaren Health Plan | Michigan | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: G-3245 Beecher Road, Flint, MI 48532
Products: POS, PPO, Medicaid
URL: http://www.mclarenhealthplan.org

Total Health Care, Inc. | Michigan | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 3011 W. Grand Blvd. Suite 1600, Detroit, MI 48202
Products: HMO, POS, Medicaid
URL: http://www.thc-online.com

UnitedHealth Group, Inc. | Minnesota | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Itasca Medical Care | Minnesota | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 1209 SE 2nd Avenue, Grand Rapids, MN 55744
Products: Medicaid, Medicare Advantage
URL:

Metropolitan Health Plan | Minnesota | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 822 South 3rd Street, Suite 140, Minneapolis, MN 55415
Products: Medicaid, Medicare Advantage
URL: http://www.mhp4life.org

PreferredOne Health Benefits Administration | Minnesota | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 6105 Golden Hills Drive, Golden Valley, MN 55416
Products: HMO, PPO, Rental Network
URL: http://www.preferredone.com

South Country Health Alliance | Minnesota | 2011 | Plan Profile

Thu, 18 Aug 2011 00:00:00 GMT

Address: 110 W. Fremont Street, owatonna, MN 55060
Products: Medicaid, Medicare Advantage
URL:

White Paper | What Innovative Markets Can Teach | August 2011

Tue, 16 Aug 2011 00:00:00 GMT

HealthLeaders-InterStudy periodically publishes special analyst reports on healthcare topics of interest.

Formulary Advantages in Psychiatric Drugs: Medicare plans readily employ cost-sharing measures and formulary restrictions to direct early use of generics and preferred brands for psychiatry.

Tue, 16 Aug 2011 00:00:00 GMT

Report Summary: According to the National Institute of Mental Health, each year tens of millions of Americans are affected by mental illness. Although significant strides have been made toward understanding the pathophysiology of depression, bipolar disorder, and schizophrenia, it remains difficult for physicians to predict an individual patientÕs response to therapy. Accordingly, patients require access to a wide range of therapies on formulary to find an optimal regimen. Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of therapies for psychiatric disorders, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Health Net | 2Q 2011 | Health Plan Earnings Summaries

Mon, 15 Aug 2011 00:00:00 GMT

Molina | National MCO Analyzer | 2011 (Event Driven)

Fri, 12 Aug 2011 00:00:00 GMT

Report Summary: Still controlled and run by the family who founded the company, Molina Healthcare has focused entirely on Medicaid and those dually eligible for Medicaid and Medicare. It administers benefits to 1.5 million lives in 10 states. Medicaid, which has been the fastest-growing segment of the healthcare industry for the past four years, is set to expand by an estimated 16 million beginning in 2014, when eligibility is opened to adults earning less than 133 percent of the poverty level. Beyond the sheer numeric expansion of Medicaid, its exponential cost expansion is driving more states to seek managed care contracts to help rein in costs. Molina's recent purchase of the Medicaid IT administration business of Unisys Corp. expands its ability to compete, particularly in those states where HMO-style Medicaid management isn't being used. HealthLeaders-InterStudy's National Health Plan Analyzer Series profiles the nation's top 12 healthcare companies, with data and analysis of each national health plan's finances, its strength in various markets, its products in the commercial, Medicaid, Medicare, government employee and ancillary segments, its competitive standing, mergers and acquisitions, pharmacy administration, history, and its prospects for the near future.

HealthSpring | 2Q 2011 | Health Plan Earnings Summaries

Thu, 11 Aug 2011 00:00:00 GMT

CIGNA | 2Q 2011 | Health Plan Earnings Summaries

Thu, 11 Aug 2011 00:00:00 GMT

Humana | 2Q 2011 | Health Plan Earnings Summaries

Wed, 10 Aug 2011 00:00:00 GMT

WellCare | 2Q 2011 | Health Plan Earnings Summaries

Wed, 10 Aug 2011 00:00:00 GMT

Humana, Inc. | Kansas | 2011 | Plan Profile

Mon, 08 Aug 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

Humana, Inc. | Illinois | 2011 | Plan Profile

Mon, 08 Aug 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

Aetna Inc. | Kansas | 2011 | Plan Profile

Mon, 08 Aug 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

Blue Cross and Blue Shield of Kansas City | Kansas | 2011 | Plan Profile

Mon, 08 Aug 2011 00:00:00 GMT

Address: 2301 Main Street, Kansas City, MO 64108-2428
Products: HMO, PPO
URL: http://www.bluekc.com

Humana, Inc. | Iowa | 2011 | Plan Profile

Mon, 08 Aug 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

Amerigroup | 2Q 2011 | Health Plan Earnings Summaries

Fri, 05 Aug 2011 00:00:00 GMT

Coventry | 2Q 2011 | Health Plan Earnings Summaries

Fri, 05 Aug 2011 00:00:00 GMT

HealthSpring, Inc. | Maryland | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 9009 Carothers Parkway, Suite 501, Franklin, TN 37067
Products: Medicare Advantage, Medicare PDP
URL: http://www.healthspring.com

MedStar Health | Maryland | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 5565 Sterrett Place, Columbia, MD 21044
Products: Medicaid
URL: http://www.medstarhealth.org

Maryland Care, Inc. DBA Maryland Physicians Care, MCO | Maryland | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 7104 Ambassador Road, Suite 100, Baltimore, MD 21244
Products: Medicaid
URL: http://www.marylandphysicianscare.com

Priority Partners Managed Care Organization | Maryland | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 6704 Curtis Court, Glen Burnie, MD 21060
Products: Medicaid
URL: http://www.jhhc.com

Coventry Health Care, Inc. | Louisiana | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, CDHP
URL: http://www.cvty.com

WellPoint, Inc. | Connecticut | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

Aetna Inc. | Louisiana | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

Peoples Health | Louisiana | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: Three Lakeway Center 3838 N. Causeway Blvd. Suite 2200, Metairie, LA 70002
Products: Medicare Advantage
URL: https://www.peopleshealth.com

Vantage Health Plan, Inc. | Louisiana | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 130 DeSiard Street, Suite 300, Monroe, LA 71291
Products: HMO, Medicare Advantage, CDHP
URL: http://www.vhpla.com

Midwest Health Plan, Inc. | Michigan | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 5050 Schaefer Road, Dearborn, MI 48126
Products: Medicaid, Medicare Advantage
URL: http://www.midwesthealthplan.com

Molina Healthcare, Inc. | Michigan | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 200 Oceangate Suite 100, Long Beach, CA 90802
Products: Medicaid, Medicare Advantage
URL: http://www.molinahealthcare.com

Sparrow Health System | Michigan | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 1400 E. Michigan Avenue, Lansing, MI 48912
Products: HMO, POS, PPO, Medicaid, CDHP, Rental Network
URL: http://www.sparrow.org

Coventry Health Care, Inc. | Georgia | 2011 | Plan Profile

Thu, 04 Aug 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicare Advantage, CDHP
URL: http://www.cvty.com

Aetna | 2Q 2011 | Health Plan Earnings Summaries

Wed, 03 Aug 2011 00:00:00 GMT

WellPoint | 2Q 2011 | Health Plan Earnings Summaries

Wed, 03 Aug 2011 00:00:00 GMT

Salt Lake City | Utah | 2011 | Market Overview (Event Driven)

Wed, 03 Aug 2011 00:00:00 GMT

Report Summary: The Salt Lake City region is one of the youngest, healthiest markets in the United States, characterized by large families and a conservative, business-oriented culture. We predict little change in this landscape over the near term. No challengers appear to be positioning for a run at Intermountain. Legislators and state regulators are focused on enacting progressive healthcare reform, largely in a desire to take care of it themselves rather than have the federal government force reform upon the state. At the same time, state officials have filed a waiver request to convert Utah’s Medicaid program to an accountable care organization model, and the progress of building a clinical health information exchange for all stakeholders is moving forward steadily.

Executive Briefing | PBM Industry Rocks And Reels From Mega-Merger Talk | August 2011

Wed, 03 Aug 2011 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive briefing.

Executive Briefing | Healthcare Reform Will Accelerate the Move to Self-Insured Products | August 2011

Mon, 01 Aug 2011 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive briefing.

Minnesota Health Plan Data (HMO Financials)

Sun, 31 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Nebraska Health Plan Data (HMO Financials)

Fri, 29 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Idaho Health Plan Data (HMO Financials)

Fri, 29 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Utah Health Plan Data (HMO Financials)

Fri, 29 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Oklahoma Health Plan Data (HMO Financials)

Fri, 29 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

New Mexico Health Plan Data (HMO Financials)

Fri, 29 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Arkansas Health Plan Data (HMO Financials)

Fri, 29 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Delaware Health Plan Data (HMO Financials)

Fri, 29 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

West Virginia Health Plan Data (HMO Financials)

Fri, 29 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Scranton | Pennsylvania | 2011 | Market Overview (Event Driven)

Fri, 29 Jul 2011 00:00:00 GMT

Report Summary: Scranton’s health system sector is rapidly consolidating, with for-profit Franklin, Tenn.-based Community Health Systems’ recent acquisitions of its second and now third health systems in the market in two years, ultimately positioning it to control more than half of the total share of inpatient discharges. The market also includes Danville-based nonprofit Geisinger Health System, which has announced plans to acquire a local hospital and continues to provide integrated care, bundled payments and medical homes. Geisinger is heavily involved in a range of other innovative, quality and cost-control efforts that are driving healthcare reform. The Scranton economy is showing signs of improvement, with regional unemployment dropping and falling below the national average. At the same time, the area has the highest unemployment among metropolitan statistical areas in Pennsylvania and struggles to overcome a reputation as a place from which patients flee to nearby Philadelphia to seek specialized care.

Centene | 2Q 2011 | Health Plan Earnings Summaries

Fri, 29 Jul 2011 00:00:00 GMT

Molina | 2Q 2011 | Health Plan Earnings Summaries

Thu, 28 Jul 2011 00:00:00 GMT

Simply Healthcare Plans | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 2121 Ponce De Leon Blvd, Coral Gables, FL 33134-5224
Products: Medicaid
URL: http://www.simplyhealthcareplans.com

Orlando | Florida | 2011 | Market Overview (Event Driven)

Thu, 28 Jul 2011 00:00:00 GMT

Report Summary: Florida Hospital and Orlando Health, which account for nearly 80 percent of local acute-care discharges, are collaborating on cardiac, surgical care and other quality initiatives. They are also battling to out-build and out-bid one another through major construction projects, acquisitions, and targeted geographic growth. If access to capital tightens, free standing emergency rooms and outpatient facilities may emerge as a cost efficient alternative in medically underserved areas. Economic woes have also caused leading health systems, physician groups, and health plans to cancel managed care contracts in the past year. Employers may find more coverage options via Florida Hospital’s newly licensed insurance company and through TrustMark, which offers self-insured plans that cover as few as five employees. In pharmacy news, watch for how the continued growth of e-prescribing in Orlando will affect the use of branded drugs, and how UnitedHealthcare’s prior-authorization requirements on oral oncology drugs may affect access.

Santa Cruz-Monterey Managed Medical Care Commission | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 1600 Green Hills Road Suite 101, Santa Cruz, CA 95066-4981
Products: Medicaid
URL:

Coventry Health Care, Inc. | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, CDHP
URL: http://www.cvty.com

Freedom Health, Inc. | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 5501 49th Street North, St. Petersburg, FL 33709
Products: Medicaid, Medicare Advantage
URL: www.freedomhealth.com

Humana, Inc. | Louisiana | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

JMH Health Plan | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 1801 NW 9th Avenue Suite 700, Miami, FL 33136
Products: HMO, POS, Medicaid, Medicare Advantage
URL: www.jmhhp.com

Molina Healthcare, Inc. | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 200 Oceangate Suite 100, Long Beach, CA 90802
Products: Medicaid, Medicare Advantage
URL: http://www.molinahealthcare.com

Palm Beach County Healthcare District | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 324 Datura Street, West Palm Beach, FL 33401
Products: Medicaid
URL: http://www.hcdpbc.org

Preferred Care Partners, Inc. | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 9100 Dadeland Blvd., Suite 1250, Miami, FL 33156
Products: Medicare Advantage
URL: http://www.mypreferredcare.com

Preferred Medical Plan, Inc. | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 4950 Southwest 8th Street, Coral Cables, FL 33134
Products: HMO, Medicaid
URL: http://www.pmphmo.com

Quality Health Plans, Inc. | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 2435 U.S. Hwy 19, Suite 470, Holiday, FL 34691
Products: Medicare Advantage
URL: http://www.qualityhealthplans.com

Universal Health Care, Inc. (FL) | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 150 2nd Avenue North, Suite 400, St. Petersburg, FL 33701
Products: HMO, Medicaid, Medicare Advantage, Medicare PDP
URL: http://www.univhc.com

AMERIGROUP Corporation | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 4425 Corporation Lane, Virginia Beach, VA 23462
Products: Medicaid, Medicare Advantage
URL: http://www.amerigroupcorp.com

Blue Cross and Blue Shield of Kansas | Kansas | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: P.O. Box 3518, Topeka, KS 66601
Products: PPO
URL: http://www.bcbsks.com

Coventry Health Care, Inc. | Kansas | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.cvty.com

Humana, Inc. | Arizona | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

Citizens Choice HealthPlan | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 17315 Studebaker rd Suite 200, Cerritos, CA 90703
Products: Medicare Advantage
URL: http://www.citizenschoicehealth.com

Valley Health Plan | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 2325 Enborg Lane, San Jose, CA 95128
Products: HMO
URL: http://www.valleyhealthplan.org

L.A. Care | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 555 W. Fifth Street 29th Floor, Los Angeles, CA 90013
Products: Medicaid, Medicare Advantage
URL: http://www.lacare.org

Florida Health Care Plans | Florida | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 1340 Ridgewood Avenue, Holly Hill, FL 32117
Products:
URL: http://www.fhcp.com/

Wyoming Health Plan Data (HMO Financials)

Thu, 28 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Athens Area Health Plan Select, Inc. | Georgia | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 295 West Clayton Street, Athens, GA 30601
Products: HMO, PPO, CDHP
URL:

Alliant Health Plans | Georgia | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 401 S. Wall Street Suite 201, Calhoun, GA 30701
Products: HMO, Rental Network
URL: http://www.alliantplans.com

UnitedHealth Group, Inc. | Kentucky | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

UnitedHealth Group, Inc. | Colorado | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

Humana, Inc. | Colorado | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

Aetna Inc. | Colorado | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

UnitedHealth Group, Inc. | District of Columbia | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 9900 Bren Road East, Minnetonka, MN 55343
Products: HMO, POS, PPO, Medicaid, Medicare PDP, CDHP, Indemnity, Rental Network
URL: http://www.uhc.com

D.C. Chartered Health Plan, Inc. | District of Columbia | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 1025 15th Street Northwest, Washington, DC 20005
Products: Medicaid
URL: http://www.chartered-health.com

Humana, Inc. | Indiana | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

UCare | Minnesota | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 500 Stinson Blvd, Minneapolis, MN 55413
Products: Medicaid, Medicare Advantage
URL: http://www.ucare.org

Medica | Minnesota | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 401 Carlson Parkway, Minnetonka, MN 55305-5387
Products: HMO, PPO, Medicaid, Medicare Advantage, CDHP, Rental Network
URL: http://www.medica.com

HealthPartners, Inc. | Minnesota | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 8170 33rd Avenue South P.O. Box 1309, Minneapolis, MN 55440
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, CDHP, Indemnity, Rental Network
URL:

Aetna Inc. | District of Columbia | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

CalOPTIMA | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 1120 West La Veta Avenue, Orange, CA 92868
Products: Medicaid, Medicare Advantage
URL: http://www.caloptima.org

North Dakota Health Plan Data (HMO Financials)

Thu, 28 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

South Dakota Health Plan Data (HMO Financials)

Thu, 28 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Hawaii Health Plan Data (HMO Financials)

Thu, 28 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Montana Health Plan Data (HMO Financials)

Thu, 28 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Mississippi Health Plan Data (HMO Financials)

Thu, 28 Jul 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Western Health Advantage | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 2349 Gateway Oaks Dr Suite 100, Sacramento, CA 95833
Products: HMO
URL:

Partnership HealthPlan of California | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 360 Campus Lane Suite 100, Farifield, CA 95434
Products: Medicaid, Medicare Advantage
URL:

Inter Valley Health Plan | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 300 South Park Avenue P.o. Box 6002, Pomona, CA 91769
Products: Medicare Advantage
URL: http://www.ivhp.com

Kern Health Systems | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 1600 Norris Road, Bakersfield, CA 93308
Products: Medicaid
URL: http://www.kernfamilyhealthcare.com

Molina Healthcare, Inc. | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 200 Oceangate Suite 100, Long Beach, CA 90802
Products: Medicaid, Medicare Advantage
URL: http://www.molinahealthcare.com

San Francisco Health Plan | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 568 Howard Street 4th Floor, San Francisco, CA 94105
Products: Medicaid
URL: http://www.sfhp.org

Alameda Alliance for Health | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 1240 South Loop Road, Alameda, CA 94502
Products: Medicaid, Medicare Advantage
URL: http://www.alamedaalliance.com

Care 1st Health Plan | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 601 Potrero Grande Dr, Monterey Park, CA 91755
Products: Medicaid, Medicare Advantage
URL: http://www.care1st.com

Sharp Health Plan | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 4305 University Avenue, Suite 200, San Diego, CA 92105
Products: HMO
URL: http://www.sharp.com/health-plan/index.cfm

Sistemas Medicos Nacionales | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 303 H Street, Chula Vista, CA 91910
Products: HMO
URL: http://www.simnsa.com

The Health Plan Of San Joaquin | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 7751 South Manthey Road, French Camp, CA 95231
Products: HMO, Medicaid
URL: http://www.hpsj.com

Ventura County Health Care Plan | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 2323 Knoll Drive, Ventura, CA 93003
Products: Medicaid
URL: http://www.vchealthcareplan.org

Community Health Group | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 740 Bay Boulevard, Chula Vista, CA 91910
Products: Medicaid, Medicare Advantage
URL: http://www.chgsd.com

Community Health Plan (CA) | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 1000 S. Fremont Avenue Building A-9, East 2nd FL, Unit #4, Alhambra, CA 91803
Products: Medicaid
URL: http://chp.dhs.lacounty.gov/

Health Plan of San Mateo | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 701 Gateway Blvd. Suite 400, South San Francisco, CA 94080
Products: Medicaid, Medicare Advantage
URL: http://www.hpsm.org/?gclid=CLWP356BzaICFQG4sgod0zxpyA

Contra Costa Health Plan | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 595 Center Avenue Suite 100, Martinez, CA 94553
Products: HMO, Medicaid, Medicare Advantage
URL: http://www.contracostahealthplan.org

Inland Empire Health Plan | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 303 E. Vanderbilt Way, San Bernardino, CA 92408
Products: Medicaid, Medicare Advantage
URL: http://www.ieph.org

Santa Clara Family Health Plan | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 210 E. Hacienda Avenue, Campbell, CA 95008
Products: Medicaid
URL: http://www.scfhp.com

Santa Barbara Regional Health Authority | California | 2011 | Plan Profile

Thu, 28 Jul 2011 00:00:00 GMT

Address: 110 Castilian Drive, Goleta, CA 93117
Products: Medicaid
URL: http://www.cencalhealth.org

Columbia | South Carolina | 2011 | Market Overview (Event Driven)

Tue, 26 Jul 2011 00:00:00 GMT

Report Summary: Although health systems in the market reached an agreement in 2010 that ended a series of decades-long disputes over facility expansions, the market remains highly competitive. With issues surrounding facilities expansions resolved, systems in Columbia have shifted their attention to physician recruitment and acquisition, often in the primary service areas of their competitors. A positive for MCOs, however, is that consolidation of physicians and hospitals could lay the foundation for development of integrated-care systems and the further adoption of coordinated patient-care delivery systems, such as accountable care organizations and patient-centered medical homes. The potential for such programs to reduce long-term medical costs could work in favor of MCOs.

UnitedHealth Group | 2Q 2011 | Health Plan Earnings Summaries

Tue, 26 Jul 2011 00:00:00 GMT

Humana Inc. | National MCO Analyzer | 2011 (Event Driven)

Mon, 25 Jul 2011 00:00:00 GMT

Report Summary: Humana Inc. is betting heavily on its ability to deliver low-cost Medicare Advantage and stand-alone Part D products, partnering with retail giant Wal-Mart Stores and blanketing the country with Medicare Advantage options. Because of the growth in its Part D products, Humana's in-house PBM is carrying much more clout in the marketplace, and may use it to further its aims for re-building its shrinking commercial business.

Spokane | Washington | 2011 | Market Overview (Event Driven)

Thu, 21 Jul 2011 00:00:00 GMT

Report Summary: The provider segment of the Spokane healthcare market is roiling with change as its two health systems consolidate rapidly and form competing integrated delivery systems. Physician groups, worried about the financial toll of healthcare reform in the form of reimbursement cuts and inability to afford the cost of implementing electronic medical record technology are looking for health system partners to help them absorb those costs. There also is movement among providers toward development of reimbursement models that would produce shared savings for providers in exchange for improved efficiency and outcomes. Managed care organizations have not seen a large decline in enrollment, but continued premium increases could hamper enrollment growth. Small groups are seeking to redesign their plans to try to reduce the rate increases that remained in the double-digit percentages this year.

Bluegrass Family Health | Kentucky | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 651 Perimeter Drive Suite 300, Lexington, KY 40517
Products:
URL: http://www.bgfh.com

IASIS Healthcare Corporation | Arizona | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 117 Seaboard Lane, Building E, Franklin, TN 37067
Products: Medicaid, Medicare Advantage
URL: http://www.iasishealthcare.com

Southwest Catholic Health Network | Arizona | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 2800 North Central Avenue Suite 400, Phoenix, AZ 85004
Products: Medicaid, Medicare Advantage
URL: http://www.mercycareplan.com

University Physicians Healthcare | Arizona | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 2502 East University Drive Suite 125, Phoenix, AZ 85034
Products: Medicaid
URL: http://www.mhpaz.org

Phoenix Health Plan/CC | Arizona | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 7878 North 16th Street, Suite 105, Phoenix, AZ 85020
Products: Medicaid
URL: www.phoenixhealthplan.com

Aetna Inc. | Maryland | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Centene Corporation | Indiana | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 7711 Carondelet Avenue, St. Louis, MO 63105
Products: Medicaid
URL: http://www.centene.com

WellPoint, Inc. | Indiana | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity, Rental Network
URL: http://www.wellpoint.com

Kaiser Foundation Health Plans, Inc. | Maryland | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 1800 Harrison Street 8th Floor, Oakland, CA 51098
Products: HMO, PPO, Medicare Advantage, CDHP, Indemnity
URL: http://www.kp.org

Banner Health Arizona | Arizona | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 13632 North 99th Avenue, Suite B, Sun City, AZ 85351
Products: Medicare Advantage
URL: www.bannerhealth.com

Blue Cross and Blue Shield of Arizona, Inc. | Arizona | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 2444 W Las Palmaritas Dr., Phoenix, AZ 85021
Products: HMO, PPO, CDHP, Indemnity, Rental Network
URL: http://www.azblue.com

Care 1st Health Plan | Arizona | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 601 Potrero Grande Dr, Monterey Park, CA 91755
Products: Medicaid, Medicare Advantage
URL: http://www.care1st.com

AvMed Health Plans | Florida | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 9400 S. Dadeland Blvd., Miami, FL 33156
Products: HMO, Medicare Advantage, CDHP
URL: http://www.avmed.org

Aetna Inc. | Florida | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

California Physicians' Service dba Blue Shield of California | California | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 50 Beale Street 23rd Floor, San Francisco, CA 94105
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, CDHP, Indemnity
URL: http://www.blueshieldca.com

Aetna Inc. | California | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Health Net, Inc. | California | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 21650 Oxnard Street, Woodland Hills, CA 91367
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, CDHP, Indemnity
URL: http://www.healthnet.com

Kaiser Foundation Health Plans, Inc. | California | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 1800 Harrison Street 8th Floor, Oakland, CA 51098
Products: HMO, PPO, Medicaid, Medicare Advantage, CDHP, Indemnity
URL: http://www.kp.org

WellPoint, Inc. | California | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

CareFirst, Inc. | District of Columbia | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 10455 Mill Run Circle, Owings Mills, MD 21117
Products: HMO, POS, PPO, CDHP, Indemnity
URL: http://www.carefirst.com

MDWise, Inc. | Indiana | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 3901 West 86th Street, Suite 230, Indianapolis, IN 46268
Products: Medicaid
URL: http://www.mdwise.org

Physicians Health Plan of Northern Indiana, Inc. | Indiana | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 8101 W. Jefferson Blvd., Fort Wayne, IN 46804
Products: HMO
URL: http://www.phpni.com

Southeastern Indiana Health Organization | Indiana | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 417 Washington Street PO Box 1787, Columbus, IN 47202-1787
Products: HMO, POS, CDHP
URL: http://www.siho.org

Medical Associates Clinic and Health Plans | Iowa | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 1500 Associates Drive, Dubuque, IA 52002
Products: HMO, POS
URL: http://www.mahealthcare.com

Wellmark, Inc. | Iowa | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 636 Grand Avenue, Des Moines, IA 50309
Products: HMO, POS, PPO, Medicaid, Indemnity
URL: http://www.wellmark.com

ADVANTAGE Health Solutions, Inc. | Indiana | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 9490 Priority Way West Drive, Indianapolis, IN 46240
Products: HMO, POS, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.advantageplan.com

HealthSpring, Inc. | Illinois | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 9009 Carothers Parkway, Suite 501, Franklin, TN 37067
Products: Medicare Advantage
URL: http://www.healthspring.com

Coventry Health Care, Inc. | Iowa | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 6705 Rockledge Drive, Bethesda, MD 20817
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP
URL: http://www.cvty.com

Family Health Network | Illinois | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 910 West Van Buren, 6th floor, Chicago, IL 60607
Products: Medicaid
URL: www.fhnchicago.com

Aetna Inc. | Illinois | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Kaiser Foundation Health Plans, Inc. | District of Columbia | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 1800 Harrison Street 8th Floor, Oakland, CA 51098
Products: HMO, PPO, CDHP, Indemnity
URL: http://www.kp.org

Blue Cross and Blue Shield of Minnesota | Minnesota | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 3535 Blue Cross Road, Eagan, MN 55122-1154
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Rental Network
URL: http://www.bluecrossmn.com

Colorado Access | Colorado | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 10065 East Harvard Avenue, Denver, CO 80231
Products: Medicaid, Medicare Advantage
URL: http://www.coaccess.com

Denver Health Medical Plan, Inc. | Colorado | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 777 Bannock Street MC 600, Denver, CO 80204
Products: HMO, Medicaid, Medicare Advantage
URL: http://www.denverhealth.org

University Health Care, Inc. | Kentucky | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 305 W. Broadway, Louisville, KY 40202
Products: Medicaid, Medicare Advantage
URL: http://universityhealthcareinc.com

WellPoint, Inc. | Kentucky | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, Indemnity, Rental Network
URL: http://www.wellpoint.com

Aetna Inc. | Maine | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.aetna.com

Harvard Pilgrim Health Care, Inc. | Maine | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 93 Worcester Street, Wellesley, MA 02481-9181
Products: HMO, PPO, CDHP
URL: http://www.harvardpilgrim.org

Humana, Inc. | Kentucky | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

AMERIGROUP Corporation | Georgia | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 4425 Corporation Lane, Virginia Beach, VA 23462
Products: Medicaid
URL: http://www.amerigroupcorp.com

Centene Corporation | Georgia | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 7711 Carondelet Avenue, St. Louis, MO 63105
Products: Medicaid
URL: http://www.centene.com

Humana, Inc. | Georgia | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 500 West Main Street, Louisville, KY 40202
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, CDHP, Rental Network
URL: http://www.humana.com

Kaiser Foundation Health Plans, Inc. | Georgia | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 1800 Harrison Street 8th Floor, Oakland, CA 51098
Products: HMO, PPO, Medicare Advantage, CDHP, Indemnity
URL: http://www.kp.org

Harvard Pilgrim Health Care, Inc. | Massachusetts | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 93 Worcester Street, Wellesley, MA 02481-9181
Products: HMO, PPO, CDHP
URL: http://www.harvardpilgrim.org

Health New England, Inc. | Massachusetts | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: One Monarch Place Suite 1500, Springfield, MA 01144
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, CDHP
URL: http://www.hne.com

Neighborhood Health Plan | Massachusetts | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 253 Summer Street, Boston, MA 02210
Products: HMO, Medicaid
URL: http://www.nhp.org

Boston Med Ctr Health Plan | Massachusetts | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: Two Copley Place, Suite 600, Boston, MA 02116
Products: Medicaid
URL: http://www.bmchp.org

WellCare Group of Companies | Georgia | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 6800 North Dale Mabry Highway Suite 270/299, Tampa, FL 33614
Products: Medicaid, Medicare Advantage
URL: http://www.wellcare.com

WellPoint, Inc. | Georgia | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 120 Monument Circle, Indianapolis, IN 46204
Products: HMO, POS, PPO, Medicare Advantage, Medicare PDP, Indemnity
URL: http://www.wellpoint.com

Triton Health Systems, LLC | Alabama | 2011 | Plan Profile

Wed, 20 Jul 2011 00:00:00 GMT

Address: 1222 14th Avenue South, Birmingham, AL 35205
Products: HMO, Medicare Advantage
URL: http://www.vivahealth.com

Aetna Inc. | Alabama | 2011 | Plan Profile

Tue, 19 Jul 2011 00:00:00 GMT

Address: 151 Farmington Avenue, Hartford, CT 06156
Products: HMO, PPO, Medicare PDP, Indemnity
URL: http://www.aetna.com

Northern New Jersey | New Jersey | 2011 | Market Overview (Event Driven)

Mon, 18 Jul 2011 00:00:00 GMT

Report Summary: Northern New Jersey is a fragmented market for health systems and physicians, but managed care organizations are consolidated, giving them the edge in contract negotiations. While the financial performance of health systems and hospitals has improved, profit margins are low and many challenges remain. The health system sector is moving toward more consolidation through ownership changes and collaborative service agreements. This survival-of-the-fittest atmosphere and the need to reduce costs are driving other trends, such as hospital employment of physicians and the development of accountable care organizations and patient-centered medical homes. Managed care organizations are taking steps to reward providers for quality of care rather than quantity of care, and employers are shifting more costs to workers.

Norfolk | Virginia | 2011 | Market Overview (Event Driven)

Fri, 15 Jul 2011 00:00:00 GMT

Report Summary: Although Virginia officials, including Attorney General Ken Cuccinelli, have been opponents of federal healthcare reform, the state has been gradually preparing for an influx of newly insured residents when health exchanges become operable and Medicaid eligibility requirements are lowered in 2014. Health systems in the Norfolk market are also showing signs of preparation as they increase emergency room capacity to meet expected demand and as they increase the size of their physician networks. Meanwhile, commercial health plan enrollment growth has been stagnant as economic recovery has been slow. The two largest managed care organizations, WellPoint's Anthem Blue Cross and Blue Shield of Virginia and Sentara Healthcare's Optima Health Plan, continue to dominate the health plans sector and have broadened their consumer-directed health plan product offerings as employer demand for lower-cost options continues to rise.

Pharmacy Benefit Evaluator 2.0 | Product Manual | January 2011

Mon, 11 Jul 2011 00:00:00 GMT

Grand Rapids | Michigan | 2011 | Market Overview (Event Driven)

Mon, 11 Jul 2011 00:00:00 GMT

Report Summary: Grand Rapids is fast becoming a healthcare megalopolis with its downtown Medical Mile nexus of research institutes and acute-care hospitals and its stated ambition of becoming a medical tourism destination. The region is dominated by Spectrum Health, but its smaller rivals have banded together to challenge that supremacy by creating the Pennant Health Alliance. Physicians are beginning to consolidate into larger groups as well and this integration will bode well for the potential creation of accountable care organizations in the next year. The local health insurance market is dominated by Priority Health, which is expected to grow as a result of local unemployment rates dipping below state and national rates.

Market Overview Interactive Database

Fri, 01 Jul 2011 00:00:00 GMT

Harrisburg | Pennsylvania | 2011 | Market Overview (Event Driven)

Thu, 30 Jun 2011 00:00:00 GMT

Report Summary: All the major players in the market are designing their strategies to prepare for the major overhauls underway in healthcare reform. Some health systems are benefiting from reclassifications in the Medicare wage index, resulting in additional revenues. But the reimbursement environment isn’t all positive, and growth continues in low-reimbursement government plans and high-deductible health plans. Also, some hospitals in the region are seeing declining demand for healthcare services because of a poor economic climate and strong competition from smaller medical facilities. The market is still without a regional health information exchange, although the state is making significant headway in this area.

Los Angeles | California | 2011 | Market Overview (Event Driven)

Thu, 30 Jun 2011 00:00:00 GMT

Report Summary: Hospitals and physicians have proven they can work together to gain leverage in the HMO-dominant Los Angeles market. Both agree that they must come together to control costs and respond to federal healthcare reform. How they do that is a different story. While an emerging medical foundation model will allow for physician employment and help smaller, community-based hospitals become stronger players in Los Angeles and Ventura counties, a healthy contingent of physicians is not taking the bait. One result may be the development of distinct accountable-care-organization models in Los Angeles and Ventura counties. Health plans, employers and consumers, too, are looking for ways to reduce the cost of coverage. For pharma, a relatively negative sales environment may be buoyed by innovative delivery channels and an expansion of the state’s Medicaid program.

Executive Briefing | Health Plans in 2011: Technology, Baby Boomers and Where We Go From Here | June 2011

Mon, 27 Jun 2011 00:00:00 GMT

A recap of the America’s Health Insurance Plans annual meeting and trade show and the most talked about topics facing health plans in 2011.

Formulary Advantages in Immune Biologic Therapies: Health plans' support for certain drug attributes drive formulary coverage for immune biologic brands.

Mon, 27 Jun 2011 00:00:00 GMT

Report Summary: The market for immune biologics has grown increasingly crowded in recent years with the launches of newer brands such as Simponi, Cimzia, and Stelara looking to take share away from longer-marketed products such as the TNF-alpha inhibitors Enbrel and Humira, as well as Remicade. Despite some of the advantages of newer therapies, commercial and Medicare plans continue to favor longer-marketed products that have known efficacy and safety/tolerability track records. Tiering data from Fingertip Formulary show that health plans have increased their advantaged tier coverage (Tier 1 or 2 placement) for some of these newer therapies in the past year, but plans continue to offer the best tier positions to the longer-marketed brands. Importantly, surveyed health plans report that increased spending on prescription drugs for rheumatoid arthritis, Crohn's disease, and psoriasis over the past five years have not resulted in flat or lower costs for non-drug (i.e., medical) expenses. This finding suggests that plans are not seeing the desired results for greater prescription drug costs and may make them more interested in TNF-alpha inhibitors and drugs that feature an alternative mechanism of action (MOA) that can reduce medical costs. 26% of surveyed plans report that they favor a single TNF-alpha inhibitor brand for treating RA, and they are split between Enbrel and Humira. A survey of pharmacy directors resulted in similar findings for therapies with an alternative MOA.

Colorado Springs | Colorado | 2011 | Market Overview (Event Driven)

Tue, 21 Jun 2011 00:00:00 GMT

Report Summary: Although Colorado Springs has a relatively active and healthy population, its economy is under the weather. With the exception of the military and science and technology related sectors, unemployment remains high and businesses are still feeling the recession, leading them to downscale or drop medical and prescription drug coverage for employees. The situation has insurers looking for ways to keep small businesses from dropping insurance altogether. Meanwhile, Colorado Springs’ largest hospital may finally have its ownership status resolved this fall after years of debate. Residents are poised to decide in November whether Memorial Health System should remain a city-owned entity or convert to an independent nonprofit.

Charlotte | North Carolina | 2011 | Market Overview (Event Driven)

Mon, 20 Jun 2011 00:00:00 GMT

Report Summary: In the Charlotte market, health plans in are increasingly moving toward performance-based contracting, and so we expect to see greater coordination and consolidation among the region’s health systems and physicians as they strive for better quality and efficiency. Health systems here are also expanding considerably, even as the economy shows slow growth. Areas of the market that have continued to see population growth and have weathered the recession, such as the Fort Mill area of South Carolina, will continue to be a hotbed for competition between health systems.

Greenville | South Carolina | 2011 | Market Overview (Event Driven)

Tue, 14 Jun 2011 00:00:00 GMT

Report Summary: In Greenville, health system acquisition of physician groups continues at a rapid pace, growing the four largest health systemsÕ networks and giving them more power in future negotiations with health plans. Medicaid in South Carolina has required all beneficiaries to enroll in managed care, giving an enrollment boost to MCOs. But lawmakers cut provider rates, leaving hospitals in the market dealing with increased financial pressures after the turmoil of recession and physicians wondering if they will need to stop seeing Medicaid patients.

Providence | Rhode Island | 2011 | Market Overview (Event Driven)

Fri, 10 Jun 2011 00:00:00 GMT

Report Summary: The Providence healthcare market, which spans Rhode Island and southeastern Massachusetts, is being shaped by a dedicated health insurance commissioner and an executive branch commission led by the lieutenant governor that has already introduced legislation to form a health insurance exchange. The market also has a patient-centered medical home project, now in its third year, which has reported demonstrable success in improving patient outcomes and cutting costs. Some of those cost savings are coming from tiered prescription drug formularies, and the state Medicaid program has gone to an all-generic preferred drug list.

West | Regional Intelligence Briefing | Spring | 2011

Fri, 27 May 2011 00:00:00 GMT

Regional Intelligence Briefings are semi-annual Webinar-based presentations from HealthLeaders-InterStudy analysts. The presentations focus on commercial, provider, care management and healthcare reform trends for five different regions throughout the United States. The presentations draw upon insights from Health Plan Analysis, Market Overview and Patient Finder products.

Recorded Playback Link:
West Regional Intelligence Briefing

Central | Regional Intelligence Briefing | Spring | 2011

Fri, 27 May 2011 00:00:00 GMT

Recorded Playback Link:
Central Regional Intelligence Briefing

Mid-Atlantic | Regional Intelligence Briefing | Spring | 2011

Fri, 27 May 2011 00:00:00 GMT

Recorded Playback Link:
Mid-Atlantic Regional Intelligence Briefing

Northeast | Regional Intelligence Briefing | Spring | 2011

Fri, 27 May 2011 00:00:00 GMT

Recorded Playback Link:
Northeast Regional Intelligence Briefing

Southeast | Regional Intelligence Briefing | Spring | 2011

Fri, 27 May 2011 00:00:00 GMT

Recorded Playback Link:
Southeast Regional Intelligence Briefing

The Health Plan of the Upper Ohio Valley, Inc. | West Virginia | 2011 | Plan Profile

Thu, 26 May 2011 00:00:00 GMT

Address: 52160 National Road East, St. Clairsville, OH 43950
Products: HMO, POS, PPO, Medicaid, Medicare Advantage, Medicare PDP
URL: http://www.healthplan.org

University of Utah Health Plans | Utah | 2011 | Plan Profile

Thu, 26 May 2011 00:00:00 GMT

Address: PO Box 45180, Salt Lake City, UT 84145
Products: Medicaid
URL: http://www.uuhsc.utah.edu/uhealthplan

WellCare | 1Q 2011 | Health Plan Earnings Summaries

Thu, 26 May 2011 00:00:00 GMT

Amerigroup | 1Q 2011 | Health Plan Earnings Summaries

Wed, 25 May 2011 00:00:00 GMT

CommunityCare Managed Healthcare Plans of Oklahoma | Oklahoma | 2011 | Plan Profile

Wed, 25 May 2011 00:00:00 GMT

Address: 218 W. 6th St., Tulsa, OK 74119
Products: HMO, POS, Medicare Advantage, Rental Network
URL: http://www.ccok.com

HealthSpring | 1Q 2011 | Health Plan Earnings Summaries

Tue, 24 May 2011 00:00:00 GMT

CIGNA | 1Q 2011 | Health Plan Earnings Summaries

Tue, 24 May 2011 00:00:00 GMT

Formulary Advantages in Hepatitis C: Despite the near certainty of emerging oral protease inhibitors, pharmacy directors remain unsure of the...

Fri, 20 May 2011 00:00:00 GMT

Report Summary: According to the American Liver Foundation, 4 million Americans, or 1.8% of the population, are or have been infected with the hepatitis C virus. Approximately 70% of infected persons will develop a chronic infection that may progress to liver cirrhosis, hepatocellular carcinoma or even end-stage liver disease requiring transplantation. The United Network for Organ Sharing (UNOS) reports that healthcare costs during the year surrounding liver transplantation surgery can exceed $500,000. And while emerging therapies for the treatment of hepatitis C demonstrate superior sustained virologic response (SVR) rates compared with current therapies, our survey data suggest plans remain skeptical about the economic and clinical benefits of emerging therapies. Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of therapies for hepatitis C, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Denver | Colorado | 2011 | Market Overview (Event Driven)

Wed, 18 May 2011 00:00:00 GMT

Report Summary: Denver has a big head start when it comes to healthcare given its healthy and wealthy population. The payoff is seen in its highly profitable hospitals, which have the added benefit of a renowned public hospital to provide care for DenverÕs plentiful uninsured, allowing private hospitals to spend their dollars solidifying market dominance through expansions. Health plans are also racking up surpluses as commercial enrollment grows. Benefitting less are employers, whose health insurance premiums are higher and increasing faster than the national average, and pharmaceutical companies, which face not only the lowest demand for their products of any state in the country but a crackdown on their relationships with physicians by both legislators and hospitals.

Executive Briefing | ACO Regulations Put Spotlight On 65 Indicators For Care Delivery | May 2011

Tue, 17 May 2011 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive brief on ACO Regulations.

Aetna | 1Q 2011 | Health Plan Earnings Summaries

Mon, 16 May 2011 00:00:00 GMT

Health Net | 1Q 2011 | Health Plan Earnings Summaries

Wed, 11 May 2011 00:00:00 GMT

Coventry | 1Q 2011 | Health Plan Earnings Summaries

Tue, 10 May 2011 00:00:00 GMT

Humana | 1Q 2011 | Health Plan Earnings Summaries

Tue, 10 May 2011 00:00:00 GMT

WellPoint | 1Q 2011 | Health Plan Earnings Summaries

Thu, 05 May 2011 00:00:00 GMT

Centene | 1Q 2011 | Health Plan Earnings Summaries

Thu, 05 May 2011 00:00:00 GMT

Executive Briefing | A Medical Home For All? Physicians And Payers Transforming Primary Care | April 2011

Fri, 29 Apr 2011 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive brief on Medical Homes.

White Paper | Regional Managed Care Trends, Healthcare Reform Highlight Advisory Services | April 2011

Fri, 29 Apr 2011 00:00:00 GMT

HealthLeaders-InterStudy periodically publishes special analyst reports on healthcare topics of interest.

Molina | 1Q 2011 | Health Plan Earnings Summaries

Wed, 27 Apr 2011 00:00:00 GMT

UnitedHealth Group | 1Q 2011 | Health Plan Earnings Summaries

Tue, 26 Apr 2011 00:00:00 GMT

Wilmington | Delaware | 2011 | Market Overview (Event Driven)

Thu, 14 Apr 2011 00:00:00 GMT

Report Summary: Christiana Care Health System and Nemours Delaware Valley/Alfred I. DuPont Hospital for Children are expanding capacity while working overtime to strengthen the partnerships they have with physicians in an effort to secure valuable referrals. A proposed affiliation between Blue Cross Blue Shield of Delaware and dominant Pennsylvania insurer Highmark Blue Cross Blue Shield would allow the local Blue plan to strengthen investments in technology and operate more efficiently. This alliance is not a certainty, however, because it must be approved by Delaware officials. We expect employers will continue shifting higher costs to workers through consumer-driven health plans. We also expect to see greater demands for emergency services as cuts to Medicaid benefits seem inevitable and unemployment remains high.

Formulary Advantages in Therapies for Multiple Sclerosis: Health plans await the arrival of orally administered therapies to compete with existing brands

Thu, 31 Mar 2011 00:00:00 GMT

Report Summary: With increased diagnosis rates and higher drug prices for multiple sclerosis (MS), U.S. health plans have grown more focused on their coverage of and spending on MS therapies. Partly because of the profile of typical MS patients (younger and otherwise healthier than Medicare beneficiaries), private and Medicare plans tend to use different strategies in reimbursing for MS therapies. Private plans cover the therapies we analyze in this report on a lower tier and with fewer restrictions, resulting in increased access to these drugs for beneficiaries. An analysis of commercial and Medicare plans' formulary treatment of beta-interferon (beta-IFN) and other MS therapies shows that Medicare plans, especially larger ones, are aggressively restricting access to top-selling therapies such as Teva's Copaxone (glatiramer acetate), Bayer HealthCare's Betaseron (beta-IFN-1b), and Novartis's Avonex (beta-IFN-1a) through use of higher tiers and increased prior authorization. In addition, both commercial and Medicare plans have started making coverage decisions about the recently launched therapies Acorda Therapeutics/Biogen Idec's Ampyra (dalfampridine) and Novartis's Gilenya (fingolimod); these decisions could augur the market potential of these drugs as well as the prospects for emerging therapies.

A survey of pharmacy directors suggests that plans expect the cost of MS therapies to increase over the next five years, but national plans expect a slower climb or potential decrease as biosimilars enter the market. Health plans are expecting to increase their use of restrictions on existing brands once biosimilar versions of beta-IFNs reach the market (as soon as 2015), potentially affecting the tier status of some top-selling therapies. For emerging therapies, health plans report they will likely reimburse for these therapies, including orally administered ones that may compete with Gilenya. However, the high cost of these agents will likely drive plans to not reimburse for new drugs on an advantaged tier and restrict access to many of them. Surveyed plans do not indicate that they see much differentiation among the new therapies, but their concerns about cost may drive them to reward only a few drugs with better tier placement in exchange for better discounts and rebates.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of MS therapies, the drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Alabama Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Arizona Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Connecticut Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Washington, D.C., Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Florida Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Georgia Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Indiana Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Kentucky Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Louisiana Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Oregon Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Rhode Island Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

South Carolina Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Tennessee Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Texas Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Wisconsin Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Vermont Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Virginia Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Missouri Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Nevada Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Washington Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

California Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Colorado Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Illinois Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Iowa Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Kansas Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Maine Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Michigan Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Minnesota Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

New Hampshire Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

New Jersey Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

New York Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

North Carolina Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Ohio Health Plan Data (Physicians)

Thu, 31 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Honolulu | Hawaii | 2011 | Market Overview (Event Driven)

Wed, 30 Mar 2011 00:00:00 GMT

Report Summary: The Honolulu market is not waiting for national healthcare reform deadlines and has begun to implement various tenets of the Patient Protection and Affordable Care Act. Most notably, the market’s largest health insurer—Hawaii Medical Service Association—has teamed up with health systems in Honolulu and Hawaii at large to begin the creation of the patient-centered medical home model of care. Through the model, 15 percent of HMSA’s reimbursements to health systems will be tied to quality and patient care. Look for continued medical home expansion and collaboration among insurers and health systems, along with the utilization of electronic medical records to help coordinate care among Hawaii’s limited number of physicians. As the PCMH model of care becomes more popular, the need for physicians in the Aloha State will grow. Hawaii is currently short around 500 physicians, and an aging population is increasing the need for primary care in the state.

Pennsylvania Health Plan Data (Physicians)

Tue, 29 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Maryland Health Plan Data (Physicians)

Tue, 29 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Massachusetts Health Plan Data (Physicians)

Mon, 28 Mar 2011 00:00:00 GMT

Health plan data offers comprehensive statewide data and information for trending and planning.

Formulary Advantages in Dyslipidemia: Will outcomes data dominate the reimbursement landscape for dyslipidemia?

Fri, 18 Mar 2011 00:00:00 GMT

Report Summary: The significant impact of cardiovascular disease on human morbidity and mortality alongside the proven efficacy of many lipid-modifying therapies drives both the aggressive treatment of dyslipidemia by physicians and the generous reimbursement of therapies among U.S. health plans. Some branded therapies continue to receive generous reimbursement from health plans despite the availability of in-class generics because they possess highly valued qualities or capabilities such as improved risk reduction, higher potency or better tolerability. A number of upcoming events may reshape the reimbursement landscape for dyslipidemia including generic entry of Pfizer's blockbuster statin, Lipitor (atorvastatin), in 2012 and the likely emergence of two first-in class therapies, Genzyme/Isis' mipomersen and Roche's dalcetrapib. Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of therapies for dyslipidemia, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

CareMore Health Plan | California | 2011 | Plan Profile

Tue, 15 Mar 2011 00:00:00 GMT

Address: 18000 Studebaker Road Suite 100, Cerritos, CA 90703
Products: Medicare Advantage
URL: http://www.caremore.com

Chinese Community Health Plan | California | 2011 | Plan Profile

Tue, 15 Mar 2011 00:00:00 GMT

Address: 170 Columbus Avenue Suite 210, San Francisco, CA 94133
Products: HMO, Medicare Advantage
URL: http://www.cchphmo.com

CIGNA HealthCare | Wisconsin | 2011 | Plan Profile

Mon, 14 Mar 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

University Family Care | Arizona | 2011 | Plan Profile

Mon, 14 Mar 2011 00:00:00 GMT

Address: 575 E. River Road, Tucson, AZ 85704
Products: Medicaid
URL: www.universityfamilycare.com

Centene Corporation | Arizona | 2011 | Plan Profile

Thu, 10 Mar 2011 00:00:00 GMT

Address: 7711 Carondelet Avenue, St. Louis, MO 63105
Products: Medicaid, Medicare Advantage
URL: http://www.centene.com

Southern Connecticut | Connecticut | 2010 | Market Overview (Event Driven)

Wed, 02 Mar 2011 00:00:00 GMT

Report Summary: Southern Connecticut is something of an anomaly in the state, an affluent region more aligned with New York City than with the rest of Connecticut. The market combines affluent Fairfield County, home to New York City commuters and Fortune 500 companies, with New Haven County, centered on Yale University the elite Yale New Haven Health System. Contract negotiations between health plans and providers are somewhat fractious in this market, and may become more so with a recent health plan acquisition, while important legislative changes could include creation of a public option to compete with private plans.

WellCare | 4Q 2010 | Health Plan Earnings Summaries

Tue, 01 Mar 2011 00:00:00 GMT

Amerigroup | 4Q 2010 | Health Plan Earnings Summaries

Fri, 25 Feb 2011 00:00:00 GMT

HealthSpring | 4Q 2010 | Health Plan Earnings Summaries

Fri, 25 Feb 2011 00:00:00 GMT

Molina | 4Q 2010 | Health Plan Earnings Summaries

Wed, 23 Feb 2011 00:00:00 GMT

Raleigh | North Carolina | 2011 | Market Overview (Event Driven)

Tue, 22 Feb 2011 00:00:00 GMT

Report Summary: Cancer care is a chief concern in Raleigh, and there is an acute awareness among providers and managed care organizations of the need to develop additional facilities and services to treat a growing number of patients. The state has high cancer rates compared with national levels, and Raleigh leads the state in these statistics. The area’s dominant health systems, UNC Health Care and Duke University Health System, are increasing capacity through the development of major new cancer facilities. The power structure in this market is strongly tilting toward the consolidated and highly influential health systems, which are positioned to develop accountable care organizations, wellness programs and medical homes.

Centene | 4Q 2010 | Health Plan Earnings Summaries

Fri, 18 Feb 2011 00:00:00 GMT

Coventry | 4Q 2010 | Health Plan Earnings Summaries

Wed, 16 Feb 2011 00:00:00 GMT

Humana | 4Q 2010 | Health Plan Earnings Summaries

Sat, 12 Feb 2011 00:00:00 GMT

CIGNA | 4Q 2010 | Health Plan Earnings Summaries

Thu, 10 Feb 2011 00:00:00 GMT

Aetna | 4Q 2010 | Health Plan Earnings Summaries

Wed, 09 Feb 2011 00:00:00 GMT

Health Net | 4Q 2010 | Health Plan Earnings Summaries

Fri, 04 Feb 2011 00:00:00 GMT

WellPoint | 4Q 2010 | Health Plan Earnings Summaries

Tue, 01 Feb 2011 00:00:00 GMT

Executive Briefing | Top Managed Care Trends for 2011 | January 2011

Mon, 31 Jan 2011 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive brief on Top Managed Care Trends for 2011.

UnitedHealth Group | 4Q 2010 | Health Plan Earnings Summaries

Wed, 26 Jan 2011 00:00:00 GMT

Pharmacy Benefit Evaluator 2.0 | Product Manual | July 2010

Mon, 17 Jan 2011 00:00:00 GMT

Description

CIGNA HealthCare | Georgia | 2011 | Plan Profile

Mon, 17 Jan 2011 00:00:00 GMT

Address: 900 Cottage Grove Rd. Suite 314, Hartford, CT 06002
Products: HMO, POS, PPO, Medicare Advantage, CDHP, Indemnity, Rental Network
URL: http://www.cigna.com

Market Overview | 2011 | Release Schedule

Mon, 10 Jan 2011 00:00:00 GMT

Webinar | National MCOs: A Year to Remember and a Look Ahead to 2011

Thu, 06 Jan 2011 00:00:00 GMT

Recorded Playback Link:
National MCOs: A Year to Remember and a Look Ahead to 2011

Managed care plans have encountered monumental developments over the past few months—the passage of health reform and the continuing effects of the recession on health insurance enrollment and benefits. At the same time, pressure from employers and individuals to keep costs low has signaled a shift into deeper medical management.

This first-ever webinar about this 12-report series provides a look at the products/services, strategies and competitive landscape among the top national publicly held plans, along with nonprofit players Health Care Service Corp. and Kaiser Permanente. In this session, the presenters discuss:

Medical and pharmacy product design updates and how those might look in 2011
Strategies related to Medicaid and Medicare markets and where opportunities lie
Developments in care management
How merger and acquisition activity could play out in 2011

Presenters: Jane DuBose, Product Director
Rebecca Waller, Senior Health Plan Data Analyst

Pharmacy Benefit Evaluator 2.0 | Data | January 2011

Sat, 01 Jan 2011 00:00:00 GMT

Pharmacy Benefit Evaluator 2.0 | Parent & Child Relationship | January 2011

Sat, 01 Jan 2011 00:00:00 GMT

Description

Employer Vantage

Sat, 01 Jan 2011 00:00:00 GMT

Employer influence on the prescribing of brand name drugs is increasing, making understanding employer health benefits more important than ever. For some regions, direct-to-employer sales strategies are vital to growth, especially in areas where the largest employers are self-insured.

What benefits are employers offering? Which insurers are providing them? Who are the largest employers in an MSA? Employer Vantage makes the connections to inform targeted planning strategies, including sales force allocation and partnership development.

Pharmacy Benefit Evaluator 2.0

Sat, 01 Jan 2011 00:00:00 GMT

With comprehensive analysis of national and local health plans’ pharmacy benefit structure and spending, Pharmacy Benefit Evaluator provides the insights needed to identify plans and pharmacy benefit managers (PBMs) that offer the greatest return for partnering.

Who controls a plan’s formulary?

How does a plan compare with other plans on co-pays, spending and benefit design?

Where are PBMs exerting the greatest formulary controls?

Pharmacy Benefit Evaluator delivers the answers.

Please note:

In order to make companies and managed care organizations easier to find within our data products, HealthLeaders-InterStudy has started using alternate company and MCO names within its products. These names remain close to the names users have been viewing in previous data releases, but have been standardized for ease in searching in dropdown boxes and lists.

Managed Market Surveyor

Sat, 01 Jan 2011 00:00:00 GMT

Description:

Managed Market Surveyor delivers medical benefit enrollment data by managed care organization and geography to better inform strategic planning and resource allocation. Relying on primary research and HealthLeaders-InterStudy’s proprietary validation methodology, Managed Market Surveyor provides an accurate look at how medical lives are covered.

View data by:

Geographic level—national, state, MSA, county

Managed care organization

Plan and funding type

Please note:

Managed Market Surveyor Rx

Sat, 01 Jan 2011 00:00:00 GMT

Description:

Managed Market Surveyor-Rx delivers medical and pharmacy benefit enrollment data by managed care organization and geography to better inform strategic planning and resource allocation. Relying on primary research and HealthLeaders-InterStudy’s proprietary validation methodology, Managed Market Surveyor-Rx provides the most accurate managed care database available.

View data by:

Geographic level—national, state, MSA

Managed care organization

Plan and funding type

Please note:

Formulary Advantages in Oral Oncology Drugs: Health plans respond to generic entry, base formulary decisions on survival data

Thu, 30 Dec 2010 00:00:00 GMT

Report Summary: Private and Medicare plans will continue their receptiveness to oral oncology therapies over the next five years, but anticipated increases in coinsurance rates and copays will shift more of the cost burden to beneficiaries. An analysis of commercial and Medicare plans’ formulary treatment of solid-tumor and hematological tumor therapies shows that payers within different channels follow divergent tiering strategies. For breast cancer and other solid-tumor cancer therapies, commercial plans are more likely to cover the therapies on an advantaged tier, while larger-than-average plans remain the most favorable to these therapies across both channels. This trend has benefited emerging therapies such as GlaxoSmithKline’s Votrient (pazopanib), which launched in the summer of 2010 and now enjoys favorable tiering on 48% of plans. Meanwhile, the rise of a generic version of AstraZeneca’s Arimidex (anastrozole) will make the breast cancer market more challenging as drug marketers increasingly must find justification for charging branded therapy prices.

For emerging therapies, health plans appear mostly receptive and will likely cover these newer treatments as a pharmacy benefit. However, these plans are interested in new drugs’ data regarding overall survival and progression-free survival, which could drive tiering strategies for these new therapies. In addition to quality data, marketers of these emerging therapies must consider prices for their products, as surveyed plans report that oral agents used in oncology represent a disproportionately growing percentage of their prescription drug spending. Three emerging therapies surveyed – Boeringer Ingelheim’s Tovok (BIBW-2992), Pfizer’s axitinib and Pfizer’s neratinib – will enter a marketplace that features multiple brands already entrenched on Tier 1 or 2. In order to obtain comparable formulary coverage, surveyed results show that these therapies must be priced competitively with existing products while also offering comparable or better outcomes measures.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 44 pharmacy directors, this report determines the key trends in reimbursement of oral oncology therapies, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

HPDA Test Multi-State

Tue, 21 Dec 2010 00:00:00 GMT

Description

North & South Carolina | Fall | 2010 | Health Plan Analysis

Tue, 21 Dec 2010 00:00:00 GMT

Report Summary: The recent renewal cycle was especially challenging for employers in the Carolinas, owing to the poor economy and new requirements under federal healthcare reform. Carriers continued to increase copays and coinsurance to slow the healthcare cost trend, but as premiums continue to rise, insurers may begin to look at alternatives such as narrow networks. The Blue plans in North and South Carolina, meanwhile, are expanding the number of patient-centered medical homes for their members. Results from a yearlong study of a medical home in Charleston, S.C., revealed medical and pharmacy cost savings and reductions in hospitalizations and emergency-room visits for participants. Seeing an influx of new Medicaid beneficiaries, South Carolina has requested approval from the Center for Medicare & Medicaid Services to make it mandatory for most recipients to move to managed care. The program is also making benefit cuts, including a reduction in the allowed number of prescriptions each month, and says provider payments could end in the spring if the agency can't run a deficit or make additional cuts.

Pennsylvania-Mid-Atlantic | Fall | 2010 | Health Plan Analysis

Tue, 21 Dec 2010 00:00:00 GMT

Report Summary: A still-struggling economy has done nothing to improve commercial enrollment trends in the Pennsylvania-Mid-Atlantic region. Consumers and employers are increasingly turning to consumer-directed health plan options, which have seen significant enrollment gains, allowing insurers in some instances to offset lackluster enrollment in other commercial plan designs. Virginia is expanding its Medicaid program to 16 additional counties and while it's hoped the expansion will lead to cost savings for the state, it's not likely to be enough and the adjustments to the state's prescription drug list are likely. In Pennsylvania, one of the state's major Blue plans has reworked its small-group offerings, embedding pharmacy benefits within its medical plans.

Oregon & Washington | Fall | 2010 | Health Plan Analysis

Mon, 20 Dec 2010 00:00:00 GMT

Report Summary: The commercial market in Oregon and Washington is seeing an increase in cost sharing with high-deductible plans and higher premiums. Employers are trying to control rising costs by implementing innovative plan designs that improve employee wellness and encourage members to make smart healthcare decisions. Medicare Advantage private-fee-for-service plans have exited most of the Oregon and Washington market. Other companies are seizing opportunity where PFFS exits have forced seniors to choose new plans. The Medicare Advantage Plan star rating system will factor into plan reimursement rates in 2012. Plans are ramping up to improve star ratings by hiring additional staff and using incentives to help members make healthier choices. The Oregon and Washington state Medicaid programs use disease management programs aimed at helping members take control of their healthcare outcomes by seeing their primary-care physicians regularly and adhering to drug therapies. Both states use vendors that are actively involved in managing the programs. The Oregon Coalition of Healthcare Purchasers is teaming up with Pfizer to help employers design and implement value-based insurance design. Pfizer will analyze the data and make recommendations to the employer groups about their plan designs. A recent report examines Group Health Cooperative's medical home pilot in Washingon. The report outlines benefits and challenges of patient-centered medical homes.

Texas | Fall | 2010 | Health Plan Analysis

Fri, 17 Dec 2010 00:00:00 GMT

Report Summary: Texas employers are making only minor benefit changes to retain grandfathered status, including small increases to drug copays. The next state budget includes a major expansion of managed Medicaid and would carve in the drug benefit, giving MCOs more control over drug benefit administration. HealthSpring's planned purchase of Bravo Health could shake up the Medicare market by giving the insurer entrance to El Paso and San Antonio.

Webinar | MMS Rx | Staying Ahead of the Game in an Uncertain Economy

Thu, 16 Dec 2010 00:00:00 GMT

The Medicaid program enrollment has soared, adding another 1.8 million enrollees in the first half of the year. Although employment trends have stabilized, healthcare costs are still rising and company funds are still tight, contributing to the MCO commercial enrollment decline of nearly 1.9 million between January and July 2010.

Formulary Advantages in Therapies for Type II Diabetes: Crowding among anti-diabetic agents necessitates brand differentiation

Wed, 15 Dec 2010 00:00:00 GMT

Report Summary: Type 2 diabetes is a leading cause of cardiovascular disease, blindness, renal failure and neurologic dysfunction in the United States. Current epidemiologic studies estimate that nearly 24 million Americans have type 2 diabetes and another 57 million have impaired glucose tolerance known as "pre-diabetes." On the whole, therapies for the treatment of type 2 diabetes receive widespread, restriction-free reimbursement on low formulary tiers because health plans understand the value of early and aggressive glycemic control. Nonetheless, patent expiry of several branded anti-diabetic therapies over the next three years, most-notably Takeda's Actos, will not only lead to in-class generic erosion, but will likely negatively impact reimbursement of all branded oral therapies and GLP-1 inhibitors.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 44 pharmacy directors, this report determines the key trends in reimbursement of type 2 diabetes treatments, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Wisconsin & Minnesota | Fall | 2010 | Health Plan Analysis

Wed, 15 Dec 2010 00:00:00 GMT

Report Summary: Health plans in Wisconsin and Minnesota are rolling out new suites of wellness products that offer premium discounts, among other perks, for hitting specified wellness targets. Minnesota's State Employee Group Insurance Program has rolled out a medication therapy management program, which is designed to improve prescription drug adherence and compliance for members who are taking at least four maintenance drugs to treat two different conditions. In addtion, commercial health plans in Wisconsin and Minnesota have turned toward value-based pharmacy benefits, coupled with MTM efforts, for employer groups. On the Medicare front, Humana stands to gain membership in a stand-alone prescription drug plan it is launching in conjunction with Wal-Mart. Meanwhile, Minnesota has made headway in its statewide patient-centered medical home initiative, certifying participating clinics and formulating a payment structure.

TriState | Fall | 2010 | Health Plan Analysis

Tue, 14 Dec 2010 00:00:00 GMT

Report Summary: New York health plans are under more pressure than ever to keep a lid on rates, but their requests for premium increases have been curtailed under the new prior approval law. As one alternative, carriers are trotting out innovative new plan designs to lower the cost for employers. Despite the challenging economy, MVP Health Care has entered the Buffalo market to compete with three entrenched insurance carriers. In New Jersey, Horizon Blue Cross Blue Shield has agreed in a settlement not to sell a controversial new plan design in the large-group market that caps its claims liability on out-of-network ambulatory surgical centers. For the Medicare segment, plan offerings have been streamlined in both the Medicare Advantage and Part D programs, while some operators are making bold moves in prescription drug offerings. On the healthcare reform front, TriState carriers are having to remove annual limitations on pharmacy benefits, which is in some cases resulting in small premium increases for employers. New York insurers have to live under a new law that prohibits them from establishing separate pricing tiers for specialty drugs in the regulated individual and small-group insurance segments. The TriState delves into the latest wellness trends, while some New York plans test a system of bundling medical payments.

News for South Dakota

Mon, 13 Dec 2010 05:00:00 GMT

Florida | Fall | 2010 | Health Plan Analysis

Mon, 06 Dec 2010 00:00:00 GMT

Report Summary: In the face of reimbursement pressures and uncertainty, Florida's Medicare and Medicaid insurers have tweaked their offerings as part of strategies to continue enrollment growth while the state's commercial market lags amid a weak job market. Florida's Medicare HMOs have responded to tighter reimbursements and intense competition in some parts of the state by diversifying their product offerings and entering new markets. Medicaid vendors are doing the same, but the threat of payment cuts from the state limits their ability to expand further.

Formulary Advantages in Analgesics for Chronic Pain: How will emerging reformulations and fixed-dose combinations fare among U.S. health plans?

Wed, 01 Dec 2010 00:00:00 GMT

Report Summary: Chronic pain syndromes of neuropathic, nociceptive and mixed origins cause substantial human suffering and disability. Despite the number of pain therapies marketed in the U.S., there remains an unfilled need for drugs that provide improved efficacy, safety and tolerability. Branded reformulations and fixed-dose combinations of previously marketed active molecules provide increased convenience, safety and tolerability for patients; however, health plans often have difficulty gauging the value of these qualities, especially when efficacy is equivalent, compared with the lower cost-burden of generic alternatives. Further, the subjective nature of assessing pain outcomes, compared with other conditions that are monitored by laboratory testing and imaging, and increasing brand crowding within the pain market means that marketers bear a greater responsibility to differentiate the value of their drug to health plans in order to receive widespread reimbursement.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 47 pharmacy directors, this report determines the key trends in reimbursement of analgesics for chronic pain, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition and provides insight for stakeholders looking to capitalize on future shifts in coverage in order to better position their products among competitors.

Webinar | Formulary Forum | Asthma and COPD: Tactics to Maneuver Through Formulary Strategies

Wed, 01 Dec 2010 00:00:00 GMT

Recorded Playback Link:
Asthma and COPD: Tactics to Maneuver Through Formulary Strategies

Formulary Advantages in Asthma and COPD examines the current market for asthma and COPD drugs as it relates to coverage and reimbursement by U.S. payers. When CFC propellant-free asthma and COPD drugs left the market, branded therapies drove up health plan costs. As a result, health plans are seeking ways to control their spending via formulary design and restrictions at the patient level. Our data reveal how uptake of these strategies affect formulary design and demonstrate the effect on coverage and tiering over five consecutive quarters. Private and Medicare plans are taking separate steps that require drug companies to formulate strategies that match the needs of both payer groups. Although many of the existing therapies have been on the market for years, emerging agents should increase competition, forcing payers to evaluate their formulary approach. Understanding the impact of these changing dynamics for brands and their competitors is critical for marketers to maneuver through these strategies and garner more market share.

Presenters:
Roy Moore and Keith Rourke

Michigan | Fall | 2010 | Health Plan Analysis

Tue, 30 Nov 2010 00:00:00 GMT

Report Summary: BC/BS of Michigan, the heavyweight among Michigan carriers, is reacting to both the downed economy and strides made by its nearest competitor, Priority Health, by launching in 2011 a new slimmed-down commercial PPO that is in line with what other insurers offer. The Michigan Blue plan, with 3.9 million members, dominates the commercial market, but Priority Health, with about 464,000 members, continues to build enrollment. BC/BS of Michigan has the largest Medicare Advantage membership in the state, and Priority is again second. For 2011, just nine carriers will offer MA, down from 13 this year. Nineteen carriers, the same as this year, will sell stand-alone Medicare prescription drug plans, but there will be 12 fewer offerings. BC/BS of Michigan is continuing to support pay-for-performance initiatives--nine so far--and the promise of a tenth next year. The latest initiative is a targeted effort aimed at reducing blood clots in non-surgical patients.

West | Fall | 2010 | Health Plan Analysis

Wed, 17 Nov 2010 00:00:00 GMT

Report Summary: Outside of changes related to healthcare reform, most insurers avoided major changes to benefit design for 2011. UnitedHealth Group launched a pilot in Phoenix and other markets which reimburses the YMCA and Walgreens pharmacists for improved outcomes of members with metabolic syndrome, diabetes and prediabetes, as well as those who meet a certain number of risk factors for diabetes. Colorado Medicaid's preferred drug list saved $7 million in the past fiscal year after it included more classes, while Medicare Advantage plans in Arizona and Nevada instituted changes to drug benefits and preventive care, likely drawing new members in diminished Medicare Advantage markets.

Executive Briefing | Healthcare Reform After The 2010 Election: Implementation Just Got a Lot Harder | Nov 2010

Thu, 11 Nov 2010 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive brief on healthcare reform after the 2010 election.

WellCare | 3Q 2010 | Health Plan Earnings Summaries

Wed, 10 Nov 2010 00:00:00 GMT

Ohio, Kentucky & Indiana | Fall | 2010 | Health Plan Analysis

Wed, 10 Nov 2010 00:00:00 GMT

Report Summary: The insurance market in Ohio, Kentucky and Indiana reacted to new reform rules that began this fall. Employers with group plans were forced to decide whether or not to pursue grandfather status with their health plans, delaying the onset of the mandates but relinquishing the ability to make any substantial changes in benefits.Medical Mutual of Ohio tried to offer an acceptable alternative with its Step Plans, which feature deductibles that increase just enough each year to stay under the mandated limits for grandfathering but still show employers some cost savings. Reform's ban on exclusions for children with pre-existing conditions caused Humana, Aetna and UnitedHealthcare to drop their child-only policies. Reform's promise of enormous increases in Medicaid on the horizon had insurers positioning themselves to handle this market. Insurers such as UnitedHealth are making a case for more managed Medicaid as a cost-saver for states. In addition, reform's emphasis on accountable care organizations caused an upsurge in ACOs in the region and promises more for the future.

Health Net | 3Q 2010 | Health Plan Earnings Summaries

Tue, 09 Nov 2010 00:00:00 GMT

Coventry | 3Q 2010 | Health Plan Earnings Summaries

Tue, 09 Nov 2010 00:00:00 GMT

Southeast | Fall | 2010 | Health Plan Analysis

Tue, 09 Nov 2010 00:00:00 GMT

Report Summary: The only plans in the South seeing significant enrollment growth are Medicaid and Medicare plans. Congress' approval of another FMAP extension is enabling states to avoid deep Medicaid cuts for now. Most of the major carriers for Medicare Advantage are keeping rates flat for 2011 in the South. In the South, at least 27,000 seniors will shift to different Medicare coverage in 2011 as their current MA plans exit the market. HealthSpring, which offers MA and Part D prescription drug plans, will move up to ninth in size among Medicare plans next year with its purchase of Bravo Health. In the commercial market, employers have largely abandoned ideas of grandfathering their existing plans, realizing that it is no advantage to them to wait three years to make changes just to stay grandfathered. Some health plans are offering narrow provider networks to keep down costs, and others are pushing wellness programs to keep customers healthy. CDHPs continue to rise in popularity. While pharmacy cost trends have been flat nationwide, they have gone up in Georgia among HMOs, mainly because they were low to begin with. BlueCross BlueShield of Tennessee has begun a major pharmacy adherence initiative aimed at keeping all of its 1.2 million commercial members on their maintenace prescription drugs.

Aetna | 3Q 2010 | Health Plan Earnings Summaries

Mon, 08 Nov 2010 00:00:00 GMT

WellPoint | 3Q 2010 | Health Plan Earnings Summaries

Mon, 08 Nov 2010 00:00:00 GMT

AMERIGROUP | 3Q 2010 | Health Plan Earnings Summaries

Thu, 04 Nov 2010 00:00:00 GMT

Humana | 3Q 2010 | Health Plan Earnings Summaries

Thu, 04 Nov 2010 00:00:00 GMT

HealthSpring | 3Q 2010 | Health Plan Earnings Summaries

Tue, 02 Nov 2010 00:00:00 GMT

Centene | 3Q 2010 | Health Plan Earnings Summaries

Mon, 01 Nov 2010 00:00:00 GMT

CIGNA | 3Q 2010 | Health Plan Earnings Summaries

Mon, 01 Nov 2010 00:00:00 GMT

Molina | 3Q 2010 | Health Plan Earnings Summaries

Mon, 01 Nov 2010 00:00:00 GMT

Heartland | Fall | 2010 | Health Plan Analysis

Fri, 29 Oct 2010 00:00:00 GMT

Report Summary: More employer groups are offering high deductible health plans as the sole offering to their employees due to recessionary pressures. Employers are banking on these plans as ways to save on health care costs. Illinois has awarded Aetna and Centene contracts to adminster the Medicaid Integrated Care Program. The program will attempt to improve health care oucomes through the utilization of medical homes and pay for performance. Many Medicare Advantage private fee for service plans will be disappearing from the market in 2011. Humana, in particular, has kept most PFFS plans in the market and is also marketing a new prescription drug plan that is co-branded with Wal-Mart. The state of Illinois will require employees on its health plans to try certain generic or low-cost brand drugs before more expensive non-formulary drugs will be approved. Accountable Care Organizations are starting to form in the Heartland region. CIGNA will team up with St. John's Mercy Medical Group in Missouri and Blue Cross and Blue Shield of Illinois will partner with Advocate Health Care.

California | Fall | 2010 | Health Plan Analysis

Wed, 27 Oct 2010 00:00:00 GMT

Report Summary: Sorting out the complexities of healthcare reform has kept health plans and employer groups busy this enrollment season, overshadowing the typical product innovation seen this time of year. Financially stressed employers are turning to new plan designs to hold down costs, even when it means giving up grandfathered status under reform. The trend toward lower-cost products with restricted provider networks continues to heat up in San Diego. A new Performance HMO that PacifiCare developed for a schools purchasing coalition sets up three tiers of benefits, charging the lowest copays to employees who choose physicians ranked tops in cost and quality. Medicaid budget woes are putting a strain on rates for the Healthy Families program for children, prompting withdrawal from some counties by the state’s two Blue plans. Meanwhile, Medicaid managed care organizations are being financially penalized by the state for spending too much on generic drugs—the first result of a new push for efficiencies. The new Medicare products are out for 2011—starring a new Wal-Mart plan from Humana—but there’s also growth forecast for the alternative Medicare supplement market. CalPERS is starting one pilot and ending another regarding its prescription drug program. California’s huge pay-for-performance program is undergoing a major transformation that will focus more developing a total-cost-of-care standard that plans can use in performance-based contracting.

UnitedHealth Group | 3Q 2010 | Health Plan Earnings Summaries

Thu, 21 Oct 2010 00:00:00 GMT

Getting Ahead of the Reimbursement Curve: How Will Your Immune Biologic Brand Fare?

Thu, 21 Oct 2010 00:00:00 GMT

Thanks to healthcare reform, prodding by the federal government and new benefit designs, we’re seeing substantial changes in store with the market.With the rollout of new Medicare plans for 2011, we’re able to get a view of the changing design of Part D plans and how it could affect buying behavior.

New England | Fall | 2010 | Health Plan Analysis

Wed, 13 Oct 2010 00:00:00 GMT

Report Summary: Massachusetts, continuing to look for answers to its escalating heatlhcare costs, has passed legislation requring insurers to offer a limited network option for small employers--apparantly modeled off Fallon Community Health Plan's successful model. In Rhode Island, the state's largers insurer-Blue Cross & Blue Shield-has exited the Medicaid HMO landscape as new contracts--with tighter pharmacy controls--go into place. Massachusetts is set to remain a challenging environment for pharma reps after a bill to allow prescription drug coupons failed to pass.

Formulary Advantages in Asthma and COPD

Thu, 30 Sep 2010 00:00:00 GMT

Report Summary: The asthma and chronic obstructive pulmonary disease (COPD) market represents a brand-dominated market that could face substantial changes over the next few years by the possible arrival of generic medications as well as the launch of several new monotherapies and combination therapies. Approximately 10 million Americans are currently diagnosed with COPD (although the actual number suffering from this condition could be several million more). Another 22 million are diagnosed with asthma, generating billions of dollars in healthcare expenses. Those suffering from these conditions can take monotherapy medications that include both long and short-acting beta-2 agonists (SABAs) as well as long-acting muscarinic antagonists and inhaled corticosteroids (ICSs). Major brands will have to contend with the expected rise of branded generic therapies of GlaxoSmithKline's Flovent (fluticasone) and Advair (salmeterol/fluticasone propionate), which may drive payors to tighten their formularies and cover expensive branded therapies on Tier 3 or higher. Drug manufacturers are reacting to this prospect by developing new therapies that offer improved administration over existing therapies and by combining various types of drugs to boost their effectiveness. With multiple drugs slated to launch featuring similar combinations, the COPD and asthma market may see intense competition centered on these new therapies.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 47 pharmacy directors, this report determines the key trends in reimbursement of immune biologics, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

News for Mississippi

Mon, 27 Sep 2010 00:00:00 GMT

Formulary Advantages in Immune Biologics: Brand Maneuvering in a Market Increasingly Constrained by Limited Payer Reimbursement

Wed, 22 Sep 2010 00:00:00 GMT

Immune diseases such as rheumatoid arthritis, psoriasis, inflammatory bowel disease, psoriatic arthritis and ankylosing spondylitis produce a substantial amount of human suffering and disability. Biologic therapies used for the treatment of these conditions (i.e., immune biologics) represent a significant stride in the development of therapies aimed at inhibiting disease progression and limiting disability. However, the costs of these agents constrain their widespread use compared with conventional small molecule therapies. Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of immune biologics, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Questions Answered in This Report:

While HealthLeaders-InterStudy and Decision Resources forecasts continued market growth for immune biologics, payers’ reluctance to reimburse these agents will serve as the single, most-pressing market constraint. What strategies do payers currently employ to limit the costs of reimbursing immune biologics, and what strategies will be adopted within the next five years? Which agents will benefit from current and future trends in reimbursement and which will suffer? How do strategies used by health plans to limit costs of immune biologics vary by health plan size? Where are there opportunities for marketers to better position their immune biologic brands among payers? How have previously-implemented strategies already affected the immune biologics market in the U.S.?
If conventional disease modifying therapies fail to limit disease progression, physicians typically prescribe one of three Tumor Necrosis Factor-alpha (TNF-alpha) inhibitors, Amgen/Pfizer’s Enbrel (etanercept), Abbott Laboratories’ Humira (adalimumab), or Centocor Ortho’s Remicade (infliximab), as a first-line biologic therapy, and these agents frequently receive preferential reimbursement by payers over other immune biologics. Of these three agents, which will emerge as the top preferred agent among U.S. payers? What attributes of immune biologics dictate preference among payers now and in the future? How can marketers better position their brands to increase patient access? Which newer-to-market agents pose the largest threat to established TNF-alpha inhibitors?
A substantial portion of patients with an immune condition will fail therapy with a first-line biologic. Competition among next-line agents will be fierce, especially in light of the growing number of marketed agents and the lengthening list of indications for which immune biologics may be prescribed. What agents are in direct competition as next-line immune biologics? How does competition break down by immune indication? For which immune indications are there opportunities to capture early-line market share? What can marketers of next-line immune biologics do to better position their brand, given market constraints and limited payer reimbursement?

Scope:

Current reimbursement: Nationwide coverage of tier placement, prior authorization and step therapy restriction rates for both commercial and Medicare plans from Fingertip Formulary’s database of over 1,600 plans. Longitudinal analysis of data over five quarters by both percentage of plans and percentage of covered lives.
Primary research: Surveys with 50 U.S. pharmacy directors, each with at least 3 years experience on their plan’s Pricing and Therapeutic Committees and each responsible for at least 100,000 covered lives.

Oregon & Washington | Summer | 2010 | Health Plan Analysis

Wed, 22 Sep 2010 00:00:00 GMT

Report Summary: Employment and health plan enrollment appear to have stabilized in Oregon and Washington, and both states are pushing ahead in response to federal health reforms, improving their regulatory capacity and laying the groundwork for the advent of healthcare exchanges. Both states have taken interim steps toward providing subsidized care to those who are currently uninsured. Major insurers in Oregon are forming a multi-payor medical home initiative, modeled after Boeing's successful coordinated care program in Washington.

Pennsylvania-Mid-Atlantic | Summer | 2010 | Health Plan Analysis

Tue, 21 Sep 2010 00:00:00 GMT

Report Summary: Pennsylvania's commercial insurance market suffered in 2009 as employment losses and the rising cost of employer-based health insurance forced many to drop coverage. The state's major communities all saw declines, which ranged from minor enrollment losses in economically stable regions to more severe losses in manufacturing communities. Carriers fought over market share in individual communities and insurers have responded with new products in hopes of attracting new customers. In comparison, the Mid-Atlantic region remained stable in 2009, helped by a strong labor market that is tied to the federal government. As a result, carriers in this region kept their enrollment rolls intact, but worries over healthcare reform rules may prompt signficant changes to benefit design. Meanwhile, Medicaid enrollment continues to grow and health plans are looking for ways to limit their prescription drug costs with many showing success.

North & South Carolina | Summer | 2010 | Health Plan Analysis

Tue, 14 Sep 2010 00:00:00 GMT

Report Summary: Commercial carriers are trying to weather uncertain times as the government imposes new regulations under health reform. In advance of new rules governing medical loss ratios, Bradley Wilson, the new CEO of Blue Cross and Blue Shield of North Carolina, is leading the way, announcing plans to cut 20 percent of administrative costs before the major portion of health reform kicks in in 2014. Company officials are studying 80 potential opportunities to restructure administrative costs. High unemployment in the Carolinas continues to dictate few new commercial enrollees, but Medicaid enrollment is on the rise. In response, South Carolina is shifting fee-for-service Medicaid members to managed care, and North Carolina is changing its Medicaid pharmacy policies.

Texas | Summer | 2010 | Health Plan Analysis

Wed, 08 Sep 2010 00:00:00 GMT

Report Summary: Although it appears unlikely there will be widespread, dramatic design changes in 2011 as plan sponsors attempt to understand the full implications of healthcare reform, there will be some adjustments, primarily among small-group plans. All signs point to cost shifting from employer to employees with the biggest changes focused on deductibles, out-of-pocket maximums and coinsurance. For the managed Medicaid segment, changes in the rules governing rebates from pharmaceutical companies could lead to to a carve-in of pharmacy benefits for the state's Medicaid program. On the Medicare front, Texas providers are moving quickly to establish accountable care organizations.

TriState | Summer | 2010 | Health Plan Analysis

Fri, 03 Sep 2010 00:00:00 GMT

Report Summary: Still reeling from a weak job market, the insurance industry in the Tristate is looking under every stone for cost controls and efficiencies. Carriers still challenged in growing their commercial business, although UnitedHealthcare will increase its footprint with the assumption of Health Net of the Northeast's commercial business. Meanwhile, some carriers are drastically streamlining their product offerings to eliminate unpopular products and focusing on those that are cost-effective. One health plan is attacking costs by taking the drastic step of removing the expensive brand-name drugs treating acid reflux and high cholesterol from the formulary. Several health insurers are stepping up their care management programs, resulting in a new medical home project downstate and a new company being formed in New Jersey. In New York, health plans are scrambling to file rate increases for 2010 as the state ushers in a new era of prior approval. In the Medicaid arena, New York State is getting ready to pull some levers in negotiations with pharmaceutical companies to boost volume discounts, or rebates, on drug purchases, while Connecticut is still debating whether to convert Medicaid MCOs to administrative-only contracts.

Wisconsin & Minnesota | Summer | 2010 | Health Plan Analysis

Fri, 03 Sep 2010 00:00:00 GMT

Report Summary: Thousands of state residents currently receiving care in Minnesota through the state-subidized MinnesotaCare program could be moved into state exchanges as a part of national healthcare reform. However, Minnesota is welle equipped to handle the influx of new members due to Medicaid expansions. Molina has entered the Wisconsin managed care landscape with its purcahse of local Abri Health Plan, and stands to gain members quickly due to the state re-bidding HMO contracts for Southeastern Milwaukee. A medication therapy management program in Wisconsin, already showing some cost savings for particpating health plans, is set to gained much-needed size and scope, while Minnesota HMO Medica is exploring launching an MTM program for its commercial book of business.

Webinar | HPDA | Medication Therapy Management: Expanding Beyond Medicare

Thu, 02 Sep 2010 00:00:00 GMT

Recorded Playback Link:
Medication Therapy Management: Expanding Beyond Medicare

Health plans are putting a growing emphasis on medication therapy management as a way of keeping members compliant with drug therapies and preventing hospitalizations. Vice President of Market Analysis Sheri Sellmeyer and Product Director Jane DuBose will examine findings from the current issues of HealthLeaders-InterStudy’s Health Plan Analysis about how plans are deploying medication therapy management with both commercial and Medicare members, what they hope to accomplish and how drug utilization is affected.

This presentation, open ONLY to subscribers of HealthLeaders-InterStudy's Health Plan Data & Analysis, will analyze the impact this trend will have on the pharmaceutical industry.

This webinar will address the following questions:

How are health plans implementing medication therapy management in the commercial sector and what disease states are they focusing on?
What is the role of pharmacists in medication therapy management?
What are the results of medication therapy management?
How has medication therapy management been incorporated into emerging models of care such as medical homes and accountable care organizations?

Presenters:
Sheri Sellmeyer, VP-Market Analysis
Jane DuBose, Product Director

Florida | Summer | 2010 | Health Plan Analysis

Tue, 24 Aug 2010 00:00:00 GMT

Report Summary: Job losses continued to drag down Florida’s commercial insurance market in 2010, with the self-insured rolls taking the largest hit, likely reflecting layoffs and attrition in the state’s biggest self-funding employers. Most carriers were affected, but a few like AvMed Health Plans managed to produce gains through competitively priced products. The industry is awaiting the effects of health reform, particularly rules around minimum medical loss ratios for the individual books of business. Elsewhere, Medicare Advantage enrollment has surged over the past year despite a reduction in federal reimbursements to plans. This improvement points to health plans’ ability to market their products to seniors who will gain extra drug benefits for joining an MA plan even at the expense of a restricted network.

Heartland | Summer | 2010 | Health Plan Analysis

Fri, 20 Aug 2010 00:00:00 GMT

Report Summary: The commercial healthcare segment is consolidating in the Heartland, where dominant Blue Cross plans hold their solid top positions, and players such as Coventry are buying up regional plans in hopes of gaining economies of scale. New emphasis on medical homes and other care coordination initiatives have healthcare providers and insurers making transformative decisions. Medicaid programs are seeing their rolls continue to swell, but struggle to fund services even with the recent extension of federal funds--so they're turning to the few choices they have to create savings, including prescription drug management, provider rates, and extending managed care.

News for Delaware

Fri, 20 Aug 2010 00:00:00 GMT

Michigan | Summer | 2010 | Health Plan Analysis

Mon, 16 Aug 2010 00:00:00 GMT

Report Summary: Michigan's economy has begun to recover from its bottom, but health plan purchasers are only coming back into the market cautiously. Demand is up for products that will yield better medical outcomes, more productive employees and a focus on population management. To that end, leading health plans in the state have gotten on board with innovative care delivery concepts like the patient-centered medical home. Blue Cross Blue Shield of Michigan has the largest single-state medical home initiative in the country, now designating 1,800 physicians across 500 practices, with plans to designate 3,200 more doctors. Priority Health has a similar, but smaller, initiative and several other concepts in testing to help it continue to erode the leading Blue plan's share. Providers are also scrambling to align themselves into accountable care organizations in preparation for Medicare's efforts to contract ACOs in 2012. The Southeast Michigan E-prescribing Initiative, or SEMI, has made the state the third largest in e-prescribing volume, but the effort remains confined to the areas around Detroit. Employers continue to demand wellness programs from all insurers, and in fact did not drop these programs when they cut back during the recession, suggesting they see them as high-value. Consumer-driven plans continue to gain favor in Michigan, where they have been slow to catch on. With the purchase of an account-based plan by a unionized education group in Jackson, the floodgates may be about to open. Medication therapy management programs have also started to show some acceptance in commercial health plans. Priority Health has such a program in the West Michigan market on a pilot basis.

WellCare | 2Q 2010 | Health Plan Earnings Summaries

Wed, 11 Aug 2010 00:00:00 GMT

AMERIGROUP | 2Q 2010 | Health Plan Earnings Summaries

Tue, 10 Aug 2010 00:00:00 GMT

Molina | 2Q 2010 | Health Plan Earnings Summaries

Tue, 10 Aug 2010 00:00:00 GMT

Health Net | 2Q 2010 | Health Plan Earnings Summaries

Tue, 10 Aug 2010 00:00:00 GMT

CIGNA | 2Q 2010 | Health Plan Earnings Summaries

Tue, 10 Aug 2010 00:00:00 GMT

Humana | 2Q 2010 | Health Plan Earnings Summaries

Fri, 06 Aug 2010 00:00:00 GMT

West | Summer | 2010 | Health Plan Analysis

Fri, 06 Aug 2010 00:00:00 GMT

Report Summary: Commercial markets in Colorado and Nevada have been shaken up by expansion of HMOs and, in the case of Las Vegas, new market entrants. At the same time, local brokers say employers are not likely to stick with their old health plans just to receive "grandfathered" status, and may opt for high-deductible and account-based designs in order to control cost. More health insurers are examining strategies for specific classes of specialty drugs, such as rheumatoid arthritis or oncology. Adults served by the Arizona Health Care Cost Containment System will undergo major benefit cuts, while Colorado Medicaid has seen strong uptake as a hospital fee allows it to open enrollment to new populations.

California | Summer | 2010 | Health Plan Analysis

Fri, 06 Aug 2010 00:00:00 GMT

Report Summary: Health reform has spiked consumer interest in the individual insurance market California, but policyholders are finding shrinking benefits in the sector; in particular, plans with maternity coverage are hard to come by. The sticker shock of rising insurance premiums is creating a backlash against insurers as regulators intensify scrutiny of rate proposals. Meanwhile, small employer groups are buying down benefits to keep premiums down, and many are turning to lower-cost plans with restricted provider networks. Carriers saw little growth in their commercial books for 2009 as the economy continued to put pressure on job growth. As more people turn to Medicaid for coverage, the state is moving closer to its goal of expanding managed Medicaid to more beneficiaries in the aged, blind and disabled population, which represents 380,000 covered lives in California. In the senior market, Medicare Advantage plans are bracing for reimbursement to remain flat in 2011 and start declining in 2012, plotting a strategy that's likely to involve pullouts from high-cost counties and elimination of some optional benefits. In both the commercial and Medicare sectors, provider groups of all stripes are taking steps to become accountable care organizations when Medicare adopts this new care-coordination and payment model in 2012 for the fee-for-service population.

Coventry | 2Q 2010 | Health Plan Earnings Summaries

Thu, 05 Aug 2010 00:00:00 GMT

WellPoint | 2Q 2010 | Health Plan Earnings Summaries

Fri, 30 Jul 2010 00:00:00 GMT

Centene | 2Q 2010 | Health Plan Earnings Summaries

Fri, 30 Jul 2010 00:00:00 GMT

Aetna | 2Q 2010 | Health Plan Earnings Summaries

Fri, 30 Jul 2010 00:00:00 GMT

Southeast | Summer | 2010 | Health Plan Analysis

Fri, 30 Jul 2010 00:00:00 GMT

Report Summary: Uncertainty about the economy and the effects of health reform put a damper on the South's health insurance market. Commercial enrollment is essentially flat in Alabama, Georgia, Louisiana and Tennessee, and profits are down. The biggest commercial contract in Louisiana, the state employee contract, is still in the air. It was awarded to Blue Cross Blue Shield of Louisiana, but Humana and UnitedHealth Group brought the matter to court due to a discrepancy in the RFP. As of July 22, no decision had been made. In Tennessee, the effect of last year's increase in the HMO tax forced one company, Bluegrass Family Health, to back out of the commercial market. Alabama's Medicaid Agency is making a landmark change to its pharmacy reimbursement method, moving from average wholesale price to average acquisition cost, to determine prices. In conjunction, it is raising the dispensing fee it pays pharmacists to almost double what it was before, the highest dispensing fee in the country. Louisiana's Department of Health & Hospitals continues to move forward to change its Medicaid delivery system to a managed care model with coordinated care organizations. In all four states, hospital associations report that their members are looking into becoming accountable care organizations, and medical centers in Alabama, Georgia and Tennessee are all participating in a pre-ACO arrangement with Premier healthcare alliance.

Webinar | Is the Recession Over for MCOs?: Enrollment Trends in the Commercial and Government Markets

Mon, 26 Jul 2010 00:00:00 GMT

Recorded Playback Link:
Is the Recession Over for MCOs?: Enrollment Trends in the Commercial and Government Markets

Discription: Enrollment in commercial managed care organizations (MCO) is showing signs of making a rebound in the coming year, according to the latest data from HealthLeaders-InterStudy. In this webinar we'll examine why some markets are doing better than others and where the pharmaceutical industry can expect the most opportunity in the next year. This presentation will analyze the impact of MCO enrollment shifts on the pharmaceutical industry in both the commercial and government sectors.

New England | Summer | 2010 | Health Plan Analysis

Thu, 22 Jul 2010 00:00:00 GMT

Report Summary: Health plans in Massachsuetts, coming off one of their toughest years financially, are battling state regulators over premium increases, and the battle is hitting insurers' bottom lines. Maine is set to move away from its primary-care case management Medicaid program and into managed care, opening the door for Medicaid HMOs or even local accountable care organizations to gain contracts. In Rhode Island, the state's largest insurer—Blue Cross & Blue Shield—has launched its first value-based benefit design initiative, rolling it out for members in its Direct Pay line of products. Blue Cross Blue Shield of Massachusetts, the state's largest insurer, is continuing to sign providers to its Alternative Quality Contract, which seeks to re-shape the way providers are paid.

UnitedHealth Group | 2Q 2010 | Health Plan Earnings Summaries

Wed, 21 Jul 2010 00:00:00 GMT

Formulary Advantages Among Monoclonal Antibodies in Oncology: Health plans report high priority on reducing oncology drug costs.

Mon, 19 Jul 2010 00:00:00 GMT

Report Summary: While we forecast sales of oncology drugs in the United States to grow at a compound annual growth rate of 4.4% between now and 2016, we forecast sales of monoclonal antibodies (MAbs) in oncology to grow at a CAGR of 6.7% over that same time period. This disproportionate growth in spending on MAbs in oncology, combined with the efficacy of these agents versus life-threatening diseases, will lead to increasing pressure on payers' budgets.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of MAbs in oncology, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition and provides insight for stakeholders looking to capitalize on future shifts in coverage in order to better position their products among competitors.

Ohio, Kentucky & Indiana | Summer | 2010 | Health Plan Analysis

Mon, 19 Jul 2010 00:00:00 GMT

Report Summary: Commercial health insurers in the Indiana-Kentucky-Ohio region have experienced declining enrollment due to the economic effects of employers dropping or cutting workplace-sponsored coverage. But insurers who hold a large percentage of their books in public-employee groups, like state employee plans, have emerged as the enrollment leaders in their states. Medicaid health plans in Indiana and Ohio have now had several months to learn to live with a prescription drug carve-out. They're starting to see some disruptions in care, and would like their respective states carve pharmacy back in. States might not be in any hurry to do that, however, since the biggest argument in favor of a carve-out - that the better rebates help states balance tight budgets - remains in full force. Medication therapy management programs have also started to show some acceptance in commercial health plans. Anthem Blue Cross and Blue Shield has just completed such a program in the Cincinnati market, and would like to begin offering it to other employers, and replicate the program in other WellPoint state markets. UnitedHealthcare has also employed some medication therapy management precepts in a new diabetes control program.

Webinar | HPDA | The MLR Rule: An Earthquake for Insurers, But What Are the Implications for Pharma?

Fri, 16 Jul 2010 00:00:00 GMT

Recorded Playback Link:
The MLR Rule: An Earthquake for Insurers, But What Are the Implications for Pharma?

This 15-minute analyst call, presented by HealthLeaders-InterStudy Senior Analyst Roy Moore, will answer the following questions:

What are the strategies health plans will be taking to comply with new rules on medical loss ratios as part of healthcare reform?
Which health plans and sectors are most likely to be affected by the MLR regulations?
What is the latest guidance from the National Association of Insurance Commissioners? How might pharmaceutical contracting and patient care be impacted by the changes?

Presenter:
Roy Moore - Senior Market Analyst

Pharmacy Benefit Evaluator 2.0 | Data | July 2010

Thu, 01 Jul 2010 00:00:00 GMT

Pharmacy Benefit Evaluator 2.0 | Parent & Child Relationship | July 2010

Thu, 01 Jul 2010 00:00:00 GMT

Pennsylvania | Spring | 2010 | Health Plan Analysis

Mon, 28 Jun 2010 00:00:00 GMT

Report Summary: Now that federal healthcare reform is passed, insurance companies and their regulators are turning their focus to immediate tasks, in particular setting up a high-risk pool for an estimated 5,000 individuals with pre-existing conditions. In addition, insurers are facing a federal mandate to spend a prescribed amount of their premium dollars on medical care, which will limit profits. This comes at a time when the state is scrutinizing their rating practices. In fact, Highmark has temporarily backed off plans to medically underwriting small groups under pressure from the insurance commissioner. With their attention diverted to regulation, carriers are not making the bold plays for market share they had in the past, which, along with the slow economy, will likely continue for 2010 the flat growth rate in the commercial sector the plans saw in the last half of 2009. Meanwhile, health plans are focusing on quality programs. Independence Blue Cross has boosted its incentive programs for providers to set up medical homes and improve quality of care, while Highmark Inc. is getting attention from other Blue plans across the country for its hospital incentive program. On the pharmacy front, insurers are starting to loosen up policies that restricted customers from getting 90-day supplies of maintenance medications at retail pharmacies. IBC has a new drug plan that pushes generic medications.

White Paper | Targeting Pharmaceutical Sales Opportunity and Maximizing Resources

Fri, 25 Jun 2010 00:00:00 GMT

HealthLeaders-InterStudy periodically publishes special analyst reports on healthcare topics of interest.

North & South Carolina | Spring | 2010 | Health Plan Analysis

Thu, 24 Jun 2010 00:00:00 GMT

Report Summary: Stakeholders in the healthcare industry are looking at the health reform law, planning ways to minimize losses and take advantage of opportunities. In North Carolina, federal and state high risk pools will run concurrently, operated by the state. While debate about healthcare reform raged alongside recession in 2009, most commercial health plans in the Carolinas continued to show slight gains in enrollment and retained HMO profitability though not at previous rates. In North Carolina, CDHP enrollment took off, nearly doubling in a year. In South Carolina, commercials plans expanded, but they were outpaced by Medicaid MCOs. In both states, UnitedHealthcare unveiled a new value-based pilot program for small groups, covering some brand name prescription drug on low tiers. CIGNA and Humana began a partnership, allowing CIGNA to sell Humana Medicare Advantage plans, allowing employers to offer seamless coverage into retirement.

Formulary Advantages in Multiple Sclerosis: How will price impact the uptake of emerging orally-delivered therapies?

Thu, 24 Jun 2010 00:00:00 GMT

Report Summary: Multiple sclerosis (MS), an inflammatory disease of the central nervous system, is characterized by progressive neuronal loss and worsening physical disability. Although there are a number of currently marketed therapies that target the immune component of MS, including interferon-beta (IFN-?) therapy and Teva Copaxone (glatiramer acetate), few available drugs are able to reduce or reverse disability progression. There is great opportunity for emerging agents that are neuroprotective, as well as for therapies that offer greater convenience and improved quality of life for MS patients.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 51 pharmacy directors, this report determines the key trends in reimbursement of MS treatments, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition and provides insight for stakeholders looking to capitalize on future shifts in coverage in order to better position their products among competitors.

Tennessee | Spring | 2010 | Health Plan Analysis

Wed, 23 Jun 2010 00:00:00 GMT

Report Summary: Tennessee health plans continued to show declining enrollment as the "jobless recovery" began in early 2010, and health plans are anticipating a renewal season that will see increasing numbers of employers moving to higher deductible plans and account-based plans. Meanwhile, Tennessee's dominant insurer, BlueCross BlueShield, has begun the process of contracting with the state's emerging "medical home" practices, all of whom are just beginning the transformation to the patient-centered care management model. E-prescribing is growing in Tennessee, as it is across the country, and more plans are tying incentives to wellness programs to encourage healthy behaviors and health assessments.

Kansas & Missouri | Spring | 2010 | Health Plan Analysis

Wed, 16 Jun 2010 00:00:00 GMT

Report Summary: The early returns from a massive valued-based benefit design initiative in Kansas City have led to five new pilots nationwide. In concert with its PBM, CVS Caremark, the Kansas State Employee Health Plan will pilot a preferred specialty formulary benefit for rheumatoid arthritis and human growth hormone therapies to lower costs without sacrificing member safety. While carriers use similar strategies for mail-order pharmacy, more self-insured plan sponsors have leveraged mail-order incentives to lower their pharmacy expenditures.

Managed Market Surveyor State Cuts

Tue, 15 Jun 2010 00:00:00 GMT

View data by:

Geographic level—national, state, MSA, county

Managed care organization

Plan and funding type

Mid-Atlantic | Spring | 2010 | Health Plan Analysis

Fri, 11 Jun 2010 00:00:00 GMT

Report Summary: Medicaid programs in the District of Columbia and Virginia are looking at ways to save money and adapt to changes mandated in the federal health reform law. The District is planning to shift the costs of 35,000 members of its city-funded Health Alliance program to the federal government by expanding its Medicaid program early. Virginia is limiting provider rates and practicing more aggressive control of utilization of services. In addition, it is tightening its pharmacy program for fee-for-service plans. In Maryland and the District, top insurer CareFirst BlueCross BlueShield is launching a new health plan, HealthyBlue, this summer and will introduce a primary care medical home to work in conjunction with it beginning next year. The company will provide phased-in incentives to physicians if they decide to work as a medical home. The drawback is that physicians will have to wait years for the payback to build. Maryland's hospital rate-setting commission is nearly ready to unveil reimbursement rates for next year and is keeping a close eye on federal Medicare reimbursement, which sets the standard the state must meet to keep its rate-setting capability.

Michigan | Spring | 2010 | Health Plan Analysis

Fri, 11 Jun 2010 00:00:00 GMT

Report Summary: The passage of the Patient Protection and Affordable Care Act will, in the short run, expand coverage for young people, create new high-risk pools, shift incentives for Medicaid drug rebates and make federal assistance available for reinsurance of early retirees. Michigan health plans find themselves in good shape, as they are already doing much of what the new law requires. The continued growth of mail-order pharmacy delivery appears anything but certain, as most insurers in Michigan have leveled the playing field between retail pharmacy dispensing and mail order. Competing forces, like retailers offering low-cost generics, health plans re-contracting with PBMs that don't give the best pricing and a broad-based push for more generic dispensing, have all worked against mail order, even though it usually offers a better deal to members and employers. Blue Cross Blue Shield of Michigan has offered a new PPO-based wellness product that takes a more aggressive approach to rewarding good health. Using a typical two-tiered benefit, it requires members to actually have better health, as documented by evidence-based measures, to qualify for lower cost-sharing.

Florida | Spring | 2010 | Health Plan Analysis

Thu, 10 Jun 2010 00:00:00 GMT

Report Summary: Unable to reach a compromise between the House and Senate, Florida's state Legislature did not expand Medicaid Reform, which requires beneficiaries in certain counties elect to join an HMO or a Provider-Sponsored Network. Instead, these 250,000 beneficiaries will remain in MediPass, the state's primary care case management program. HMOs didn't lose completely though because as Florida's Medicaid rolls have swelled, HMOs - which administer the drug benefit - have proven successful at recruiting beneficiaries to join HMOs voluntarily. Although the Medicaid HMO is adding enrollment, the commercial market continues to suffer because of the economy. Commercial HMO enrollment fell in 2009 for nearly every major carrier with areas such as Tampa and south Florida experiencing the most notable drops. Health plans say employers are looking to reduce costs, but churn between plans may be down for those employers not wanting to face experience rating for the premiums at new carriers. With unemployment stabilizing and likely falling in coming months, the resulting uptake in health plans may take at least six months or longer to materialize.

Webinar | HPDA | Mid-year Health Plan Forecast: Amid Big Q1 Profits, Health Insurers Brace for Change

Thu, 10 Jun 2010 00:00:00 GMT

Recorded Playback Link:
Mid-year Health Plan Forecast: Amid Big Q1 Profits, Health Insurers Brace for Change

Profits rose—in some cases dramatically—for the top publicly held insurers in the first quarter of 2010, as membership stabilized and the economy showed signs of recovery. This analyst call will review key trends from the Q1 2010 earnings calls from the country’s leading publicly held health plans, including UnitedHealth Group, Aetna and WellPoint, as well as discuss how insurers are preparing for healthcare reform and their reactions to employers’ demands for lower-cost coverage.

This 15-minute analyst call will answer the following questions:

With the economy still fragile, what health plan designs are employers buying now?
Which health plans will put increasing emphasis on their Medicaid business as they prepare for 16 million more people to be added to the program by 2014?
How are health insurers reacting to the federal reform law’s medical loss ratio guidelines that will require 85 percent of the premium in small-group plans goes to medical care and wellness? What does this mean for pharma benefits?

Presenter: HealthLeaders-InterStudy Assistant Director, Managed Markets Analysis Paula Wade

AMERIGROUP | 1Q 2010 | Health Plan Earnings Summaries

Thu, 03 Jun 2010 00:00:00 GMT

Wisconsin & Minnesota | Spring | 2010 | Health Plan Analysis

Wed, 02 Jun 2010 00:00:00 GMT

Report Summary: Thousands of state residents currently receiving care in Wisconsin through the state-subsidized BadgerCare Plus program could be moved into state exchanges as a part of national healthcare reform. However, Wisconsin is well equipped to handle the influx of new members due to Medicaid expansions. Minnesota and Wisconsin have taken different approaches in response to the federal requirement for establishment of new high risk pools in the state, to stand alongside existing pools. Wisconsin has informed the federal government it will operate such a pool, while Minnesota has deferred to the feds. Minnesota's high risk pool is the largest in the nation. As part of its statewide healthcare homes push, Minnesota has announced it plans to pay healthcare providers fees ranging from $10 to $60 a month for chronic-needs patients enrolled in state public programs.

Texas | Spring | 2010 | Health Plan Analysis

Fri, 28 May 2010 00:00:00 GMT

Report Summary: Health reform could completely change the landscape of Texas healthcare, bringing new people into the system while challenging smaller plans to meet requirements on their spending on medical care. Medicaid changes will be unlike those in any other state, with an estimated 2.2 million residents entering the system. The state has chosen managed care plans to coordinated care for those eligible for aged, blind and disabled Medicaid benefits in north Texas. Meanwhile the medical home concept has begun to appear in Texas, with private payors and the Medicaid program launching pilot initiatives.

Webinar | HPDA | Is Rx Going Postal? Payers Deploy a Host of Incentives to Drive Mail Order

Thu, 27 May 2010 00:00:00 GMT

Recorded Playback Link:
Is Rx Going Postal? Payers Deploy a Host of Incentives to Drive Mail Order

Mail-order delivery of prescription drugs continues to rise in some quarters as health plans and employers look to control escalating costs. We’ll examine findings from the spring issues of HealthLeaders-InterStudy’s Health Plan Analysis about how benefits are designed around mail order, how state laws affect the trend and where it’s headed.

This presentation, open ONLY to subscribers of HealthLeaders-InterStudy's Health Plan Data & Analysis, will analyze the impact this trend will have on the pharmaceutical industry.

After attending this webinar you will have a better understanding of:

The variety of benefit designs available in mail-order drug distribution.
Factors that may be limiting or pushing the mail-order trend forward.
How home delivery relates to treatment compliance.

Presenters:
Jane DuBose, Product Director
Chris Lewis, Senior Health Plan Analyst

TriState | Spring | 2010 | Health Plan Analysis

Tue, 25 May 2010 00:00:00 GMT

Report Summary: Healthcare reform will be less of a game-changer in the TriState, at least for New York and New Jersey, which already ban medical underwriting, exert some controls over insurer rates and benefit plans. However, these states, along with Connecticut, will have to reconcile their state laws with the immediate impacts of the federal act to cover older dependents and set up high-risk pools, among other things. New York regulators continue to push for prior approval of HMO rate hikes in that state and impose stricter limits on profits than the federal government. Meanwhile, momentum is building to get more physicians wired up for the future of healthcare in the TriState. Connecticut is embarking on its largest medical home project to date—one that pairs up the state employee health plan and the state’s largest primary-care practice group, ProHealth Physicians Inc. New York Medicaid is paying its providers and pharmacies incentive payments for each prescription they send in electronically, which has the potential to boost overall e-prescribing there. On the pharmacy front, Horizon Blue Cross Blue Shield of New Jersey learns some shocking lessons about how often members skip needed prescriptions, while health plans throughout the TriState seek to promote mail-ordered prescriptions to varying degrees. One New York health plan is approaching wellness with a novel benefit design that is sure to catch on in the rest of the state.

Oregon & Washington | Spring | 2010 | Health Plan Analysis

Fri, 21 May 2010 00:00:00 GMT

Report Summary: Individual states are on the frontline for implementing the recently passed Patient Protection and Affordable Care Act. A few of the first pieces of that landmark legislation include the implementation of high-risk pools, cuts in Medicare provider reimbursements and new populations moving into state Medicaid programs. Against this shifting backdrop, Washington state is preparing an RFP for its Medicaid plan that could double enrollment to 1.4 million because of the reforms. The RFP may or may not pit some national MCOs against relatively entrenched local players. Oregon may have a headstart on exchanges that will be mandated by 2014 as it rolls out a five-company exchange of insurers focused on children and awaits a report in the fall examining the possibility of beginning an exchange for adults. Molina Healthcare of Washington and Compass Health are pioneering a clinic in Everett to coordinate medical care with Compass’s mental health patients, a population whose physical needs are frequently overlooked. State employees in Washington improved their health status, mostly through lifestyle changes such as exercise and diet.

Webinar | HPDA | Does Medicaid Expansion Mean Boom Time

Tue, 18 May 2010 00:00:00 GMT

Recorded Playback Link:
Does Medicaid Expansion Mean Boom Time

The largest single expansion of the Medicaid program ever will be phased in over the next few years, opening up billions in Medicaid drug spending. The challenge for pharma is to know where the greatest opportunities lie, how current state trends will affect their future spend and what kind of utilization to expect in this new, unknown population of people who are low-income but not poor enough for current Medicaid.

This 15-minute analyst call, presented by Product Director Jane DuBose, will answer the following questions:

- What does the Medicaid market look like for pharma beginning in 2014 (when Medicaid expansion begins) through 2019?
- How will current preferred drug lists and state carve-out programs be affected by the addition of 16 million Medicaid members across the country?
- In which states will the Medicaid drug spend be even more significant because of a sicker population moving into the program?

Presenter:
Jane DuBose, Product Director

Illinois & Iowa | Spring | 2010 | Health Plan Analysis

Thu, 13 May 2010 00:00:00 GMT

Report Summary: A decision by Gov. Pat Quinn to bid out two contracts to serve the aged, blind and disabled population in Illinois' Medicaid program represents a return to the HMO model in a state that had essentially abandoned the HMO in recent years. The contract is only for 40,000 beneficiaries, but spending last year for this group reached $700 million. The success of this program would auger a larger role for HMOs as more RFPs are issued. Several companies are expected to bid for the contract, which has been amended to include prescription drug coverage. Elsewhere in the state, Illinois and Iowa plan to run their own high-risk pools that are slated to launch July 1. Under the health reform law, these two states are expected to receive $66 million to treat these beneficiaries. Illinois' previous experience with its own high-risk pool shows this group to be very expensive with an average per member per month cost of around $850 with 27 percent of that money going toward drug use.

CIGNA | 1Q 2010 | Health Plan Earnings Summaries

Wed, 12 May 2010 00:00:00 GMT

Molina | 1Q 2010 | Health Plan Earnings Summaries

Tue, 11 May 2010 00:00:00 GMT

WellCare | 1Q 2010 | Health Plan Earnings Summaries

Tue, 11 May 2010 00:00:00 GMT

Health Net | 1Q 2010 | Health Plan Earnings Summaries

Fri, 07 May 2010 00:00:00 GMT

Coventry | 1Q 2010 | Health Plan Earnings Summaries

Fri, 07 May 2010 00:00:00 GMT

Ohio, Kentucky & Indiana | Spring | 2010 | Health Plan Analysis

Fri, 07 May 2010 00:00:00 GMT

Report Summary: The passage of the Patient Protection and Affordable Care Act has the potential to dramatically increase Medicaid and commercial enrollment in Ohio, Kentucky and Indiana with expansion of Medicaid eligibility and the creation of healthcare exchanges. The continued growth of mail order pharmacy delivery appears anything but certain, even though most insurers in the Indiana-Kentucky-Ohio region have enhanced the benefit, and offered members more incentives to take advantage of it. Competing forces, like retailers offering low-cost generics, health plans re-contracting with PBMs that don't give the best pricing and a broad-based push for more generic dispensing have all worked against mail order, even though it usually offers a better deal to members and employers. Smoking is the main cause of preventable death in the U.S., and has a high prevalance in Indiana and Kentucky, and moderately so in Ohio. Yet health plans in the region have an underwhelming approach to the problem, not covering all available treatments, and not heavily incentivizing the best treatments. A couple of insurers have gotten serious about smoking cessation, however, and are setting the standard that others should follow.

HealthSpring | 1Q 2010 | Health Plan Earnings Summaries

Fri, 07 May 2010 00:00:00 GMT

Formulary Advantages Among Hepatitis C Virus Therapies: Pharmacy directors do not yet understand the pharmacoeconomic incentives to cover emerging therapies

Mon, 03 May 2010 00:00:00 GMT

Hepatitis C virus (HCV) is the leading cause of end-stage liver disease and hepatocellular carcinoma. Increasing diagnosis and treatment rates, and substantial unmet need combine to make HCV a high-growth opportunity over the next several years. Coverage of the two major brands of pegylated interferon-alfas (peg-IFN), Roche’s Pegasys (peginterferon-alfa-2a) and Merck’s PegIntron (peginterferon-alfa-2b), varies greatly between the private and Medicare channels. Three Rivers Pharmaceuticals’ Infergen (Interferon alfacon-1), a more recent market entrant with less favorable dosing, trails the peg-IFNs in coverage and tiering.

Because there is essentially only one choice for HCV drug treatment—combination therapy of IFN and ribavirin (Roche’s Copegus, Merck’s Rebetol, generics)—and there are limited options for treatment of non-responders, emerging agents that can offer improved efficacy will have a substantial market opportunity. Furthermore, the high current and historical failure rates for IFN/ribavirin combination therapy mean there is a large population of HCV patients awaiting new options that will likely take the first new therapy that is available and reimbursed. Vertex and Merck are racing to bring telaprevir and boceprevir, respectively, to market to try and capture this large population of HCV non-responders.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 51 pharmacy directors, this report determines the key trends in reimbursement of HCV treatments, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

WellPoint | 1Q 2010 | Health Plan Earnings Summaries

Mon, 03 May 2010 00:00:00 GMT

Aetna | 1Q 2010 | Health Plan Earnings Summaries

Mon, 03 May 2010 00:00:00 GMT

Georgia, Alabama & Louisiana | Spring | 2010 | Health Plan Analysis

Sat, 01 May 2010 00:00:00 GMT

Report Summary: Value-based insurance designs, medical homes and Medicaid reform, as well as the federal health reform law, are affecting the healthcare landscape in Georgia, Louisiana and Alabama. Large employers in Georgia are showing an interest in value-based insurance designs, especially blended with wellness or disease management programs, and carriers stand ready with applicable models. Long-time efforts to revamp Medicaid in Louisiana will soon come to fruition with a new Coordinated Care Network system that will involve health plans and medical practices, including medical homes. Louisiana began adopting the medical home model after Hurricane Katrina destroyed hospitals, medical centers and medical records, leaving clinics and medical practices to take up the slack. The state now has the largest network on medical homes in the country. Health professionals are trying to understand federal health reform, especially as it pertains to insurance models, such as consumer driven health plans. If these plans can remain affordable and meet federal minimum standards, they will continue to attact buyers, especially in Louisiana where they are now on solid footing.

Humana | 1Q 2010 | Health Plan Earnings Summaries

Fri, 30 Apr 2010 00:00:00 GMT

Centene | 1Q 2010 | Health Plan Earnings Summaries

Fri, 30 Apr 2010 00:00:00 GMT

New England | Spring | 2010 | Health Plan Analysis

Fri, 23 Apr 2010 00:00:00 GMT

Report Summary: The practice known as "academic detailing," which aims to provide physicians with a more complete, evidence-based, and presumably unbiased education about what specific drugs will do, has spread rapidly in New England. Maine's Medicaid program, in an attempt to implement tighter controls and cut down on non-adherence and waste of prescriptions medications, has implemented a new policy limiting initial prescriptions to 15-day supplies on certain medications. Rhode Island's Medicaid program could see its generics first policy expand to a new subset of beneficiaries as the state re-bids its managed care contracts. Massachusetts, which implemented a near-universal reform initiative in 2006, is at a crossroads as costs are threatening the program's affordability.

UnitedHealth Group | 1Q 2010 | Health Plan Earnings Summaries

Thu, 22 Apr 2010 00:00:00 GMT

Executive Briefing | Medical Homes: Reforming the Healthcare System One Primary-Care Practice at a Time | April 2010

Thu, 22 Apr 2010 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive brief on Medical Homes.

Webinar | Managed Care Medicaid in for a Wild Ride: How to Get on Board

Thu, 15 Apr 2010 00:00:00 GMT

Recorded Playback Link:
Managed Care Medicaid in for a Wild Ride: How to Get on Board

Summary:

Medicaid enrollment is up substantially and with budget deficits and declining tax revenue, states are desperate to control costs. With health care reform expected to add 16 million more enrollees to CHIP and Medicaid roles, more changes and innovations are expected from states.

Because each state Medicaid program’s eligibility, benefits and management is different, understanding state-level data and analysis is imperative to identify opportunities and risks in this rapidly changing environment.

This webinar addresses Medicaid trends HealthLeaders-InterStudy analysts are following across the country. This presentation highlights: The recession’s impact on Medicaid enrollment trends at the national, state and local level. How health reform legislation will affect drug benefits and other facets of the program. Targeting managed care plans as they move into the aged, blind and disabled segments. Identifying partnering opportunities in patient-centered medical homes rolling out across the country.

Presenter:
Roy Moore, Health Plan Analyst
Rebecca Waller, Senior Health Plan Data Analyst

Colorado & Nevada | Spring | 2010 | Health Plan Analysis

Thu, 15 Apr 2010 00:00:00 GMT

Report Summary: Colorado Medicaid has seen a reduction in emergency room use and a drop in per-member spending among children due to a medical home initiative. Health plans in Colorado and Nevada have taken highly individualized approaches to dealing with health plan members who have chronic lung illnesses. Nevada Medicaid has instituted a number of cost-saving measures, including the use of preferred drug lists for diabetic, anti-convulsant and anti-psychotic drugs.

California | Spring | 2010 | Health Plan Analysis

Tue, 13 Apr 2010 00:00:00 GMT

Report Summary: Health reform doesn't make its biggest splash until 2014, but health plans are getting their feet wet this year having to comply with numerous new mandates in the next 12 months. Among the most challenging are paring down administrative expenses and spending more revenue on medical care, as well as dealing with reduced subsidies in the Medicare Advantage program. California's major commercial carriers maintained comfortable profit margins in 2009, and should be able to maintain the status quo through the sluggish economy and first-year impacts of reform. Insurers in general have read the tea leaves and are no longer pricing aggressively to gain market share. Meanwhile, changes are afoot on the pharmacy front, with more intensive medication reviews in Medicare Advantage, the continued trend toward mail-ordered drugs and the possibility that the state's largest healthcare purchaser may start charging its members more out-of-pocket for prescriptions. Not to be left out of the world of Facebook and MySpace, Health Net of California is exploring the use of social media to reach out to its younger insured members. Blue Shield is partnering with a hospital system and a purchasing coalition in a joint effort to improve both quality and cost efficiencies in hospital care.

Tennessee | Winter | 2010 | Health Plan Analysis

Mon, 29 Mar 2010 00:00:00 GMT

Report Summary: Tennessee Gov. Phil Bredesen likely will not have to enact draconian cuts to TennCare this year, but is still pursuing two methods to trim the pharmacy program in ways that will cut into pharmaceutical profits across the supply chain. His original pharmacy benefit cuts included narrowing the state’s list of preferred drugs, $4 pricing on widely available generic drugs, a reduction in the pharmacy payment on generic drugs and going to a single vendor source for selected pharmaceutical supplies. However, it now appears that only the narrowing of the PDL and supplies vendors are still being pursued. The move provides insight into the measures some states are willing to take as Medicaid budgets tighten. BlueCross BlueShield of Tennessee, the state’s largest insurer, began in January to require prior authorization for specialty drugs in its Medicare Advantage BlueAdvantage plans. Before that time, prior authorization was only needed on specialty drugs that cost more that $200. UnitedHealthcare's recent moves pushing mail order distribution of certain chronic care drugs is not happening in Tennessee because of measures enacted more than a decade ago.

North & South Carolina | Winter | 2010 | Health Plan Analysis

Fri, 26 Mar 2010 00:00:00 GMT

Report Summary: Managed Medicaid continues to evolve in South Carolina with the consolidation of plans, peaks in enrollment and proposed cost containment measures. To help keep Medicaid prescription drug costs in line, the state supports education for Medicaid providers through a program of academic detailing, which is expected to go statewide soon. In the senior market, the Carolinas continue to gain momentum with regular Medicare Advantage plan growth and with special needs plans. In North Carolina, the SNP sector is dominated by UnitedHealth Group, and in South Carolina Care Improvement Plus enrolls most SNP beneficiaries.

White Paper | Changing Population Demographics and Treatment Trends Require Continuous Reprioritization of Target Markets for Sales and Marketing Teams

Fri, 26 Mar 2010 00:00:00 GMT

HealthLeaders-InterStudy periodically publishes special analyst reports on healthcare topics of interest.

Formulary Advantages in Parkinson's Disease Drugs: Impact of Generic Entry and Novel Formulation on Reimbursement

Fri, 26 Mar 2010 00:00:00 GMT

Report Summary: Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the elderly. The launch of several new therapies and new formulations of key brands will drive market growth, but growth will be offset with the genericization of several key PD therapies, including Boehringer Ingelheim's Mirapex (pramipexole) and GlaxoSmithKline's Requip (ropinirole). We analyze the impact of genericization on the reimbursement of key brands and survey pharmacy directors on how they expect to reimburse PD therapies currently in Phase III development.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 51 pharmacy directors, this report determines the key trends in reimbursement of Parkinson's Disease treatments, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Executive Briefing | Healthcare Reform Bill: What It Means For Managed Markets | March 2010

Wed, 24 Mar 2010 00:00:00 GMT

HealthLeaders-InterStudy has prepared an executive brief on healthcare reform outlining how the Medicare, Medicaid and individual insurance markets will be affected, and what these changes mean for the pharmaceutical industry.

Pennsylvania | Winter | 2010 | Health Plan Analysis

Thu, 18 Mar 2010 00:00:00 GMT

Report Summary: One by one, the Blue Cross and Blue Shield plans in Pennsylvania are changing their underwriting practices to better compete with for-profit insurers they say are cherry picking the best health risks in their markets. The latest move comes from Pittsburgh-based Highmark Inc., which is moving non-HMO products to a for-profit subsidiary so it can start medically underwriting small-groups. Blue Cross of Northeastern Pennsylvania took the same step about a year ago. As a result, older groups with health risks are bracing for higher rate quotes and state insurance regulators are renewing their call to end Pennsylvania's lonely distinction as one of two states, including Hawaii, that have not imposed small-group rate controls on health insurers. In Medicaid, two health plans new to the HealthChoices managed care program-Aetna Better Health and Coventry Cares-will be vying for the business of new enrollees, getting some initial help from auto-assignments. In another Medicaid development, an e-prescribing project is under way for all the state's providers. Medicare Advantage enrollment has dropped sharply in Philadelphia. Enactment of Pennsylvania's new dependent coverage law of adults up to age 30 is causing a rift in interpretations. And Medicare-eligible state retirees have a new choice of HMO and PPO plans.

Wisconsin & Minnesota | Winter | 2010 | Health Plan Analysis

Mon, 15 Mar 2010 00:00:00 GMT

Report Summary: Health plans nationwide have been struggling to retain membership amid the ongoing economic crisis. Minnesota state health plans have responded by rolling out new plan designs targeting the growing individual market as well as lower-cost options for struggling businesses. Wisconsin health plans have suffered membership losses, though the state's unique geographic landscape has kept some plans better insulated than others. Medicare Advantage private fee-for-service plans have been the product choice for seniors in Wisconsin, but more are beginning to gravitate toward networked PPO options. Minnesota seniors, meanwhile, favor the HMO and Cost product options available in the state. On the pharmacy front, Minnesota is continuing a value-based program for state employees suffering from diabetes, high cholesterol and high blood pressure.

Webinar | HPDA | Publicly Traded Health Insurers: 5 Trends and a Forecast

Mon, 15 Mar 2010 00:00:00 GMT

Recorded Playback Link:
Publicly Traded Health Insurers: 5 Trends and a Forecast

Summary:
Despite sharp declines in commercial enrollment, the health insurance industry has been holding steady and even improving profits in a difficult economy. Declines in commercial enrollment were fueled mainly by employers trimming their work forces, rather than dropping coverage universally. Most insurers believe they will begin adding to their rolls by the middle of 2010. Medicaid and Medicare will continue to play a key role, and insurers will put renewed focus on the individual and small-group market as Congress continues to debate healthcare reform. Meanwhile, insurers face backlash from dramatic rate increases in the individual market, as they put in place conservative pricing after poor medical loss ratios in some markets.

This 15-minute analyst call will answer the following questions:

What does the commercial market look like for major insurers in 2010 – are enrollment declines behind them and are they financially healthy?
What are health plans looking at in the way of wellness programs and narrow networks as part of value-based insurance design?
What kind of growth can be expected in the Medicaid and Medicare markets, and which insurers look especially strong in these areas?

Presenter:
Rick Byrne, health plan analyst

Kansas & Missouri | Winter | 2010 | Health Plan Analysis

Fri, 12 Mar 2010 00:00:00 GMT

Report Summary: Missouri has embarked on an ambitious strategy to better coordinate care for the costliest members of MO HealthNet, its Medicaid program, with the hope of reducing expenses. With managed care in place for children and custodial parents its Medicaid program, Kansas will consider extending managed care to its elderly and disabled populations. Insurers and business coalitions sdee the merit of taking a value-based approach to diabetes management, with more health plans offering a wide array of incentives to improve drug adherence.

WellCare | 4Q 2009 | Health Plan Earnings Summaries

Mon, 08 Mar 2010 00:00:00 GMT

Michigan | Winter | 2010 | Health Plan Analysis

Mon, 08 Mar 2010 00:00:00 GMT

Report Summary: The Michigan agency that oversees Medicaid has elected to expand the pharmacy carve-out for psychotropic drugs, taking the responsibility away from the state's Medicaid HMOs. The advantage to the state is the ability to recoup better rebates from pharmaceutical manufacturers, saving the state some money. For the health plans, however, they will lose the revenue they would have received for managing the administration of the psych drug claims. The Medicaid plans may come out ahead, though. Later this year, two new classes of Medicaid member will be deemed for mandatory managed care enrollment: foster children, and the dual-eligibles. A number of the MCOs are already managing the dual-eligibles in Medicare Advantage special needs plans.

On Jan. 1, 2010, the United Auto Workers assumed responsibility for providing health benefits for the hourly retired workers from General Motors Corp, Ford Motor Co. and Chrysler LLC. Some myths surround the launch of the union-run trusts, known as voluntary employees' beneficiary associations, or VEBAs. The first is that there were no big changes on Jan. 1; indeed there were. The other is that the trusts are being operated as a bloated bureaucracy pushing cushy benefits. In fact, a lean staff has unified slimmed-down benefit packages for all retirees, and is carefully considering its next moves as it tries to put the purchasing power of 875,000 members to work making the trust finances sustainable. Medicare Advantage held its annual election period and the exodus has begun from the private fee-for-service product. Blue Croos Blue Shield of Michigan sustained losses of over 190,000 members as it shut down two PFFS plans, but most of them remained Blue Cross customers as they signed up for Medicare supplemental plans. That didn't stop Priority Health and other Michigan MA carriers from making gains in enrollment.

Market Overview | 2010 | Product Manual

Mon, 08 Mar 2010 00:00:00 GMT

Florida | Winter | 2010 | Health Plan Analysis

Wed, 03 Mar 2010 00:00:00 GMT

Report Summary: Florida's Medicaid program faces a massive reshaping as legislators grapple with a $2 billion budget deficit for the program. The Legislature is considering two options for the $18 billion program -- one expanding mandatory managed care for 375,000 beneficiaries in some of the state's largest counties and the other a patient-centered medical home pilot. As they determine the future of Medicaid, legislators may also change the benefits that they, state employees and dependents receive. Looking to save costs, the state may do away with its fully insured HMO option that has richer benefits and rising costs. In addition, UnitedHealthcare has implemented a mail-order program for 18 common chronic care drugs for its fully insured members as part of efforts to control costs for its risk-based pharmacy clients. Statewide, commercial health plans continue to see slipping enrollment, but consumer-directed health plans have seen increased interest. Blue Cross and Blue Shield of Florida has shifted all of its employees to health savings accounts and the HSA has experienced growth in self-funded groups, but state rules over rates have impeded much of the gains possible in fully insured plans.

Mid-Atlantic | Winter | 2010 | Health Plan Analysis

Mon, 01 Mar 2010 00:00:00 GMT

Report Summary: Brokers predict that enrollment for 2010 will be flat and that insurers will bump up their revenue with premium increases and changes in benefit designs. Health plan enrollment went down only slightly in Virginia and Maryland the first half of 2009, with the big Blue plans in both states keeping numbers steady. Aetna and CIGNA showed enrollment gains, Kaiser remained about even and UnitedHealth Group plans lost enrollees. The high price of specialty drugs is a key driver of the overall cost of healthcare. Plans are spending 15 to 20 percent of their pharmacy dollars on specialty drugs used by only 1 to 2 percent of their members. But they're learning ways to better control costs by care management and other methods. Virginia Medicaid is keeping a grip on pharmacy expenses in the state-managed fee-for-service programs with the help of a strong advisory panel.

Oregon & Washington | Winter | 2010 | Health Plan Analysis

Fri, 26 Feb 2010 00:00:00 GMT

Report Summary: In an effort to curtail the growing cost of specialty drugs, Regence has developed a new benefit design with a standard and extended six-tier formulary that combines medical and prescription drug benefits. The design, called Medication Cost Integration, recognizes medication options traditionally covered under the medical benefit meaning there is potential for increased competition among drug manufacturers hoping to get their products placed on favorable tiers. Group Health Cooperative is converting its 26 Washington and Idaho clinics to patient-centered medical homes following a successful two-year pilot. The GHC model has been shown to cut emergency department visits by 29 percent and hospitalizations by 11 percent. The cost of patient care did not increase, and preliminary results suggest that the medical home may even lead to lower costs. Five healthcare plans in Oregon are now part of a first-ever health exchange for children called Healthy KidsConnect. As of Jan. 1, 2010, families with incomes between 201 percent and 300 percent of the federal poverty level can apply for state-subsidized healthcare coverage. The plan is designed to serve as many as 34,000 children with benefits similar to those offered through the Oregon Health Plan, the state's Medicaid program.

AMERIGROUP | 4Q 2009 | Health Plan Earnings Summaries

Fri, 26 Feb 2010 00:00:00 GMT

Molina | 4Q 2009 | Health Plan Earnings Summaries

Fri, 19 Feb 2010 00:00:00 GMT

TriState | Winter | 2010 | Health Plan Analysis

Fri, 19 Feb 2010 00:00:00 GMT

Report Summary: The economy has inspired fewer bold moves and more fiscal caution in the TriState health insurance market, both in government and the private sector. Connecticut is experiencing a seismic shift in its Medicaid program that is changing the role of managed care organizations. While some of their members are opting to have a primary care practitioner coordinate their care, the MCOs are almost certainly headed for non-risk-based Medicaid contracts that will limit their role to administration. The Medicaid pharmacy program is also undergoing belt-tightening, which will affect the prescribing of mental health drugs. In the private insurance market, carriers will find organic growth hard to come by, although a few managed to eek out some growth in early 2009. Some 400,000 Health Net customers looking for a new carrier, and most are expected to go to UnitedHealthcare, which acquired Health Net’s northeast licenses. New York is quickly becoming a state of medical homes, with the addition of the Adirondack region and the state’s Medicaid program. Meanwhile, state employee and retiree benefit plans make changes in vendors in the search for cost savings, and pharmaceutical companies are opposing attempts to restrict their marketing activities in New York and New Jersey.

Aetna | 4Q 2009 | Health Plan Earnings Summaries

Fri, 12 Feb 2010 00:00:00 GMT

Integrated Payer Platform | MMSRX/PBE | July 2009

Fri, 12 Feb 2010 00:00:00 GMT

The Integrated Payer Platform combines data about health plans, PBMs and employer health benefits into one streamlined view, enabling users to fully assess market opportunities and obstacles and minimize blind spots. Leveraging data from multiple HealthLeaders-InterStudy products, the Integrated Payer Platform provides a macro-understanding of the payer landscape that is essential for coordinating effective field strategies in the pharmaceutical industry.

Texas | Winter | 2010 | Health Plan Analysis

Fri, 12 Feb 2010 00:00:00 GMT

Report Summary: Through its full carve-out of the pharmacy benefit for Medicaid and CHIP, the Texas Health & Human Services Commission has saved billions of dollars through drug rebates. Texas' public-sector retirement systems have made changes in the past to better deal with shortfalls, but continually high hospital expense trends for the Employees Retirement System of Texas could mean changes to benefits for the next fiscal year. UniCare's departure from the market surprised some, but its membership has easily transferred to the WellPoint subsidiary's insurer of choice, Blue Cross and Blue Shield of Texas. Medicare Advantage Special Needs Plans have dug down to reach the state's dual eligible population.

HealthSpring | 4Q 2009 | Health Plan Earnings Summaries

Thu, 11 Feb 2010 00:00:00 GMT

Centene | 4Q 2009 | Health Plan Earnings Summaries

Thu, 11 Feb 2010 00:00:00 GMT

Coventry | 4Q 2009 | Health Plan Earnings Summaries

Thu, 11 Feb 2010 00:00:00 GMT

Health Net | 4Q 2009 | Health Plan Earnings Summaries

Wed, 10 Feb 2010 00:00:00 GMT

CIGNA | 4Q 2009 | Health Plan Earnings Summaries

Wed, 10 Feb 2010 00:00:00 GMT

Illinois & Iowa | Winter | 2010 | Health Plan Analysis

Fri, 05 Feb 2010 00:00:00 GMT

Report Summary: The Illinois and Iowa commercial health insurance markets took hits through much of 2009 as rising unemployment resulted in fewer insured residents. The issue was more severe in Illinois where the manufacturing downturn caused enrollment losses for most major insurers. In Iowa, a more-stable economy left fewer losses, but carriers there are still feeling the pinch of employers seeking to hold down healthcare cost increases. As a result, high-deductible health plans are increasing in popularity as an option for mid-sized groups and as a sole solution for small groups. The average deductible for these plans is running at $2,500 with some preventive benefits covered before the deductible. Separately, BC/BS of Illinois – the state’s largest insurer – agreed to absorb the commercial members of UniCare, the WellPoint unit that is exiting the Illinois and Texas markets. The addition of these UniCare lives should benefit Illinois Blues at a time when the commercial market is stagnant and consolidation has removed some players from the field. Illinois Blue is also developing a patient-centered medical home pilot with physician groups in the Chicago suburbs that could expand to much of its PPO network. In Iowa, job losses are driving demand for Medicaid services, just as the state faces a budget crunch to pay for these services. With eligibility rules locked in, the state has already cut some reimbursement levels and could do so again, although hospitals are signaling support for a provider assessment program that would attract additional federal matching funds.

Webinar | HPDA | Navigating Benefit Design in the New Economy

Fri, 05 Feb 2010 00:00:00 GMT

Recorded Playback Link:
Navigating Benefit Design in the New Economy

Summary:
A shift toward high-deductible health plans and away from copays will create numerous impacts to the pharmaceutical industry.

This presentation, open ONLY to subscribers of HealthLeaders-InterStudy's Health Plan Data & Analysis, will review key managed care and benefit design trends discussed in recent Health Plan Analysis reports and what bearing these trends may have on the pharmaceutical industry.

After attending this webinar you will have a better understanding of:
· The current shift toward high-deductible health plans, and case studies in which this trend is exemplified.
· How high-deductible health plans handle prescription drug benefits.
· The emergence of pharmacy riders with high-deductible health plans.
· How the transition to coinsurance will affect pharmacy benefits.

Presenters:
Jane DuBose, director, health plan analysis.
Paula Wade, assistant director, health plan analysis.

New England | Winter | 2010 | Health Plan Analysis

Fri, 05 Feb 2010 00:00:00 GMT

Report Summary: While lawmakers in Washington, D.C., fight over a problematic national healthcare reform bill that includes an individual mandate, the only state in the nation with such a law in placeÑMassachuettsÑis seeing positive returns on that front. Data from the state department of revenue shows the vast majority of tax filers are insured and in compliance with the requirement to report that insurance on their tax form. In Rhode Island, the state's largest insurerÑBlue Cross & Blue ShieldÑhas launched a patient-centered medical home initiative focused on chronic diseases Plans are to have more than 100 primary-care physicians on board by year's end. Meanwhile, BC/BS of Massachusetts continues to lead the Bay State in total HMO enrollment, though Tufts Health Plan is the largest Medicare Advantage HMO plan. The Blue plan in Massachusetts says about one-fifth of its network providers are in global capitation contracts with compensation tied to quality.

Humana | 4Q 2009 | Health Plan Earnings Summaries

Thu, 04 Feb 2010 00:00:00 GMT

Integrated Payer Platform | EV/MMSRX/PBE | July 2009

Wed, 03 Feb 2010 00:00:00 GMT

WellPoint | 4Q 2009 | Health Plan Earnings Summaries

Tue, 02 Feb 2010 00:00:00 GMT

PatientFinder

Tue, 02 Feb 2010 00:00:00 GMT

A Novel Approach to Local Market Sizing

PatientFinder is an online, user-driven, flexible data set that you can easily manipulate to reveal the true disease opportunity at a local market level. This is the only healthcare analytics tool that assesses local markets for expansion opportunity by determining the number of insured patients in each territory who have the disease but are untreated.

Questions answered include:

Which states and metropolitan statistical areas have the greatest number of patients with insurance?
How many patients have the disease but are not treated in each territory?
How many insured patients would be gained in each local market if territories with poor treatment rates were brought up to the national average?

PatientFinder provides:

Disease-specific prevalence numbers for each U.S. state and metropolitan statistical area
Examination of treatment rates for the disease population to create percent treated and percent untreated estimates by state and metropolitan statistical area
Unique analysis of the untreated population examined through a filter of Rx benefit coverage. The end result is an estimate of how many patients are untreated but can afford therapy within each territory—the true local measure of opportunity for pharma companies

PatientFinder is the first burden of disease data set that reveals true market expansion opportunity at a local level. It will provide the following information for each of the 50 states and 318 metropolitan statistical areas:

Demographics

Population breakdown by age, gender,race and socioeconomic status
Insured population
Uninsured as percent of population
Insured with Rx benefit

Disease Insight

Prevalence of disease
Prevalence as percent of population
Treated for disease
Treated as percent of population
Untreated for disease
Untreated as percent of population
Untreated with Rx benefit

With this information, pharmaceutical organizations can identify the local markets that offer the greatest opportunity for their branded drug. Companies can identify markets that are underserved and determine if they should increase direct-to-consumer advertising, work with the local managed care organization to increase awareness of the disease and benefits of their drug or align reps to maximize market potential.

Georgia, Alabama & Louisiana | Winter | 2010 | Health Plan Analysis

Mon, 01 Feb 2010 00:00:00 GMT

Report Summary: In Georgia and Louisiana, state government is the largest employer and insures the largest group of people. In both states, cost saving changes are under way. Louisiana is looking at privatizing its state employee PPO and will add a consumer-driven health plan option in the upcoming fiscal year. Georgia is pushing for CDHPs and has already seen success in this enrollment and in its wellness initiative. Alabama, Georgia and Louisiana have all seen Medicaid increases due to the recession and, in the case of Louisiana, a strong push to add members to its Children's Health Insurance Program, LaCHIP. In Alabama and Louisiana the increase in Medicaid was accompanied by a decrease in commercial enrollment, but in Georgia that trend didn't happen. Enrollment in commercial plans in Georgia went up by 4 percent in the first half of 2009, the latest period for which data is available. Brokers in all three states warn that when the rest of 2009 enrollment is tallied, there will probably be enrollment losses. In Georgia and Alabama insurers Humana and Blue Cross Blue Shield are both pursing medical home pilots, and Humana has data to prove both improved medical outcomes and reduced costs. The Alabama Blue plan launched a patient-centered medical home last fall that features incentives for physicians. The city of New Orleans has adopted UnitedHealthcare's new diabetes program for city employees in the expectation of improving health outcomes and saving nearly $1 million annually.

Arizona | Winter | 2010 | Health Plan Analysis

Fri, 29 Jan 2010 00:00:00 GMT

Report Summary: Arizona has one of the hardest hit economies in the nation, according to various indicators. As a result, commercial healthcare enrollment is down and enrollment in the state’s CHIP program has been capped. Against that backdrop, health insurance plans are doing whatever they must to keep market share, which means answering demands by recession-hit employers to cut costs in the very competitive Arizona market. Even with a tough economy, though, health plans like Health Net are introducing products and CIGNA is monitoring its stand-alone walk-in clinics. State lawmakers have enabled the sale of "mandate-lite" plans for individuals, but so far there are none for sale.

UnitedHealth Group | 4Q 2009 | Health Plan Earnings Summaries

Wed, 27 Jan 2010 00:00:00 GMT

California | Winter | 2010 | Health Plan Analysis

Wed, 20 Jan 2010 00:00:00 GMT

Report Summary: A change in pharmacy benefit management at California's largest health insurer paves the way for a gradual shift in focus to home delivery of medications, particularly generics. Analysts say the potential to grow mail-order penetration, and thus profits, was a key motivation behind Express Script's purchase of the NextRx PBM from WellPoint Inc. The range and speed of Express Script's influence will depend upon the cooperation of WellPoint and its Anthem Blue Cross subsidiary, which retain control over formulary decisions and benefit designs. Despite the rough economy, a couple of California carriers managed to grow commercial enrollment during the first half of 2009. In the public sector, Medi-Cal system is undergoing an overhaul to improve care management for Medicaid members. If managed care plans are designated as medical homes, they could pick up another 272,000 members. That would presumably shift more of the pharmacy benefit to health plans, which employ tighter controls on prescriptions. Meanwhile, California became the latest state to ban gender as a factor in rate-setting on individual insurance policies.

Ohio, Kentucky & Indiana | Winter | 2010 | Health Plan Analysis

Wed, 20 Jan 2010 00:00:00 GMT

Report Summary: Ohio has decided to carve out Medicaid pharmacy in anticipation of the passage of a new federal law, the Drug Rebate Equalization Act. The Act will give managed care companies the same rebates - around 38 percent - for brand-name prescription drugs as state Medicaid agencies get when purchasing the same drug for their fee-for-service Medicaid populations. Previously, Medicaid MCOs could only negotiate rebates on drugs in the single digits. But Ohio and Indiana decided their state budgets would be better served by capturing all the rebates at the state level. The economy continues to drive a payor mix shift in the Indiana-Kentucky-Ohio region. Commercial employer-sponsored coverage has eroded, while Medicare and Medicaid plans have grown. The reduction in employment-based coverage is driven less by employers dropping coverage than by erosion from within existing groups - employers laying off workers, dropping dependent coverage, auditing dependents for the availability of other coverage or pricing such that employees choose to work without taking the health benefit. Medicaid statistics show that working people make up nearly all new beneficiaries, since aged, blind and disabled populations - which generally don't include working people - have remained stable or down. In Ohio, a UnitedHealthcare subsidiary, All Savers Insurance Co., has launched a pilot of a new insurance product that gives workers some up-front spending credits to purchase health services in hopes of bringing some market forces to bear on health spending. The small-group All Savers plan also offers employers the option to allow workers to "design" portions of their benefit themselves - including the amount of the spending credits - for the possibility of up to 16 different benefit designs that are all actuarially equivalent, and charge the same premium to both employee and employer.

Pharmacy Benefit Evaluator 2.0 | Data | January 2010

Thu, 14 Jan 2010 00:00:00 GMT

Colorado & Nevada | Winter | 2010 | Health Plan Analysis

Tue, 12 Jan 2010 00:00:00 GMT

Report Summary: UnitedHealthcare's Connected Care program, an effort to create a national telehealth network, has taken root in a partnership with Centura Health and rural health facilities. Diabetes management has taken different paths in Colorado and Nevada due to different populations, levels of preventive care and diabetic monitoring. Medicaid enrollment in Colorado has reached an all-time high, but program officials have made strides in evidence-based policies and tweaking practices for better results. Medicare Advantage plans in both states have tried to hold the line against expenses, with Reno's Hometown Health taking member advice to best preserve benefits without breaking the bank.

Market Overview | 2010 | Release Schedule

Mon, 04 Jan 2010 00:00:00 GMT

Pharmacy Benefit Evaluator 2.0 | Parent & Child Relationship | January 2010

Fri, 01 Jan 2010 00:00:00 GMT

Description

Formulary Advantages in Chronic Pain Therapies: How Will Price Impact the Coverage of Expensive Abuse-Deterrent Opioids and Biologics?

Wed, 30 Dec 2009 00:00:00 GMT

Chronic pain is a multi-billion dollar market saturated with well-established branded and generic analgesics that are only partially effective. While drugs with novel mechanisms of action that offer greater efficacy will contribute to market growth, reformulations of current therapies that offer improved convenience, tolerability, or abuse-deterrence will inevitably be more expensive than current generics and will likely replace low-cost generics only in specific niche populations. New agents such as Pfizer’s tanezumab, the first biologic to treat chronic pain, and King’s Embeda (morphine SR and naltrexone), the first abuse-deterrent opioid analgesic on the U.S. market, address unmet needs in the chronic pain market. However, managed care organizations (MCOs) will seek to limit these agents’ use to specific patient populations to control the cost of these expensive therapies.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of chronic pain treatments, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Government Employees Health Association (GEHA) | California | 2009 | Plan Profile

Mon, 21 Dec 2009 00:00:00 GMT

Address: 310 Northeast Mulberry, Lee’s Summit, MO 64086-0146
Products: Commercial PPO, CDHP, Medicare Part D
URL: http://www.geha.com

Pennsylvania | Fall | 2009 | Health Plan Analysis

Thu, 17 Dec 2009 00:00:00 GMT

Report Summary: Independence Blue Cross is one of the state’s largest health insurers, but is one of the last to cover its members’ self-injected specialty drugs under the medical benefit. But that’s changing in 2010, as the Blue plan catches up to the rest of the industry by requiring those drugs to be purchased through the pharmacy system. Of the 3,200 affected customers, some will have to pay more out-of-pocket for these expensive biologics. The quest for control over limited healthcare dollars is prompting more counties to opt out of fully insured plans and take on the risk of paying medical claims. They are pooling their resources in a purchasing coalition that’s gaining momentum in the commonwealth. Talk in Washington of some big changes in store for the Children’s Health Insurance Program hasn’t deterred a couple of Pennsylvania health plans from jumping into CHIP for the first time this year: Geisinger Health Plan and Health Partners. Geisinger is also taking more of a gamble with another population: those in Medicare Advantage special needs plans. The carrier is expanding participation in the program while others are begging out in 2010 because of cost and concerns about future federal policy. Bravo Health is also making waves in the Medicare program by establishing a unique medical clinic especially for its high-risk Medicare members. A new telehealth project from UPMC aims to put the gravest heart patients at ease with round-the-clock home monitoring.

North & South Carolina | Fall | 2009 | Health Plan Analysis

Wed, 16 Dec 2009 00:00:00 GMT

Report Summary: Employers in North Carolina and South Carolina are turning to so-called hybrid plans to help them continue to offer coverage in one of the regions worst hit by job losses. The hybrid plans combine features of first-dollar coverage plans with high-deductible choices so that some services carry copays while others carry coinsurance. Most of the designs have prescription drug coverage. A medical home pilot in North Charleston, S.C., sponsored by BlueCross BlueShield of South Carolina and involving the Palmetto Primary Care practice, has enrolled some 1,500 diabetic patients. Meanwhile, the medical home model in North Carolina's Medicaid program is hoping to boost adoption of electronic prescribing and better improve data reporting. BlueCross BlueShield of South Carolina's HMO has launched a two-tier generic design for commercial groups. North Carolina's huge state and teachers group is implementing a wellness program that will give nonsmokers and those at a healthy weight a better option on plan designs.

HPDA Contact Database | July 2009

Tue, 15 Dec 2009 00:00:00 GMT

Formulary Advantages in Orally Delivered Oncology Agents Impact of Cost Controls and Emerging Agents on Key Brands

Fri, 11 Dec 2009 00:00:00 GMT

Formulary Advantages in Orally Delivered Oncology Agents Impact of Cost Controls and Emerging Agents on Key Brands

Mid-Atlantic | Fall | 2009 | Health Plan Analysis

Fri, 11 Dec 2009 00:00:00 GMT

Report Summary: In what could end up as a budget buster for the state, Maryland's Medicaid rolls went up by more than 90,000 from July 2008 to October 2009. The recession accounted for some of that rise just as it has done in other states, but Maryland's legislators also passed a law in November 2007 to expand eligibility, and this pushed the numbers over the top. Enrollment in Medicare Advantage continues to grow at a fast pace in Virginia, but much more slowly in Maryland and the District. Medicare special needs needs plans, squeezed by new federal rules and lower-than-expected reimbursements, dropped significantly in the Mid-Atlantic, where enrollment has never been high. E-prescribing began to take off in Virginia and other Mid-Atlantic states though it still accounts for only 3 to 5 percent of the total number of prescriptions written. The H1N1 virus has peaked and insurers are beginning to feel the impact of extra medical claims though the worst will be in the first quarter of 2010. In Virginia, Aetna is offering a Medicare Supplement plan in addition to its Medicare Advantage plans. With this, enrollees will be able to choose their own physicians without the limitations of a network. CIGNA is beginning to offer lean benefit plans with four-tier drug benefits in an effort to provide affordable insurance for the medium to small business markets.

Kansas & Missouri | Fall | 2009 | Health Plan Analysis

Wed, 09 Dec 2009 00:00:00 GMT

Report Summary: Blue Cross and Blue Shield of Kansas City has engaged a medical home pilot with TransforMED, bringing new technologies to 13 medical practices in its operating regions. The practices can build the medical home model for patients regardless of their insurance. Coventry Health Care purchased the last provider-owned commercial plan in Kansas, Preferred Health Systems. The Missouri Consolidated Health Care Plan switched to a single plan administrator, United Medical Resources, then added Mercy Health Plans at the last minute because of provider issues. UnitedHealthcare is taking its Diabetes Health Plan nationwide for large employers, with the hopes of lowering costs for those with the chronic illness.

Wisconsin | Fall | 2009 | Health Plan Analysis

Wed, 25 Nov 2009 00:00:00 GMT

Report Summary: As the nation moves toward comprehensive healthcare reform, co-ops are gaining national recognition as a possible alternative to a public healthcare option. Wisconsin's co-ops have been successful, but took time to build. Meanwhile, local employers are moving toward value-based benefits design as a way to curb costs and increase drug complaince. Health plans statewide have been impacted by the economy, but the provider-owned HMOs are holding their own when it comes to commercial enrollment numbers.

Michigan | Fall | 2009 | Health Plan Analysis

Mon, 23 Nov 2009 00:00:00 GMT

Report Summary: The HMO subsidiary of Michigan's largest health insurer, Blue Cross Blue Shield of Michigan has begun the process to purchase an independent, Lansing-based HMO, Physicians Health Plan of Mid-Michigan. The deal faces a challenge from other HMOs who contend it will reduce competition and raise rates, but the Blue plan argues it will cut costs through synergies and pass those savings on to customers. Blue Cross Blue Shield of Michigan also operates one of the nation's largest and most advanced patient-centered medical home initiatives. It has 1,200 doctors in over 300 practices signed up, but that was the easy part. The hard part will be persuading the later adopters to change how they deliver care and accept a different payment model. As the Medicare enrollment season gets under way, Michigan seniors have evolved into two camps: those who favor a Medicare Advantage health plan, and those who favor original Medicare, stacked with perhaps a Part D prescription drug plan and a Medicare supplement product. Awareness of these different types of buyers is driving insurers to offer products they have never offered before.

Tennessee | Fall | 2009 | Health Plan Analysis

Thu, 19 Nov 2009 00:00:00 GMT

Report Summary: Several Tennessee-based companies are confident enough about the future of Medicare Advantage programs to launch expansions. Most notable in the group is BlueCross BlueShield of Tennessee, the state’s biggest carrier, which rolls out a MA PPO to more counties in 2010 with plans to have complete coverage in the state come 2011.A smaller reimbursement increase has spurred changes to this year’s Medicare Advantage market. For the coming year, fewer companies are offering MA plans, at least in the four counties that anchor the state’s major metropolitan areas. Aetna, BlueCross, CIGNA, Humana and UnitedHealthcare all submitted bids on the second request for proposals issued last spring to cover the approximately 17,000 members in the Memphis City Schools plans. CIGNA won the contract and its victory over BlueCross may also represent a shift among healthcare purchasers to consider narrower provider networks as healthcare costs accelerate. Tennessee’s Benefits Administration, which manages health plans for the state’s employees, is looking for a pharmacy benefits manager in an effort to increase efficiency and save money. The state also is considering having two, rather than three third-party administrators for health benefits.

TriState | Fall | 2009 | Health Plan Analysis

Mon, 16 Nov 2009 00:00:00 GMT

Report Summary: The individual health insurance markets in New York and New Jersey are a study in contrasts, despite the fact both are highly regulated to guarantee residents a certain level of coverage. New Jersey's individual market is taking off-a reflection of both the economic downturn and the state's loosening of pricing restrictions on the highly regulated individual market. New York's individual market, however, is shrinking and getting pricier by the day. That's why an advocacy group opposed a new state law allowing the Freelancer's Union to establish its own insurance agency to cater to a specific segment of the workforce. New Yorkers for Accessible Health Coverage believes luring independent workers away from the individual market will further distill it into an unviable high-risk pool. In Connecticut, health plans and providers have come together in a historic data-sharing project in which an estimated 4,000 physicians throughout Connecticut can now track their progress in meeting national guidelines for tests and screenings for chronic conditions such as diabetes and coronary artery disease. Meanwhile, the aggressive measures by Horizon Blue Cross Blue Shield of New Jersey to get its out-of-network medical costs under control have sent tension levels to a new high in its relations with the provider community.

Health Net | 3Q 2009 | Health Plan Earnings Summaries

Thu, 12 Nov 2009 00:00:00 GMT

CIGNA | 3Q 2009 | Health Plan Earnings Summaries

Thu, 12 Nov 2009 00:00:00 GMT

Florida | Fall | 2009 | Health Plan Analysis

Wed, 11 Nov 2009 00:00:00 GMT

Report Summary: Florida Medicare Advantage plans are reacting to reduced reimbursements by scaling back benefits and raising costs to their HMO members for 2010. The change, which comes as the federal government is cutting federal payments to plans by about 5 percent, is being felt as some carriers increased copays while others moved drugs to higher tiers. Elsewhere, the Florida HMO market continued to lose members in the first half of 2009 because of the recession, but insurers kept premium increases at a minimum, boosting profits through cost containment. The South Florida market is being partly reshaped as insurers battle for the sizable public school system contracts, which represent more than 100,000 combined lives in three counties. Medicaid enrollment continues to grow and a new analysis by the University of Florida showed the financial savings achievable by managed Medicaid. This report could shape the controversial Medicaid Reform program and comes as Mike Fernandez – former owner of PHP and CarePlus – is reentering the HMO market with a Medicaid HMO called SimplyHealthcare.

WellCare | 3Q 2009 | Health Plan Earnings Summaries

Fri, 06 Nov 2009 00:00:00 GMT

Texas | Fall | 2009 | Health Plan Analysis

Thu, 05 Nov 2009 00:00:00 GMT

Report Summary: Scott & White Health Plan has leveraged its vertical integration to keep proton pump inhibitor costs at a fraction of the national average. For the first time, Texans who have received out-of-network charges at an in-network facility will be entitled to seek mediation on those charges, known commonly as balance billing. Harris County has one of the worst uninsured rates in the nation, and a new program for small businesses could offer a glimmer of hope for reducing it.

HealthSpring | 3Q 2009 | Health Plan Earnings Summaries

Wed, 04 Nov 2009 00:00:00 GMT

Aetna | 3Q 2009 | Health Plan Earnings Summaries

Wed, 04 Nov 2009 00:00:00 GMT

AMERIGROUP | 3Q 2009 | Health Plan Earnings Summaries

Tue, 03 Nov 2009 00:00:00 GMT

Humana | 3Q 2009 | Health Plan Earnings Summaries

Tue, 03 Nov 2009 00:00:00 GMT

Coventry | 3Q 2009 | Health Plan Earnings Summaries

Tue, 03 Nov 2009 00:00:00 GMT

WellPoint | 3Q 2009 | Health Plan Earnings Summaries

Tue, 03 Nov 2009 00:00:00 GMT

Molina | 3Q 2009 | Health Plan Earnings Summaries

Mon, 02 Nov 2009 00:00:00 GMT

Centene | 3Q 2009 | Health Plan Earnings Summaries

Mon, 02 Nov 2009 00:00:00 GMT

Georgia, Alabama & Lousiana | Fall | 2009 | Health Plan Analysis

Thu, 29 Oct 2009 00:00:00 GMT

Report Summary: Enrollment in Medicare Advantage continues to grow in the South though private-fee-for-service plans are leaving the market in anticipation of the Congressional mandate for network-based products in 2011. Louisiana and Alabama are already HMO-dominated markets, but it’s a different story in Georgia. Almost half of MA enrollees are in PFFS. Alabama, Georgia and Louisiana insurers are already feeling the impact of H1N1 flu-related claims, but this is not expected to peak until the fourth quarter. In Georgia, a 25-person steering committee is developing an innovative plan to cover a segment of the working uninsured that uses federally qualified health centers for primary care. In addition to the clinics, hospitals are on board, but negotiations with insurers are still under way. Also in Georgia, Blue Cross and Blue Shield of Georgia has introduced its Blue Essential limited-benefit plan to appeal to employers struggling to afford healthcare benefits.

News for New Mexico

Thu, 22 Oct 2009 01:00:00 GMT

News for Oklahoma

Thu, 22 Oct 2009 01:00:00 GMT

New England | Fall | 2009 | Health Plan Analysis

Thu, 22 Oct 2009 00:00:00 GMT

Report Summary: Massachusetts' largest health insurer, Blue Cross Blue Shield, is embracing one of the latest trends in pharmacy benefit management, that of value-based benefit design. The Boston-based health plan, already the only state HMO offering the design to self-insured accounts, will become the first HMO in Massachusetts to offer a VBBD to the fully insured group market beginning Jan. 1, 2010. Also embracing the VBBD concept is the state of Maine, which is seeing a strong return on investment from its VBBD program revolving around diabetes for state employees. The strong results prompted the state to expand to new disease states. Meanwhile, a growing concern for health insurers across New England is rising costs of specialty drugs, prompting heatlh plans to implement a variety of strategies to control those costs. In Massachusetts, Bay State officials have been working to keep its landmark near-universal healthcare reform afloat amidst severe economic turmoil. A $5.4 billion state deficit and tax collections down by almost $3 billion forced state officials to institute cutbacks to the state's reform, shifting around 31,000 legal immigrants to a less generous—and less costly—benefit.

UnitedHealth Group | 3Q 2009 | Health Plan Earnings Summaries

Thu, 22 Oct 2009 00:00:00 GMT

California | Fall | 2009 | Health Plan Analysis

Thu, 15 Oct 2009 00:00:00 GMT

Report Summary: With all eyes focused on the national healthcare reform debate, California is already tackling many of the same thorny issues raised by policymakers. Healthy San Francisco, the city/county’s 2-year-old universal care measure, would be an ideal example of the Public Option That Could, if not for the fact this is a non-insurance program. Nevertheless, the City by the Bay took matters under its own hands, something not every community may be able to replicate. And, as reformers turn an eye to phasing out fee-for-service payments in Medicare, a significant number of physician groups are moving toward it in San Diego—ironic, given that reformers tend to favor California’s historic managed-care payment model. Amid all this political uncertainty, one company has boldly started the full first-blown health plan in recent memory in the Golden State. Meanwhile, a new breed of Medicare brokers is taking advantage of employer shifts in the way retiree health benefits are funded, which stands to invigorate the individual Medicare market.

Oregon & Washington | Fall | 2009 | Health Plan Analysis

Thu, 15 Oct 2009 00:00:00 GMT

Report Summary: Group Health's governance as a nonprofit member-owned cooperative has attracted national attention recently as healthcare reform discussions in Washington DC look toward insurance cooperatives as a possible alternative to a "public option" health plan. But the key to its ability to control costs, its leaders say, is in the integration of its insurance, hospital, clinic and pharmacy management functions. The medical home model is another concept getting attention during the national debate on healthcare reform. Premera Blue Cross, the largest insurer in Washington, and Swedish Health Systems, the largest nonprofit healthcare provider in the Seattle market, have rolled out a new out-come-based medical home initiative at Swedish's Ballard Clinic. The new payment structure includes incentives for Swedish in delivering quality care to Premera's participating members. Required "cost estimators" in Oregon might have a more far-reaching effect than just giving online price information to consumers. It might result in a marketplace where providers compete more keenly on cost and quality.

Formulary Advantages in Type 2 Diabetes: Impact of Current and Future DPP-IV Inhibitors and GLP-1 Analogues on Advantaged Reimbursement Status for Key Brands

Tue, 13 Oct 2009 00:00:00 GMT

Report Summary: Type 2 diabetes currently affects almost 24 million in the United States and the prevalence of the disease is set to grow at approximately 3% per year over the next five years. As biopharmaceutical companies seek to increase diagnosis and treatment rates, the drug-treated population in the United States will grow by about 5% per year over the next five years. Despite the growth of the treated population and the launches of several emerging therapies, the type 2 diabetes market will shrink over this same timer period, because of the looming patent expiry of Takeda's Actos (pioglitizone). Makers of novel therapeutics treating type 2 diabetes that will launch in the next few years must thus face a crowded market dominated by two oral brands (Actos and Merck's Januvia [sitagliptin]), increasing numbers of generics, and payer pressure to reduce costs associated with this disease.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 40 pharmacy directors, this report determines the key trends in reimbursement of antidiabetics and insulins, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Illinois | Fall | 2009 | Health Plan Analysis

Sat, 10 Oct 2009 00:00:00 GMT

Report Summary: A new agreement between Caterpillar and Walgreens could point the way to a change in drug dispensing for large employers. Under this agreement, Caterpillar contracts directly with Walgreens, where 100,000 employees, dependents and retirees can pick up their drugs. The difference is that the price to Caterpillar will be based off the Walgreens Propriety Price List, which is based off the cost Walgreens pays the drug manufacturer. That means that Caterpillar will have the actual drug cost from the manufacturer, eliminating the role of PBM, which profits from and hides details of the spread between payment to the manufacturer and cost to the client. The move - which is also underway at Wal-Mart - will likely be repeated for other large employers seeking transparency and savings. Elsewhere, Health Alliance has updated its value-based benefit design by reducing copays on its asthma control medication. Drug spending and adherence are up and the Urbana-based health plan is just now getting data that could show reduced medical costs.

Nevada | Fall | 2009 | Health Plan Analysis

Thu, 08 Oct 2009 00:00:00 GMT

Report Summary: A stagnant economy and record unemployment have prompted health insurers to alter their plan designs and drug formularies in the Nevada market. HMO market share has eroded by 8 percentage points between 2008 and 2009. A plan for the uninsured launched in Reno two years ago has shown promise in covering the working uninsured; while not insurance, providers and pharmacies offer highly discounted rates in exchange for upfront payment. One of the Reno's provider-owned health insurers, Hometown Health Plan, recently began Health Tracks, an aggressive wellness program in which employer groups must offer a participation incentive or guarantee 80 percent participation. Meanwhile, the financially strapped state is facing significant increases in caseloads for Medicaid, putting even more spotlight on the need to manage medical costs as revenues shrink.

Iowa | Fall | 2009 | Health Plan Analysis

Tue, 06 Oct 2009 00:00:00 GMT

Report Summary: Though Iowa has the second lowest health insurance premium rates nationwide, brokers and industry insiders warn that premiums, which went up 11 percent for many Iowa businesses over the last year, are likely to continue to rise. Nevertheless, Iowa employers are not ready to throw in the towel on employee health benefits. In the 2009 Iowa Employer Benefits Study, a survey of employers, only 1.1 percent said they would take the drastic step of dropping coverage if prices go up. They would first raise employee copays and deductibles and reduce benefits. Employers also indicated greater interest in consumer driven health plans. Commenting on the data, brokers note that CDHP premiums have not so far been low enough to be the obvious choice for many Iowa businesses. Like many other states, Iowa is looking at programs to develop health information exchanges and to establish medical homes among physician practices and hospitals. To date, the state has invested $150,000 to convene a study council on medical homes, but there have been no decisions on future financing or reimbursements. Looking at HIEs, the Department of Public Health is leading an eHealth project through a four-step process of planning, devising infrastructure, testing and then implementing best practices for future HIE development. Though it’s early days for this project, the state has a foundation of smaller but similar projects already underway. Insurers are bracing for higher medical costs due to the H1N1 virus this fall in addition to seasonal flu. In second quarter earnings reports, top national plans noted that medical costs were already rising. Most companies will pay for members’ vaccinations. Meanwhile, health experts are providing educated guesses on how long the flu season will last and how virulent it will be.

News for Arkansas

Tue, 29 Sep 2009 01:00:00 GMT

Ohio Kentucky & Indiana | Fall | 2009 | Health Plan Analysis

Fri, 25 Sep 2009 00:00:00 GMT

Report Summary: Three major insurers -- Anthem Blue Cross and Blue Shield, Humana and UnitedHealthcare -- have teamed up with 11 local physician group practices and a local organization to pilot a patient-centered medical home scheme in the Cincinnati market. Organizers hope to realign care delivery and reimbursement in ways that will improve patient outcomes, particularly for those with chronic conditions. Humana got an early start and is already reimbursing some practices with a per-member, per-month case management fee. All will officially launch Oct. 1. Getting doctors to participate required the collaboration of the three leading insurers in the market. Indiana's Medicaid Care Select program to serve certain non-institutionalized aged, blind and disabled beneficiaries has come to full implementation, and has already seen some success. As evidenced by the disbursement of holdback funds, the two participating health plans — ADVANTAGE Health Solutions and MDwise — managed to cut medical cost trend to just 1 percent, while achieving quality gains and high member satisfaction. In Ohio, four of the largest public employee retirement organizations have formed a consortium to consolidate their prescription drug purchasing, and have now opened up the consortium to every other public employee group in the state, from local municipal governments and school districts to higher education staffs. The Rx Ohio Collaborative already has nearly 500,000 covered lives under a single contract with Express Scripts even as all the local groups maintain the autonomy to keep or create their own benefit designs. In the long run, as many as 1 million public employees could end up in a single drug buy.

Minnesota | Fall | 2009 | Health Plan Analysis

Thu, 24 Sep 2009 00:00:00 GMT

Report Summary: Minnesota health plans are facing the specter of rising specialty drug costs and are implementing a variety of strategies to control those costs, including shifting specialty drugs from the medical beneit to the pharmacy side to save costs and increase oversight. Continuing on the pharmacy front, local company General Mills is instituted a program for employees who take multiple medications that in effect brings them them the benefits of their own personal pharmacists. The program is known as MyMedsManagement, from the Minnesota-based company Medication Management Systems. Meanwhile, in a move toward more outcomes-based contracting, local health plan Medica and Fairview Health Systems have inked a three-year deal through which Fairview will be paid based on quality outcomes, rather than a fee-for-service system that rewards volume. Under terms of the deal, Fairview will be able to earn performance-based payments tied to improvements in clinical quality and managing the total cost of patient care. And as the nation moves toward comprehensive healthcare reform, co-ops are gaining national recognition. Talk of moving toward a co-op structure, as opposed to a public healthcare option, has brought local HMO Healthpartners under the microscope, a successful health plan with a co-op structure. Local HMOs are also expanding their individual product portfolios, as the economic downturn have forced more into the indivudal market.

White Paper | Analyzing PBM & Health Plan Relationships | To Strategically Target Pharmaceutical Sales Opportunities

Tue, 15 Sep 2009 00:00:00 GMT

HealthLeaders-InterStudy periodically publishes special analyst reports on healthcare topics of interest.

White Paper | The Demise of the HMO May Be Exaggerated | A Primer on Managed Care Trends for Account Managers

Tue, 15 Sep 2009 00:00:00 GMT

HealthLeaders-InterStudy periodically publishes special analyst reports on healthcare topics of interest.

Pennsylvania | Summer | 2009 | Health Plan Analysis

Fri, 04 Sep 2009 00:00:00 GMT

Pennsylvania stands out from most states because of the dominance of four Blue Cross Blue Shield plans that operate, for the most part, exclusively in their own territories. Whether the Blue plans’ unique licensing structure is adversely impacting competition statewide is the subject of a probe by the state Insurance Department. Meanwhile, Highmark BC/BS, which controls more than half of the small-group market in western Pennsylvania, is driving a focus on lower-cost generic medications by increasing the price spread between generics and brand-name drugs and emphasizing a closed formulary. In the Medicare market, three of the four Blue plans (except in the Northeast) are gearing up to become part of a national PPO network similar to the BlueCard program, which will better position them against national insurers to offer retirees a portable health plan. It’s not all about Blue, however. Coventry Health Care has come up with an innovative product to transition clients into consumer driven health plans. On the state level, more seniors may be able to get prescription drug subsidies from the state, if legislation passes, but the catch is that pharmacies don’t like the state’s plan for funding the plan. The report also looks at the college student insurance market, including the key players in Pennsylvania.

Kansas & Missouri | Summer | 2009 | Health Plan Analysis

Thu, 03 Sep 2009 00:00:00 GMT

Report Summary: Kansas Medicaid members could face a preferred drug list and a streamlined prior authorization process, which could widen the number of therapeutic classes the state covers. These changes are borne out of budgets cuts expected for next year. MO HealthNet, Missouri's Medicaid program, has approved the entrance of Aetna's Missouri Care into two new managed care regions, setting up a more competitive environment in the Kansas City- and St. Louis-centered regions, as well as setting the stage for competition down the road. Aetna's unique partnership in Heartland Health, using the former Community Health Plan's wellness program and data analysis tools, could represent a model for a more inegrated approach with providers in smaller metropolitan regions.

Formulary Advantages in Osteoporosis: Rise and Fall of Access in the Wake of Fosamax Generics, Rebate and Contracting Efforts, and New Drug Launches

Tue, 01 Sep 2009 00:00:00 GMT

With 62 million cases of osteoporosis and osteopenia in the United States and a U.S. market of over $3.8 billion, few brands are competing for a very large appropriation of healthcare dollars. Major brands, however, now have to contend with generic alendronate (Merck’s Fosamax, generics) and convince payers that their brand provides a sufficient value proposition for Tier 2 reimbursement. More recently, the osteoporosis market in the United States has seen growing uncertainty as Amgen’s Prolia (denosumab) received a favorable ruling from an FDA advisory panel, and Eli Lilly announced discontinuation of Phase III clinical development of arzoxifene.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement in osteoporosis, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Mid-Atlantic | Summer | 2009 | Health Plan Analysis

Thu, 27 Aug 2009 00:00:00 GMT

Report Summary: Big contracts were renewed or awarded for the first time in the Mid-Atlantic this summer. Anthem Blue Cross and Blue Shield (the largest health insurance carrier in Virginia) and Kaiser Permanente will continue to provide administrative services for Virginia's employee benefit plan, which covers 197,600 state employees, dependents and retirees. For the first time, Optima Health also joined the mix of carriers with a contract to provide a pilot insurance program, COVA Connect, which emphasizes prevention and wellness and is limited to the Hampton Roads area. Aetna scored in the battle for big contracts in the Mid-Atlantic, by winning the North Region TRICARE contract, which is expected to bring the Hartford-based insurer $1.1 billion of gross revenue over five years and 2.8 million more members. UnitedHealth Group had to ante up in the state of Maryland, where it was forced to pay more than $1.5 million in restitution and penalties this summer, most of that amount for inappropriately denying claims in the state. Meanwhile, brokers say that the recession means that employers are searching for aggressively priced products, especially consumer driven health plans. The carriers themselves saw diminished profits in their commercial HMOs in 2008, mainly from investments, and they are scrambling to make up the difference with premium increases.

News for Hawaii

Wed, 26 Aug 2009 01:00:00 GMT

News for West Virginia

Wed, 26 Aug 2009 01:00:00 GMT

North & South Carolina | Summer | 2009 | Health Plan Analysis

Mon, 24 Aug 2009 00:00:00 GMT

Report Summary: South Carolina's expanded Medicaid managed care program attracted a crowd of health plans interested in insuring beneficiaries, but the crowd is thinning with two MCOs throwing in the towel in 2009. The program now has more than 400,000 Medicaid recipients enrolled in managed care plans or a medical home network, meaning almost two of three South Carolinians in Medicaid is not in the fee-for-service system. The development means a swelling number of Medicaid members who are under prescription drug management by MCOs and their vendors. Blue Cross and Blue Shield of North Carolina reports greater medication adherence among members with chronic conditions as a result of its Medication Dedication program launched in 2008, while employer coalitions in the Carolinas expect additional classes of drugs to be moved into step therapy. The North Carolina Medicaid program is planning to move additional drugs into a prior authorization category in a cost-saving move. Meanwhile, insurers report that the extension of benefits in COBRA is mitigating enrollment losses in the Carolinas, which have been severely affected by job losses

Tennessee | Summer | 2009 | Health Plan Analysis

Mon, 24 Aug 2009 00:00:00 GMT

Report Summary: Beginning in January 2010, Tennessee plans to test a statewide database that will include claims data from claims paid by most of the payors in the state. The database is designed to improve transparency and efficiency of healthcare. Large state-licensed health plans must participate in the database, and are generally supportive. The emergence of pharmacy kiosks or dispensaries at doctors' offices is a new wrinkle in the distribution and marketing of prescription drugs in Tennessee. Insurers have yet to come up with a consistent policy regarding this practice, which seems to be gathering steam as doctors look for additional revenue. Coinsurance appears to be making a comeback, at least in east Tennessee, where several plans are promoting it as a way to keep premiums down and shift cost to employees. Bluegrass Family Health continues its push into Tennessee from its home turf in Kentucky. BlueCross BlueShield of Tennessee continues to dominate the state's PPO and other market segments despite a hit in investment income in 2008.

Market Overview | 2009 | Markets List

Fri, 21 Aug 2009 00:00:00 GMT

Aetna | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

AMERIGROUP | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

Centene | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

CIGNA | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

Coventry | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

Health Net | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

HealthSpring | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

Molina | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

UnitedHealth Group | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

WellPoint | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

Humana | 2Q 2009 | Health Plan Earnings Summaries

Thu, 20 Aug 2009 00:00:00 GMT

Wisconsin | Summer | 2009 | Health Plan Analysis

Sat, 15 Aug 2009 00:00:00 GMT

Report Summary: Wisconsin state officials are dictating to state HMOs that changes be made in how care is delivered in the state's Medicaid/BadgerCare Plus program. Faced with unacceptable HMO quality scores as well as a mandate to cut up to $600 million in costs from its Medicaid program, the state's Department of Health Services has announced it will end its existing BadgerCare Plus contracts with HMOs in six southeastern Wisconsin counties, setting the stage for a competitive bidding process for the region's business. An RFP will be issued this fall, with new contracts in place by July 2010. The re-bid contracts cover about 230,000 managed care lives. Meanwhile, Wisconsin HMOs are awaiting final regulations on a new state mandate that requires them to cover intensive in-home therapy for autism. On the prescription drug front, state HMOs are facing the specter of rising specialty drug costs and are implementing a variety of strategies to control those costs. The state received a dose of good news when the administration of President Barack Obama approved the state's Pharmacy Plus waiver for its popular SeniorCare program. The program is the only one of its kind in the nation and in essence competes with the federal Medicare Part D program.

Florida | Summer | 2009 | Health Plan Analysis

Wed, 12 Aug 2009 00:00:00 GMT

Report Summary: The recession severely damaged Florida insurers in 2008 as the ranks of commercially insured members dropped by 1.2 million last year amid layoffs and benefit cuts at Florida businesses. Every significant market took a hit, led by Miami-Dade and the coastal communities that exploded in population this decade. With construction and real estate jobs gone, unemployment statewide has reached 10.6 percent. The uninsured rose by 936,000 last year to reach 3.74 million.. Insurers are responding to the challenging environment by tweaking products and aggressively targeting public employers to serve their workers. Blue Cross and Blue Shield of Florida has expanded its narrow-network product BlueSelect to Broward County as well as communities outside the Tampa region. The carrier also launched an individual and small group product in conjunction with Miami-Dade's local government. Separately, Florida insurers lost a battle in Tallahassee over legislation that would require insurers directly pay out-of-network providers. Under the previous system, insurers would pay the member for provided service and the member would then pay the provider. Carriers said such a system would encourage providers to join networks and hold down overall costs. Providers opposed this delayed payment and successfully lobbied the Legislature and Gov. Charlie Crist to require direct payment. The state's doctors have also stepped up their use of e-prescribing thanks to strong pushes from insurers and extra payments from Medicare. From 2007 to 2008, the total e-prescription transactions increased from 2.2 million to 5.5 million, representing 4 percent of overall prescriptions.

Texas | Summer | 2009 | Health Plan Analysis

Thu, 06 Aug 2009 00:00:00 GMT

Report Summary: Texas has taken its largest step yet toward addressing the nation's worst uninsured rate by green-lighting the first step toward Healthy Texas, a reinsurance program that could allow small businesses to offer benefits. The program still has some hurdles ahead. Regional insurer FirstCare has tackled the insured in West Texas by offering a trio of association/chamber of commerce plans offering narrower networks but keeping pharmacy benefits robust. UniCare has made a splash in Houston by teaming with Memorial Hermann Health System for a narrow-network PPO, MHealth Insured, that will pass cost savings from clinical integration onto plan members. Centene's Superior HealthPlan will have company next year in the Children's Health Insurance Program's rural operating area now that the state awarded the rural CHIP contract to Centene and Molina Healthcare.

News for Utah

Tue, 04 Aug 2009 01:00:00 GMT

TriState | Summer | 2009 | Health Plan Analysis

Mon, 03 Aug 2009 00:00:00 GMT

Report Summary: The winds of change are about to reshape the TriState health insurance market, starting with the announcement that UnitedHealth Group is planning to buy Health Net of the Northeast within 12 months. In an unusual deal, UnitedHealth is paying for a first crack at renewing some 437,000 Health Net commercial members as contracts come up for renewal. Rival carriers must now contemplate how they will go after this business, at a time when many of them are already stepping out of their comfort zones and making bold plays for customers. Oxford Health Plans, the UnitedHealthcare subsidiary that handles small business, is debuting its first HMO in recent memory in New York City, the latest play among carriers jockeying for the downstate small-group market. Meanwhile, more and more downstate group customers are opting for the menu approach to health insurance, driving record enrollment at the HealthPass insurance exchange. Across the border, Horizon Blue Cross Blue Shield of New Jersey is nudging its small groups into a new Advantage product line with a unique twist to steer members away from costly out-of-network ambulatory centers. In Connecticut, CIGNA is introducing an individual product for the first time, while Independent Health in New York is trying its hand at an online vitamin store. Meanwhile, Blue plans prepare to make a big leap in Medicare.

Georgia, Alabama & Louisiana | Summer | 2009 | Health Plan Analysis

Thu, 30 Jul 2009 00:00:00 GMT

Report Summary: The effects of the recession continue to be seen among carriers in the South, particularly the Blues in both Alabama and Georgia where big drops in enrollment and earnings in 2008 were reported. However, brokers point out that these two plans dominate their markets and are not about to be taken down by a year of losses. They are already beginning to rebound and neither actually fell into the red. Except for Kaiser, which sustained losses, other big commercial plans in Georgia (UnitedHealth Group, Aetna, CIGNA, Humana and Coventry) actually added members, and Humana made a lucrative deal to reinsure members of Evergreen Health Plan. In addition to the recession, the Georgia Blues took another hit in 2008, losing its state employee contract where it had 176,799 members last year, and it is now the target of a lawsuit brought by out-of-network surgical centers cutting reimbursement rates. Louisiana's answer to poor economic times is the consumer-driven health plan, which thrives in that state. The Louisiana Blues and Humana lead with those plans with more than 175,000 CDHP members between them. The other big news in the Louisiana market is Peoples Health's buyout of its equal partner, Tenet Healthcare. The transaction opened the door for the Peoples to extend its provider network, which was once confined to only Tenet facilities._____

Michigan | Summer | 2009 | Health Plan Analysis

Thu, 30 Jul 2009 00:00:00 GMT

Report Summary: Michigan has awarded its bids to health plans administering Medicaid throughout the state, granting additional territory and clout to two regional players and rebuffing another major plan's attempt to get into the Medicaid segment - the only growing part of the market. The $3.38 billion program is likely to spend around $370 million on prescription drugs through plan formularies next year. Health Alliance Plan's new CEO, William Alvin, discusses his company's strategy for surviving the economic downturn. Michigan's commercial insurance sector has shrunk because of the state's long economic slide, and its health plans are charting new strategies and trying new plan designs to retain members whenever possible.

California | Summer | 2009 | Health Plan Analysis

Thu, 23 Jul 2009 00:00:00 GMT

Report Summary: With the economy hitting California hard, the pressure is on more than ever for health insurers to respond to the small employer group market, in particular, with plan designs that get the premiums down. Two ways they're doing that now is through narrow-network products that steer members to low-cost doctors and hospitals, and also through high-deductible HMOs that combine the predictability of a familiar managed-care mainstay with the lower premiums of cost-sharing. The narrow-network approach is one reason the California Public Employees' Retirement System was able this year to approve 2010 rate increases that average under 3 percent. Meanwhile, the large pension fund is about to put out bids for a new pharmacy benefit manager to handle its PPO business. In the Medicaid space, the health plans are seeing their ranks swell at a time when the state is in the midst of its worst budget crisis in years. Anthem Blue Cross has revamped its main small-group flagship product portfolio, among other things, bringing pharmacy benefits more in line with its competitors. Blue Shield of California is adding a cash incentive to its consumer-driven plans, while UnitedHealthcare is helping to advance a large electronic health information exchange in California.

Oregon & Washington | Summer | 2009 | Health Plan Analysis

Thu, 23 Jul 2009 00:00:00 GMT

Report Summary: Oregon's Drug Effectiveness Review Project is just the kind of independent comparative study of prescription drugs that health policy makers are looking to as they try to trim healthcare costs toward the most cost-effective therapies.The Northwest Prescription Drug Consortium, formed between Oregon Prescription Drug Program and Washington Prescription Drug Program in 2007, is growing in its power and reach, adding major new contracts and pharmacy lives, but is bracing for its biggest potential client yet - the Washington Medicaid program. Oregon isn't waiting for national healthcare reforms following the passage of HB 2009, which created the Oregon Health Policy Board to oversee the development and implementation more centralized control of the industry including the small group and individual markets, creation of an insurance exchange, coverage for all state residents and other sweeping reforms. As the Recession continues to squeeze employers, health plans are responding with various options to help employers save money, including three-year rate guarantees for groups as small as 51 employees.

Pharmacy Benefit Evaluator 2.0 | Data | July 2009

Wed, 22 Jul 2009 00:00:00 GMT

Illinois | Summer | 2009 | Health Plan Analysis

Fri, 17 Jul 2009 00:00:00 GMT

Report Summary: Health plans have begun to put generic dispensing goals into their pay-for-performance packages with some health plans. Advocate Physicians, which works closely with its payors, instituted a focused generic dispensing rate program for some of its specialty groups. The organization, which has 2,900 doctors in the Chicagoland region and around the state, is focusing on drugs classes that treat hypertension, depression and oral contraceptives, where branded utilization is much higher than it should be. Health plans continue to focus on the individual member with copay waivers and the like. Meanwhile, the insurance market has divided between Chicago and the rest of the state. While Chicago continues to trend more toward self-insured membership, the rest of the state is moving back toward fully insured plans. Organizations such as Health Alliance are responding to the recession by launching short-term policies. In an effort to reestablish its strength in the national accounts business, Blue Cross Blue Shield of Illinois is waiving a residency rule, which required that the bulk of a client's members live in Illinois or an adjacent state.

Formulary Advantages in Immune Biologics: Tightening Payer Control Offers Opportunities for Differentiation

Thu, 16 Jul 2009 00:00:00 GMT

Biologics used to treat immune diseases cost much more than their small-molecule counterparts, and so their use involves costs disproportionate to the number of patients treated. As a result of this disconnect between cost and number of treated patients, managed care organizations (MCOs) seek to limit the overall use of immune biologics. That just four of these biologics (Amgen/Wyeth’s Enbrel [etanercept], Centocor Ortho Biotech’s Remicade [infliximab], Roche’s Rituxan [rituximab] and Abbott’s Humira [adalimumab]) together garner over $9.5 billion in annual sales in the Unites States alone makes immune biologics a massive target for cost reduction by payers. More than for other groups of drugs, reimbursement is a key barrier to entry and differentiating feature of immune biologics.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 40 pharmacy directors, this report determines the key trends in reimbursement of immune biologics, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Pharmacy Benefit Evaluator

Wed, 15 Jul 2009 00:00:00 GMT

Additional Downloads:

Pharmacy Benefit Evaluator | Product Manual | January 2010

Summary:

If you sell pharmaceuticals, you sell into the managed care market. And, whether you are in a marketing, sales or planning function, an in-depth understanding of your managed care customer and their pharmacy benefits is crucial to your bottom line.

With comprehensive analysis of national and local health plans' pharmacy benefit structure and spending, Pharmacy Benefit Evaluator provides the insights needed to identify plans and pharmacy benefit managers (PBMs) that offer the greatest return for partnering.

Who controls a plan’s formulary?

How does a plan compare with other plans on co-pays, spending and benefit design?

Where are PBMs exerting the greatest formulary controls?

Pharmacy Benefit Evaluator delivers the answers.

Please note:

Arizona | Summer | 2009 | Health Plan Analysis

Thu, 09 Jul 2009 00:00:00 GMT

Report Summary: A significant medical home pilot program has begun in the Phoenix and Tucson areas in which UnitedHealthcare is offering additional payments for primary-care providers involved in the treatment of patients with diabetes and hypertension. Diabetes is getting attention in a pay-for-performance program begun in Arizona through the Bridges to Excellence program and sponsored by Aetna – the program also focuses on cardiac care. The exit of LifeWise Health Plan of Arizona, which is a subsidiary of Washington-based Premera Blue Cross, will add more bulk to Blue Cross Blue Shield of Arizona, which is absorbing some of the small-group and individual membership from the much-smaller company. In a tough economy, the college market is one of the places that insurers are looking to find growth with Aetna putting a lot of focus on health plans geared to young adults. Seniors in Arizona are increasingly shifting to Medicare Advantage plan designs away from stand-alone PDPs as the MA plans tend to have richer drug benefits in the doughnut hole. Finally, Arizona’s fledgling electronic prescribing movement is picking up steam with the availability of federal stimulus monies and incentives from the federal government to use e-prescribing for Medicare patients.

Colorado | Summer | 2009 | Health Plan Analysis

Thu, 09 Jul 2009 00:00:00 GMT

Report Summary: Colorado has kicked off a broad medical home project in 17 primary care practices around the state. Those physicians will receive standard fee-for-service, a monthly care management fee and bonuses for meeting or surpassing quality goals, while shifting away from payment for episodic care. To further ingrain the medical home concept, a parallel program will institute patient-centered medical home tenets in the curriculum of the state's 10 residency programs. Aetna, CIGNA, Humana, UnitedHealthcare and WellPoint have all pledged support, as has the Colorado Medicaid program and Cover Colorado, the state's high-risk pool. Colorado Medicaid is poised for sweeping change, now that a new hospital provider fee has become law. The state could cover up to 100,000 more residents, due to streamlined enrollment and childless adults eligible for the first time. However, the economy has impacted the state's small group market, leaving fewer people in that group with health benefits.

New England | Summer | 2009 | Health Plan Analysis

Fri, 03 Jul 2009 00:00:00 GMT

Report Summary: Fallon Community Health Plan, based in Worcester, Mass., is reacting to local market dynamics in announcing its intention to expand into neighboring New Hampshire. The Massachusetts market is dominated by Blue Cross Blue Shield of Massachusetts, and local carriers have looked to regional expansions to expand and grow business. In Rhode Island, local insurers Blue Cross Blue Shield of Rhode Island, UnitedHealthcare of New England and Tufts Health Plan were denied their bids for rate hikes by the state insurance commissioner. The medical home concept, which is gaining steam nationwide, is making headway in New England as well. Vermont is two years into a medical home pilot, while Massachusetts's top insurer-BC/BS of Massachusetts-is launching a pilot of its own while the state works on a statewide initiative. In New Hampshire and Maine, actions by the respective state legislatures may allow Harvard Pilgrim Health Care to incrementally expand its capacity in both states. Still struggling with a sagging economy and rising costs, Massachusetts is looking at new ways to curb costs, with talk swirling around moving the healthcare payment system more toward a global cap arrangement. Vermont and Maine are reaping the benefits of a multi-state drug purchasing pool for its respective Medicaid programs.

Pharmacy Benefit Evaluator 2.0 | Parent & Child Relationship | July 2009

Wed, 01 Jul 2009 00:00:00 GMT

Ohio, Kentucky & Indiana | Summer | 2009 | Health Plan Analysis

Fri, 26 Jun 2009 00:00:00 GMT

Report Summary: As many as seven patient-centered medical home projects have cropped up throughout Ohio with CareSource working with providers on a Medicaid-focused PCMH. A medical-home initiative in Cincinnati includes UnitedHealthcare, Anthem Blue Cross and Blue Shield and Humana, while another in Cleveland involves MetroHealth System, the safety net hospital. Health plans are targeting the market dominance of Anthem BC/BS in Indiana through separate initiatives – Humana has a marketing alliance with Southeastern Indiana Health Organization in Columbus while Advantage Health Solutions is offering discounted health plan options to all six counties in Hamilton County near Indianapolis. The Medicare private fee-for-service segment, which has seen some success throughout Kentucky, Ohio and Indiana, is in for change with new rules calling for vendors to develop network-based designs for seniors come 2011, except in counties in which there is only one PFFS offering. WellPoint Inc. has turned an e-prescribing pilot program in Dayton that lapsed with the closing of a General Motors plant into a larger electronic medical records initiative with Kettering Health Network.

Managed Market Surveyor Rx State Cuts

Mon, 15 Jun 2009 00:00:00 GMT

View data by:

Geographic level—national, state, MSA

Managed care organization

Plan and funding type

Pennsylvania | Spring | 2009 | Health Plan Analysis

Fri, 12 Jun 2009 00:00:00 GMT

Report Summary: Two collaborative efforts involving multiple health insurers in Pennsylvania have the potential to improve the quality of healthcare in the state. The first is a transparency effort involving how care is delivered at 160 hospitals in four major categories of medical care. The second is a medical home initiative offering up to $13 million in incentives for primary-care physicians who coordinate care in specified ways. Meanwhile, enrollment in the private fee-for-service segment of Medicare Advantage has grown by 45 percent in 2008. Managed care companies are awaiting decisions on new contracts to serve Medicaid beneficiaries in the Lehigh/Capital regions. In the northeastern region of the state, commercial enrollment for the Blue Cross plan has been slipping as the company and its local competitor, Geisinger Health Plan, face competition from national insurers. And a new contract between Aetna and an ambulance company in the Philadelphia area is the first of its kind for Aetna in the region.

Tennessee | Spring | 2009 | Health Plan Analysis

Fri, 12 Jun 2009 00:00:00 GMT

Report Summary: Recent moves to better control pharmaceutical expenses at the large TennCare program for Medicaid beneficiaries have resulted in compliance to preferred drugs by about 98 percent of the program's pharmacy members. At the same time, SXC Health Solutions Corp., the new pharmacy benefits manager for TennCare, may be on track to meet its supplemental rebate target. Commercial enrollment in the state was steady in 2008, but losses are sure to occur in 2009 with layoffs in state government and at manufacturing plants. Consumer-driven health plan membership grew in Tennessee in 2008, with the largest CDHP operator being BlueCross BlueShield of Tennessee. CDHP occupies about 5 percent of the commercial health market. BlueCross has begun implementing medical home pilot projects with primary-care practices near Memphis and in Cookeville. The CoverTN program has created a new program called Tennesseans Between Jobs for residents who were laid off within the past six months. Meanwhile, the state has lowered copays on smoking cessation aids and drugs in anticipation of increasing premiums for state workers, university employees and others on the state plan who are using tobacco products. In the Medicare sector, BlueCross has launched a new product that pools retirees of municipal accounts; at the same time, the carrier is working to build its Medicare PPO network in advance of new rules limiting the private fee-for-service product.

Nevada | Spring | 2009 | Health Plan Analysis

Wed, 10 Jun 2009 00:00:00 GMT

Report Summary: UnitedHealth's recently-competed purchase and integration of Sierra Health Services has made it the undisputed leader in Nevada's healthcare market, but new competition from Coventry and a new push from Anthem will preserve a healthy marketplace for customers. The state has been hard-hit by the recession, and the industry has responded with new lower-cost options for strapped employers. Employers and insurers are also bearing down on drug benefits, with new emphasis on generics and generic substitution, and cost sharing strategies.

Mid-Atlantic | Spring | 2009 | Health Plan Analysis

Fri, 05 Jun 2009 00:00:00 GMT

Report Summary: Both Virginia and Maryland lawmakers took steps to make insurance for small businesses more affordable in their 2009 sessions. In Virginia, lawmakers passed legislation allowing health plan designs to remove most of the state's coverage mandates in a development that could decrease premiums by as much as 20 percent. In Maryland, a new law makes drastic changes to the state's standard benefit plan, permitting carriers to consider pre-existing conditions and health status in setting rates. Only eight carriers have been participating in the small-group market in Maryland with the large majority of the market controlled by CareFirst BlueCross BlueShield. Meanwhile, regional insurers are hoping the new subsidy for laid-off workers may stem membership drops related to the economic recession. CareFirst BC/BS has launched a $4 million medical home pilot project involving 11 primary-care practices in the District of Columbia, Virginia and Maryland. And an innovative program in Howard County, Maryland, that offers healthcare to the uninsured has received county funding for another year.

Wisconsin | Spring | 2009 | Health Plan Analysis

Wed, 03 Jun 2009 00:00:00 GMT

Report Summary: Despite a $6.6 billion two-year budget deficit, Wisconsin is going ahead with plans to expand its BadgerCare Plus program to childless adults. And, because the budget calls for state health officials to find $500 million in budget savings in the coming years, it's a fair bet that the state will be looking to expand managed care and other cost-saving mechanisms in its health programs.

Wisconsin Medicaid is saving money through its carve-out of pharmacy services, joining the multi-state pool known as TOP$. It's also moving toward greater use of medical homes.

Wisconsin employers are experimenting with more on-site medical clinics, many of which have a pharmacy component and a wellness component.

The state's health plans are adopting value-based drug benefit design to varying degrees, trying to balance their formulary decisions with both price and clinical value. Meanwhile, Dean Health Plan is expanding the reach of its pharmacy benefit manager, Navitus Health Solutions, which touts a different business model than the PBM giants.

Kansas & Missouri | Spring | 2009 | Health Plan Analysis

Tue, 02 Jun 2009 00:00:00 GMT

Report Summary: Missouri's Medicaid program is preparing to centralize management of pharmaceutical benefits for some 850,000 beneficiaries across the state. Previously, managed care plans managed the pharmacy and medical benefits for enrollees, but that will change as of October 2009 when the state also implements new contracts for winning MCOs in that state. Budget problems in Kansas, meanwhile, are jeopardizing a care management program in Wichita that has saved significant dollars despite its low enrollment. A drug commonly known as 17P is being used by Coventry Heath Care and Molina Healthcare - two Missouri Medicaid HMOs - to reduce the number of premature births. Stock market losses have cut into the earnings of the region's two large nonprofit Blue Cross Blue Shield plans, but underwriting gains were large enough to keep the plans on positive financial footing for 2008. The Kansas State Employee Health Benefits Plan is tightening up controls on popular brand-name drug classes in an effort to reduce costs. And Medicare private fee-for-service plans are evaluating their options ahead of the deadline in 2011 for converting products in many of their geographies into network-based Medicare Advantage products.

North & South Carolina | Spring | 2009 | Health Plan Analysis

Thu, 28 May 2009 00:00:00 GMT

Report Summary: BlueCross BlueShield of South Carolina is more than just the 800-pound gorilla in the Palmetto State's healthcare market - it is parent to a family of successful subsidiary companies that provide insurance, back-office services, government plan administration, Medicare claims processing, and other services nationwide. Through those subsidiaries, it has strengthened itself financially at a time when other nonprofit Blue companies have seen declines in their reserves. As the recession takes hold, health plans in the Carolinas are scrambling to provide low-cost options to employers and individuals as price becomes the primary driver in coverage decisions. The problem-plagued North Carolina State Employee Health Plan will be taking proposals soon from vendors interested in servicing the huge 667,000-member plan. A suggestion from pharmaceutical giant Merck & Co. helped spawn a new medical home pilot project in Charleston, S.C., focused on diabetes care. The program involves BC/BS of South Carolina and Palmetto Primary Care Physicians.

Florida | Spring | 2009 | Health Plan Analysis

Thu, 21 May 2009 00:00:00 GMT

Report Summary: Florida delivers managed care services to Medicaid beneficiaries in many ways, and now it's looking at adding yet another delivery system. In the summer of 2010, the state plans to test a medical home model for Medicaid beneficiaries using federally qualified health centers in two counties to coordinate care. Meanwhile, as the Medicare Advantage market matures in Florida, the number of seniors choosing plan designs with extensive drug coverage in the coverage gap is dwindling and more migration into leaner benefits is expected as policymakers consider cuts to Medicare Advantage reimbursement rates. Group enrollment in the Sunshine State was declining through most of 2008 while some carriers saw partial replacement of the lost covered lives through growth in individual plans. The attractiveness of the individual market may be one reason that the new Cover Florida program has had tepid response from buyers so far with fewer than 2,000 enrollees through the end of March 2009. Electronic health records took a significant leap forward in Florida with an agreement between Availity LLC, a partnership founded by Humana Inc. and Blue Cross and Blue Shield of Florida, and the state's Medicaid agency. In the deal, providers will have access to health data on 1.4 million non-HMO Medicaid beneficiaries.

Health Net | 1Q 2009 | Health Plan Earnings Summaries

Thu, 21 May 2009 00:00:00 GMT

Aetna | 1Q 2009 | Health Plan Earnings Summaries

Mon, 18 May 2009 00:00:00 GMT

CIGNA | 1Q 2009 | Health Plan Earnings Summaries

Mon, 18 May 2009 00:00:00 GMT

AMERIGROUP | 1Q 2009 | Health Plan Earnings Summaries

Mon, 18 May 2009 00:00:00 GMT

TriState | Spring | 2009 | Health Plan Analysis

Mon, 18 May 2009 00:00:00 GMT

Report Summary: Faced with hundreds of millions of dollars in tax increases from the state, New York health plans are hunkering down for a lean 2009. Four of the 10 major carriers in the state posted net losses in 2008 with Health Insurance Plan of Greater New York losing the most, $84 million. Health plans face more than $700 million in new taxes to help plug budget holes in New York; in Connecticut, the governor is considering cuts to Medicaid while in New Jersey, legislators are considering limiting enrollment in NJ FamilyCare, the state-subsidized insurance program for low-income adults and families. CIGNA HealthCare has launched one of the first moves in outcomes-based pharmacy contracting with Merck & Co., built around Merck's drugs, Januvia and Janumet, used to treat Type 2 diabetes. In the Rochester market, Excellus Blue Cross Blue Shield and MVP Health Care are funding a medical home program for adult primary-care practitioners. In New Jersey, UnitedHealthcare could potentially gain 10,000 members by offering 5 percent discounts to social services agencies.

WellCare | 1Q 2009 | Health Plan Earnings Summaries

Thu, 14 May 2009 00:00:00 GMT

Michigan | Spring | 2009 | Health Plan Analysis

Fri, 08 May 2009 00:00:00 GMT

Report Summary: In what may be a coming trend among large-scale employers with self-managed pharmacy plans, General Mills has hired its own in-house pharmacists to do medication management with targeted employees. Health Alliance Plan is targeting the small business segment in Southeast Michigan, packaging dental and other insurance benefits as a "Power Package" to Chambers of Commerce.

HealthLeaders-InterStudy interviews Jelka Petrovic, the new president of UnitedHealthcare in Michigan on the insurer's plans for surviving in a shrinking market.

Blue Cross Blue Shield of Michigan is investing in a strategic venture capital fund. And the federal stimulus won't fill all the gaps for Michigan's ailing state budget, but the state is going ahead with plans to expand state-sponsored coverage for children.

Molina | 1Q 2009 | Health Plan Earnings Summaries

Wed, 06 May 2009 00:00:00 GMT

Georgia, Alabama & Louisiana | Spring | 2009 | Health Plan Analysis

Wed, 06 May 2009 00:00:00 GMT

Report Summary: Georgia is a testing ground for new product designs for group and individual buyers. Blue Cross and Blue Shield of Georgia has introduced new products geared to those who want coverage for essentials, with one of the options excluding brand-name drug coverage. At the same time, Kaiser Permanente, known for its integrated HMO model, has introduced 11 high-deductible HMO designs with a variety of coverage levels and deductibles. Another competitor in Georgia, Aetna, is off to a rapid start in 2009 with net growth of almost 85,000 commercial members in the first three months of the year. In Alabama, the Medicaid Agency is hoping a disease management program targeting asthma and diabetes in seven counties will improve care and cut costs. Meanwhile, it appears that Louisiana's shift to managed care plans for its Medicaid program will occur later than expected as approval from the federal government was still pending in early May 2009. The new law that extends the Children's Health Insurance Program for four more years will add as many as 140,000 children onto health insurance benefits in Georgia, Alabama and Louisiana, meaning the states have the money to enroll children who meet the income eligibility.

Centene | 1Q 2009 | Health Plan Earnings Summaries

Wed, 06 May 2009 00:00:00 GMT

Oregon & Washington | Spring | 2009 | Health Plan Analysis

Fri, 01 May 2009 00:00:00 GMT

Report Summary: Health insurers in Oregon and Washington are paying special attention to pricing in 2009 in order to maintain their customer base, but are also casting a wary eye to any blip in medical costs as the individual market grows. At the same time, the new subsidy for COBRA coverage will keep a small number of those who might otherwise be uninsured onto group policies. Aetna's market head for Washington, meanwhile, says his company is seeing a lot of interest in consumer-driven health plan designs there. Regence, which operates BlueCross BlueShield plans in Oregon and Washington, has established guidelines for evaluating genetic tests for its members. Molina Healthcare has been successfully using a formulated injectable version of a drug that helps to prevent premature births. Molina is the largest Medicaid managed care plan in Washington and says the 17P drug's cost are negligible and the drug has proved to be about 33 percent effective.

HealthSpring | 1Q 2009 | Health Plan Earnings Summaries

Fri, 01 May 2009 00:00:00 GMT

Coventry | 1Q 2009 | Health Plan Earnings Summaries

Wed, 29 Apr 2009 00:00:00 GMT

Humana | 1Q 2009 | Health Plan Earnings Summaries

Tue, 28 Apr 2009 00:00:00 GMT

Texas | Spring | 2009 | Health Plan Analysis

Tue, 28 Apr 2009 00:00:00 GMT

Report Summary: Texas' Medicaid program is on the verge of considerable change with the potential for expansion of managed care into both adult and children's programs. At the same time, the Texas Legislature is pushing forward a bill that would place Medicaid recipients in medical homes, focus on weight reduction among children and introduce pay-for-performance for providers serving Medicaid beneficiaries. While the recession hasn't hit Texas as hard as most other states, the Texas High Risk Pool is seeing a reduction in residents able to afford premiums for the insurance pool for those whose medical conditions keep them out of the general commercial market. Cardiovascular and central nervous system drugs accounted for most of the pharmaceutical claims for the 11-year-old Pool. Meanwhile, Scott & White Health Plan, which is better known for its HMO operating in central Texas, is branching out with a statewide administrative-services-only offering for self-insured employers. Aetna and Blue Cross and Blue Shield of Texas are diving deeper into pay-for-performance with a tie-in to the national Bridges to Excellence program; Aetna has begun a cardiac care program while BC/BS of Texas is focusing on diabetes care. Humana hopes to boost its enrollment in southern Texas with an alliance with the San Antonio Hispanic Chamber of Commerce.

UnitedHealth Group | 1Q 2009 | Health Plan Earnings Summaries

Mon, 27 Apr 2009 00:00:00 GMT

WellPoint | 1Q 2009 | Health Plan Earnings Summaries

Mon, 27 Apr 2009 00:00:00 GMT

New England | Spring | 2009 | Health Plan Analysis

Fri, 24 Apr 2009 00:00:00 GMT

Report Summary: The over-arching theme of the healthcare marketplace in New England continues to be the regionalization of the well-established plans like Harvard Pilgrim, Tufts, MVP and others across the New England region. The different players are making various moves to position themselves to survive the economic downturn, take advantage of government-sponsored healthcare opportunities, and ready themselves for national health reform. In this midst of the regional plans flexing their muscles, Centene has won a piece of Massachusetts' Commonwealth Care state-subsidized program. Harvard Pilgrim has snagged the New Hampshire Healthy Kids contract from Anthem as part of its bid to expand in that state. MVP is enlarging its footprint in New Hampshire and Vermont.

California | Spring | 2009 | Health Plan Analysis

Thu, 16 Apr 2009 00:00:00 GMT

Report Summary: Even as health plans struggle to retain members in a state with one of the highest unemployment rates in the country, moves are under way to redesign health benefits both by the private and public sectors. Blue Shield of California has been approved by regulators to offer a value-based insurance design for the fully insured market - a first in the state. Value-based insurance designs shift some brand-name drugs used for chronic diseases into lower tiers in order to improve patient compliance. CIGNA HealthCare, which hoped to make a big splash in the small-group with its 2008 purchase of Great-West Healthcare, is paring the number of benefit designs for small groups to two in California. Brokers say CIGNA has offered at least eight small-group plans. Legislators are considering a measure that would mandate maternity coverage in all PPO products and another that would eliminate gender rating in the individual market. Meanwhile, the huge CalPERS program has uncovered data showing a rapid increase in the growth of diabetes among its enrollees, a development that is driving up emergency room and hospital admission trends for the disease. Most HMOs in California posted positive net income in 2008 with the exceptions being Kaiser Permanente and CIGNA. Kaiser attributes most of its loss to investment losses.

Formulary Advantages in Hypertension: Past and Future Shifts in Tier Placement of Angiotensin II Receptor Antagonists, Single Pill Fixed-Dose Combinations, and Novel Agents

Wed, 15 Apr 2009 00:00:00 GMT

Illinois | Spring | 2009 | Health Plan Analysis

Fri, 10 Apr 2009 00:00:00 GMT

Report Summary: The Illinois insurance market is poised to be hit by rising unemployment that is hitting the factory towns of Peoria, Rockford and Bradley-Kankakee. These markets are typically led by Blue Cross Blue Shield of Illinois, which is already forecasting an enrollment decline this year, the first such drop in a quarter century. Health insurers are responding with narrow-network products from Aetna and UniCare, while Aetna is rolling out a high-deductible plan that charges no copay for preventive care. Because of these issues, the placidity that has defined insurer-provider relations over the last couple of years will be strained. Providers face increasing bad debt thanks to the rising number of uninsured and have traditionally pushed to make up for this through larger reimbursements from commercial carriers. Through the first three quarters of last year, HMOs in Illinois saw a medical cost trend of around 10 percent with both hospital/medical and drug costs rising by an equal amount. Facing their own problems - namely enrollment declines - insurers won't be able to stomach large reimbursement demands from major providers.

Ohio, Kentucky & Indiana | Spring | 2009 | Health Plan Analysis

Thu, 09 Apr 2009 00:00:00 GMT

Report Summary: Humana Inc. is making a splash in both Ohio and Kentucky with provider relations issues. In Louisville, the insurer's introduction of a narrow network of providers for the Ford Motor Co. has raised the hackles of physicians who call the move "economic credentialing of providers." In Ohio, Humana's network dispute with a large Dayton hospital system raised questions about how members are notified of hospital-payor contract changes. Another large regional insurer, WellPoint reports progress in the integration of its technology systems resulting from its multiple mergers over the past decade and says that its claims backlog is completely worked through. In Indiana, Clarian Health Plans, a new for-profit venture of Clarian Health System in Indianapolis, is marketing a new Medicare Advantage HMO in Marion County.

Iowa | Spring | 2009 | Health Plan Analysis

Fri, 03 Apr 2009 00:00:00 GMT

Report Summary: Iowa lawmakers are considering major mandates for state-regulated health plans, including requirements that health plans cover autism, prosthetics, osteoporosis, and cancer treatment in approved clinical trials. But the main focus is on the economy and the challenges of the state budget.

Nationwide, healthcare plans are doing more routine screenings for depression in patients with chronic illness, in recognition that depression can lead to non-compliance with medication and slower recovery.

WellMark, Iowa's dominant insurer, is pushing generic statins through a copay waiver program, with some success. CIGNA's new positioning of Lipitor on its formulary may help the brand cling to a better share of the market as other generic statins are gaining popularity.

Minnesota | Spring | 2009 | Health Plan Analysis

Thu, 26 Mar 2009 00:00:00 GMT

Report Summary: With the economic downturn pushing more Minnesotans out of work, health plans are getting ready for a likely surge in people seeking individual health plans, but are also watching to see if the new federal subsidy for COBRA coverage will increase COBRA uptake.

Minnesota's a leader in the acceptance of account-based health plans, and the economic mess seems only likely to accelerate that trend.

Minnesota's pilot program with HealthPartners in medication management more diabetes patients is paying off, and will likely be expanded to other disease classes.

At a time when other Medicare Advantage players in Minnesota appear to be relaxing their efforts to grow, two players in the market made major gains in membership.

Pennsylvania | Winter | 2009 | Health Plan Analysis

Wed, 25 Mar 2009 00:00:00 GMT

Report Summary: Against a backdrop of rising unemployment and businesses trying to cut healthcare costs, health plans in Pennsylvania are increasing their offerings of individual products and fielding group plans with higher deductibles well into the thousands of dollars. At the same time, Gov. Ed Rendell's administration has scaled back its grand plan for healthcare reform this year to a simple expansion of the existing adultBasic program for the uninsured. Meanwhile, now that Pennsylvania's two largest health plans have backed away from a merger, the insurers will likely pursue informal partnerships, such as having Independence Blue Cross' pharmacy benefit manager take on Highmark's customers. Also, Pennsylvania remains a strong state for Medicare Advantage, but the enrollment trend appears headed away from the HMO and to the PPO.

Tennessee | Winter | 2009 | Health Plan Analysis

Wed, 25 Mar 2009 00:00:00 GMT

Report Summary: Tennessee's unemployment rate grew to 8.6 percent in January, and the number of mass layoffs in Tennessee more than doubled in the 2008 fourth quarter compared to a year ago. Things can still get worse with the fate of the large a GM plant and a Bridgestone plant in middle Tennessee still up in the air. Between layoffs and cutbacks in employer-sponsored health benefits, there is an upswing in sales of individual plans and consumer-driven health plan designs. The state is also preparing for potential cutbacks in TennCare (its Medicaid program) while also preparing for an increase in those eligible for the program. It might find some money as a result of a 21-year-old lawsuit that has been finalized. State officials also are rolling out training programs and awarding grants to get providers hooked up to e-prescribing technology, which is still being used for only 3 percent of the prescriptions written in Tennessee.

North & South Carolina | Winter | 2009 | Health Plan Analysis

Tue, 17 Mar 2009 00:00:00 GMT

Report Summary: The recession is making a big impact on health plans in the Carolinas-commercial plans predict enrollment will drop in the coming months and Medicaid rolls already are increasing. Employers are changing benefits to make health coverage more affordable-drug copays are going up and health plans are moving more brand-name drugs to higher tiers and instituting more off cycle. In addition, medical tourism is getting a boost as more consumers and employers look for more affordable surgery options-BlueCross BlueShield of South Carolina should see better-than-expected growth for its Companion Global subsidiary. Plus both states are considering wellness incentives during their legislative sessions-North Carolina could give incentives to state workers who don't smoke and maintain a healthy weight while South Carolina could pass a higher cigarette tax in order to fund tax credits for employers and fund more health programs in the state.

Kansas & Missouri | Winter | 2009 | Health Plan Analysis

Tue, 10 Mar 2009 00:00:00 GMT

Report Summary: Economic forces have put pressure on the budgets of Missouri and Kansas, putting health reforms in the backseat for 2009. Missouri Gov. Jay Nixon wants to restore some residents cut from Medicaid in 2005 and expand the State Children's Health Insurance Program with help from federal stimulus money, but it will be a tough sell with a Republican-led Legislature. With Kathleen Sebelius headed to Washington, the budget situation in Kansas has not changed. The Legislature is grappling with changes to Medicaid and a push to require health plan coverage of autism therapy. As for the state's employers, consumer-driven health plans are gaining a second look from businesses which previously avoided it. Others have expressed concerns that employer groups could face problems coming into the 2010 renewal cycle, because layoffs might have changed the makeup of their employee pool.

Florida | Winter | 2009 | Health Plan Analysis

Mon, 09 Mar 2009 00:00:00 GMT

Report Summary: The struggling economy in Florida, burdened by the bust of the real estate and construction boom, resulted in enrollment losses in 2008 and is all but sure to continue into 2009. Insurers are reacting with new products geared to the individual markets and with narrow-network products. The Cover Florida program launched Jan. 5 and is an attempt to put more residents into insurance rolls. Six carriers are offering plans with a variety of limited-benefit options, including prescription drug benefits. The economy is affecting the Medicaid program - which like Medicaid programs everywhere - will benefit from the new federal stimulus bill and is expecting an influx of more than 300,000 new beneficiaries in 2009. The managed care winners are companies such as WellCare Health Plans and UnitedHealthcare. Florida Medicare Advantage plans, like their Medicaid counterparts, are expecting an enrollment boost in 2009 as the MA market continues to grow and the stand-alone Part D program stays flat or declines.

Mid-Atlantic | Winter | 2009 | Health Plan Analysis

Thu, 05 Mar 2009 00:00:00 GMT

Report Summary: Maryland lawmakers are considering ways to extend health insurance coverage despite a budget deficit and national efforts to extend health benefits. In Virginia, lawmakers turned back an attempt to legislate coverage of autism disorders and were considering a move to exempt some small businesses from complying with all state health coverage mandates. Health plans in Virginia were holding onto members in 2008 but the rising unemployment rate means certain enrollment losses in 2009. Interest in consumer-driven health plan options is increasing, and one of the offerings comes from nHealth, a new Virginia firm that offers an affordable CDHP option by covering physician services through a separate deductible. In Maryland, the insurance commissioner has told physicians who operate so-called concierge practices how they can run their businesses without falling under the state's definition of insurance.

Wisconsin | Winter | 2009 | Health Plan Analysis

Fri, 27 Feb 2009 00:00:00 GMT

Report Summary: At a time when many states are looking to pare back healthcare programs as a way to close budget deficits, Wisconsin is taking the opposite route. Despite facing a gloomy nationwide economic forecast and a staggering $5.7 billion two-year state budget deficit, state lawmakers are crafting plans to bring extra dollars to the state while at the same time expanding-rather than cutting-healthcare services. However, Gov. Jim Doyle's plan to provide affordable healthcare options to small businesses has hit a roadblock, and its launch date is now in limbo. Meanwhile, Wisconsin's burgeoning unemployment rate could force more into the individual market, where a host of health plans operate, as well as into the state's public programs and high-risk pool. On the employer front, many in the state have turned toward high-deductible, consumer-driven offerings while commercial HMO membership has declined somewhat.

TriState | Winter | 2009 | Health Plan Analysis

Tue, 24 Feb 2009 00:00:00 GMT

Report Summary: Excellus BlueCross BlueShield will have to change part of its formulary strategy as CMS prepares to ban the practice of reference-based drug pricing, used to boost generic utilization.

The national recession is sending its shockwaves in all directions, but in urban New York, Aetna is targeting small businesses and ethnic businesses with a narrow-network plan whose cost is comparable to Healthy New York.

New York may be following New Jersey's lead in expanding the definition of "dependent children" to cover more young adults.

Health Net hopes to sell its non-California business and narrow its focus, and there are several likely suitors for its business in the Tri-State. Meanwhile, Excellus' talks with the Blues of Massachusetts have raised eyebrows as well

Oregon & Washington | Winter | 2009 | Health Plan Analysis

Thu, 19 Feb 2009 00:00:00 GMT

Report Summary: Changes in Oregon's regulation of small-group health plans are causing major fluctuations in rates for some groups, and creating opportunities for companies willing to respond to the new realities of the market. The economic downturn is also having its effects in all segments of the healthcare business, as companies lay off workers, close up shop, struggle to find plans they can afford, and as providers cope with a surge in the numbers of uninsured, and those who can't afford high copays and deductibles.

CareOregon's medical home initiative has no bottom-line ROI numbers yet, but the initial anecdotal results are promising. Washington's high-risk pool is beefing up its wellness/prevention focus in order to reduce costs.

Regional and national health plans are trying different methods of managing depression, with varying results.

AMERIGROUP | 4Q 2008 | Health Plan Earnings Summaries

Sun, 15 Feb 2009 00:00:00 GMT

Centene | 4Q 2008 | Health Plan Earnings Summaries

Sun, 15 Feb 2009 00:00:00 GMT

CIGNA | 4Q 2008 | Health Plan Earnings Summaries

Sun, 15 Feb 2009 00:00:00 GMT

WellPoint | 4Q 2008 | Health Plan Earnings Summaries

Sun, 15 Feb 2009 00:00:00 GMT

HealthSpring | 4Q 2008 | Health Plan Earnings Summaries

Sun, 15 Feb 2009 00:00:00 GMT

Humana | 4Q 2008 | Health Plan Earnings Summaries

Sun, 15 Feb 2009 00:00:00 GMT

Molina | 4Q 2008 | Health Plan Earnings Summaries

Sun, 15 Feb 2009 00:00:00 GMT

Michigan | Winter | 2009 | Health Plan Analysis

Thu, 12 Feb 2009 00:00:00 GMT

Report Summary: Economic turmoil is nothing new in Michigan, where the auto industry's woes continue to get worse, and job losses and layoffs continue to shrink the healthcare market. Against that backdrop, Blue Cross Blue Shield of Michigan has begun to raise rates and lay off employees, competitors are tweaking their product designs for individual plans, and introducing new products to the market.

HealthLeaders-InterStudy looks at the likelihood of healthcare regulatory reforms in the Michigan legislature in the aftermath of the Blue Plan's failed push for small-group reforms.

Michigan plans also are taking varying approaches to specialty drugs in order to control their costs.

And as more Michigan employers shed defined-benefit plans for retirees, HAP is enriching its wellness and complimentary medicine benefits to win membership in Medicare Advantage.

Texas | Winter | 2009 | Health Plan Analysis

Wed, 11 Feb 2009 00:00:00 GMT

Report Summary: Texas possesses the worst uninsured rate in the nation not just for adults, but children. One in five Texas children lacks health benefits, even though many qualify for Medicaid and the Children's Health Insurance Program. If the Texas Legislature gives its blessing, the Lone Star State could attempt an innovative method to insuring more children. The Senate will consider legislation that would create a health insurance pool in the state's child support system. Other initiatives designed to get more people onto insurance rolls are rolling out this year in Austin and Houston as 3-share programs. Texas insurers, meanwhile, are beginning to feel the effects of the economy even though commercial enrollment had been holding relatively strong in 2008. In pharmacy utilization management, Blue Cross and Blue Shield of Texas has made strides in getting members to stick to statin therapy. By using pharmacy and medical claims to target members who have had cardiovascular events yet not taking statins, the Texas Blue plan increased generic statin utilization by 15 percent.

Arizona | Winter | 2009 | Health Plan Analysis

Fri, 06 Feb 2009 00:00:00 GMT

Report Summary: As a former boom state in the midst of the bust, Arizona's healthcare economy is taking a bigger hit than other areas of the country. One plan is a likely acquisition target. While the biggest insurers kept premium increases around medical trend-from 10 percent to 12 percent-for this year, increases are expected to be much higher for 2010. Hospitals are taking the brunt of state government cuts, passing on costs to health plans and other private payers as a way to make up for rising costs from uncompensated care.

Medicare Advantage plans are still strong in the state, with HMOs by far the top choice. Even as Medicare HMOs continue to grow, the state is seeing major declines for commercial HMOs as employers turn to high-deductible PPOs.

Georgia, Alabama & Louisiana | Winter | 2009 | Health Plan Analysis

Wed, 04 Feb 2009 00:00:00 GMT

Report Summary: Managed Medicaid is the centerpiece of Louisiana's health reform initiative, Louisiana Health First, which has finally taken shape after years of planning. State officials are betting that a coordinated, structured Medicaid program, giving beneficiaries a choice of plans, will provide residents better health outcomes for less money than the present fee-for-service, one-size-fits-all program. Meanwhile, health plans in Louisiana, Georgia and Alabama are bracing to respond to the recession. Though there were no major losses in enrollment or income as of July 2008, when the latest data was reported, rising unemployment and financial losses are bound to have an impact. Brokers report more interest in CDHPs, individual plans and HMOs. Even as the state of Alabama continues to battle pharmaceutical giants for Medicaid fraud, it has had to muscle up to a new behemoth, the Centers for Medicare & Medicaid Services. The state filed an injunction against the federal agency after it demanded that Alabama cut it in for a lion's share of the court winnings, even before the state recovered them.

California | Winter | 2009 | Health Plan Analysis

Tue, 03 Feb 2009 00:00:00 GMT

Report Summary: Commercial membership in California health plans dropped by 12 percent in the first six months of 2008, according to data from HealthLeaders-InterStudy, and insurers are bracing for an additional drop as they cope with job losses and their impact on health benefits. A trend toward increased cost-sharing by consumers likely will accelerate in 2009 as employers struggle to afford health benefits. California's trailblazing pay-for-performance program has reached a crossroads as its leaders accelerate a focus on affordability and consider changing the way physician groups are paid. The budget plan from Gov. Arnold Schwarzenegger proposes $132.2 million in healthcare savings could be achieved in 2010 if the state contracts directly with insurers instead of CalPERS for state employee benefit packages. Kaiser Permanente has become the first HMO to achieve a four-star rating in the eight-year history of the California HMO report card. Meanwhile, the small-group market in California is shifting to deductibles and away from copays in an effort to manage pharmacy benefit costs.

New England | Winter | 2009 | Health Plan Analysis

Fri, 30 Jan 2009 00:00:00 GMT

Report Summary: Blue Cross Blue Shield of Massachusetts is reacting to market conditions in a number of ways, through talks with Excellus BlueCross BlueShield of New York about a potential collaboration in the ancillary products arena, through a new provider contracting system based on quality standards and the expansion of a wellness component to its product offering to municipalities. Two programs targeting the uninsured in Maine and Vermont are facing funding difficulties. Vermont officials say their Catamount Health program isn't sustainable without federal health, and the Dirigo program in Maine is at a funding crossroads after voters rejected a funding mechanism in the November elections. The medical home concept is making headway in Rhode Island and New Hampshire with 11 pilot sites selected in New Hampshire and the state's top insurers all involved in the two-year pilot program. Rhode Island, meanwhile, is forging ahead with its plan to reshape its Medicaid program by receiving a set amount of funding from the federal government, but be responsible for costs that go over that amount. In return, Rhode Island Medicaid would have flexibility to design benefits and manage the Medicaid program outside the usual rules.

Illinois | Winter | 2009 | Health Plan Analysis

Fri, 16 Jan 2009 00:00:00 GMT

Report Summary: Illinois' economy is tanking along with the rest of the country, and health plans are bracing for losses in membership as banking and manufacturing businesses lay off workers, shut down, or eliminate benefits. The enrollment gains will likely come in the state's Medicaid and SCHIP programs, but insurers are working with small group clients to keep benefits affordable and keep people on the rolls.

Blue Cross Blue Shield of Illinois and its parent, Health Care Service Corp., are exploring value-based benefit designs of various kinds, becoming the third major insurer in the state to focus on incentives for healthy behaviors and drug adherence.

Health plans have responded differently to Illinois' rich state coverage mandate for infertility treatment, and may yet trim back those benefits as the mandate allows.

Health plans are ratcheting up standards in their pay-for-performance programs, adding higher targets to programs aimed at rewarding providers for outcomes.

Aetna | 4Q 2008 | Health Plan Earnings Summaries

Thu, 15 Jan 2009 00:00:00 GMT

Health Net | 4Q 2008 | Health Plan Earnings Summaries

Thu, 15 Jan 2009 00:00:00 GMT

Coventry | 4Q 2008 | Health Plan Earnings Summaries

Thu, 15 Jan 2009 00:00:00 GMT

UnitedHealth Group | 4Q 2008 | Health Plan Earnings Summaries

Thu, 15 Jan 2009 00:00:00 GMT

Colorado | Winter | 2009 | Health Plan Analysis

Mon, 12 Jan 2009 00:00:00 GMT

Report Summary: Colorado Medicaid officials are asking for legislative approval to expand managed care into Medicaid in a much bigger way by 2010. They propose to phase in the movement to managed care through regions and with administrative-services only contracts before moving to full risk. On the Medicare side, several insurers are moving into new markets in the state with Medicare Advantage products, including Humana expanding into more rural areas and Kaiser Permanente into four southern Colorado counties. Businesses are examining the impact of a new law that prohibits discounts due to health status for small-group insurance. Anthem Blue Cross and Blue Shield in Colorado is reacting to affordability of health insurance products for small businesses with its SmartSense suite, which offers lower premiums and a large network of providers. Humana is appealing to the small-group market with Humana Rewards, a wellness product offered for the first time to groups with fewer than 100 employees in Colorado. The state, meanwhile, is poised to build an "autobahn of bandwith" by creating one of the nation's most complete telehealth networks.

Ohio, Kentucky & Indiana | Winter | 2009 | Health Plan Analysis

Wed, 07 Jan 2009 00:00:00 GMT

Report Summary: Health insurers in the Midwest are coping with the recession by laying off employees, holding the line on pricing and adjusting benefit design to allow employers to take advantage of additional cost-shifting. The HMO market continues to lose stature in Ohio, Kentucky & Indiana with a shift from fully insured to self-insured designs for those remaining in the more tightly managed accounts. The public sector is taking the slack with an example being the Health Indiana Plan, a Medicaid-expansion program in Indiana that is now allowing more adults to join the program by purchasing benefits on their own through the program. On the Medicare side, the number of Medicare Advantage vendors continues to contract, but the market in the Midwest is vibrant enough to attract a large number of zero-premium plan designs. Insurers launched new programs to better manage member health and costs - Anthem Blue Cross and Blue Shield in Indiana believes its Community Resource Centers can reduce unnecessary visits to hospital emergency rooms; while Kaiser Permanente in Ohio has introduced an obesity program targeting children. Finally, Ohio's Medicaid program has moved dozens of drugs used to treat mental illness into a category that requires prior authorization.

News for North Dakota

Tue, 06 Jan 2009 01:00:00 GMT

News for Montana

Thu, 01 Jan 2009 00:00:00 GMT

News for Nebraska

Thu, 01 Jan 2009 00:00:00 GMT

News for Alaska

Thu, 01 Jan 2009 00:00:00 GMT

News for Idaho

Thu, 01 Jan 2009 00:00:00 GMT

News for Wyoming

Thu, 01 Jan 2009 00:00:00 GMT

Mid-Atlantic | Fall | 2008 | Health Plan Analysis

Tue, 23 Dec 2008 00:00:00 GMT

Report Summary: The District of Columbia is targeting CareFirst BlueCross BlueShield in an effort to capture a portion of the large nonprofit's reserves for a new program serving the uninsured. The District has had contentious relationships with health plans for some time; in March the city brought lawsuits against two of its three Medicaid care management organizations, DC Chartered Health and AMERIGROUP, for alleged administrative abnormalities. The incidence of adult-onset diabetes has increased by some 90 percent over the past 11 years in Virginia. Employers and insurers are looking at a new study that pinpoints diabetes incidence by geographic area and also quantifies how money is spent on treating diabetes. Meanwhile, Virginia, Washington, D.C. and Maryland are among the 12 areas selected by the U.S. Department of Health and Human Services for a five-year Medicare demonstration project that will provide incentive payments to primary-care physicians for using certified electronic health records to improve the quality of patient care. Carriers for the Federal Employees Health Benefits Program felt the pinch of escalating medical and pharmaceutical costs over the last couple of years and are fighting back. For 2009, they are offering plans that have the largest premium increases in three years and encourage users to spend less on drugs.

Tennessee | Fall | 2008 | Health Plan Analysis

Tue, 23 Dec 2008 00:00:00 GMT

Report Summary: The economic downturn is wreaking havoc on employers nationwide and statewide, leaving insurers grappling with eroding enrollment, and more cost-shifting pressures from healthcare providers. Against that backdrop, state officials are looking to rein in TennCare costs as enrollment is expected to rise, and are expanding the state's limited-benefit three-share program for small businesses.
Employers are turning to population-based wellness, incorporating onsite health clinics and programs to combat obesity in order to control costs and boost productivity. Both trends have potential impact on pharmacy and insurance design.
Medicare Advantage options are expanding in Tennessee, and premiums for federal employee healthcare are going up.

North & South Carolina | Fall | 2008 | Health Plan Analysis

Fri, 19 Dec 2008 00:00:00 GMT

Report Summary: Premium increases moderated in the Carolinas in 2008 with health plan costs per employee rising by 6 percent to 10 percent, but the increases are expected to accelerate in the coming months. Brokers also expect a broader acceptance of consumer-driven health plan designs in North and South Carolina. Even though insurers are pushing wellness, few employers have adopted comprehensive wellness programs at work states in the region. One of the first to do so, utility company Scana Corp., operates an on-site pharmacy primarily to provide counseling from pharmacists to employees. In the Medicare sector, private fee-for-service products dominate the market in both states, but with recent legislation putting new rules on PFFS, many of those seniors are expected to migrate toward PPOs. Humana, the PFFS leader in the region, is building a network to serve regional and local PPO members. The South Carolina Medicaid market is losing a managed care plan with AMERIGROUP agreeing to shift its members to Centene Corp. in the state, while the reverse will occur between the two companies in New Jersey. Finally, the PPO that is part of the South Carolina Employee Insurance Program will not see a price increase for 2009, but the HMOs offered by CIGNA HealthCare and BlueCross BlueShield of South Carolina will have rates rising from 15 percent to 41 percent.

Pennsylvania | Fall | 2008 | Health Plan Analysis

Thu, 18 Dec 2008 00:00:00 GMT

Report Summary: The war of words over the proposed merger of Highmark Inc and Independence Blue Cross reached continued with testimony from Highmark officials that they would not move into IBC's Philadelphia service region should the merger fail. They used the company's $132 million operating loss from its foray into Central Pennsylvania as evidence the Pittsburgh-based Highmark would not try such a move again. Meanwhile, the merger could give rise to one of the nation's largest pharmacy benefits managers. That's because Highmark's pharmacy management would switch from Medco Health Solutions to the IBC-owned Future Scripts, which was founded in 2006 and now manages about $1.3 billion on drug purchases. Meanwhile, Pennsylvania will let 2008 go without adoption of a healthcare reform plan, which most recently was presented under the guise of Access to Basic Care. On the Medicare front, seniors in Pennsylvania have the most benefit design options for stand-alone Part D plans than those in any other state, but vendors are cutting options for the coverage gap and raising prices. Some Medicaid plans are posting financial losses in particular areas of the state, but the agency operating the HealthChoices program says the program as a whole remains profitable for MCOs. Aetna is eliminating copays on all preventive services for its small-group clients in Pennsylvania-the first state in Aetna's footprint that will test the model for small businesses.

Wisconsin | Fall | 2008 | Health Plan Analysis

Wed, 03 Dec 2008 00:00:00 GMT

Report Summary: Wisconsin has received approval from the Centers for Medicare & Medicaid Services to expand its BadgerCare Plus healthcare initiative, giving the state the ability to use federal funds to provide basic healthcare services to uninsured childless adults. However, the state is facing a severe financial crisis that could serve to stall efforts to roll out the program on a statewide basis. Wisconsin is facing a budget deficit that could total $5.4 million through mid-2011, and while lawmakers work to plug the holes, the states' healthcare team is forging on with plans for the healthcare expansion and its timetable. The plan calls for extensive use of the state's 16 Medicaid HMOs. Meanwhile, state officials and advocates are hoping the election of Barack Obama will pay off for the state's SeniorCare prescription drug program, which operates on a federal Pharmacy Plus waiver. That waiver was set to expire under the Bush administration before some last-minute wrangling, but Obama said during the presidential campaign he was in favor of allowing Wisconsin to keep the program. Also, local provider-owned insurer Dean Health Plan is continuing to expand the nationwide presence of Wisconsin-based pharmacy benefit manager Navitus Health Solutions.

Florida | Fall | 2008 | Health Plan Analysis

Wed, 26 Nov 2008 00:00:00 GMT

Report Summary: The small-group market in Florida posted 5 percent gains in enrollment at mid 2008, but the economic recession is likely to put a damper on small-group business in a state relying on the troubled industries of home construction and tourism. Gov. Charlie Crist's program to offer health insurance the state's 3.2 million uninsured - called Cover Florida - is getting a boost through participating health plans that are fielding products with premiums below the targeted $150 a month. The managed Medicaid market in Florida is attracting more national players lately with both Molina Healthcare and Centene Corp. expanding in the state through purchases of provider service networks. Meanwhile, it's still up in the air whether Florida lawmakers will expand the Medicaid Reform program that allows health plans and provider service networks to customize benefits to beneficiaries. The vibrant Florida Medicare Advantage market is likely to grow in 2009, but seniors will see drug benefits pared. Miami-Dade County remains the hotbed of Medicare Advantage activity - primarily because of its high reimbursement rate from the federal government - and nearly half of the county's seniors are enrolled in MA plans. Blue Cross and Blue Shield of Florida has consolidated its lead in the northern half of the Sunshine State with its purchase of Florida Health Care Plans, which has about 60,000 commercial and Medicare members.

Kansas & Missouri | Fall | 2008 | Health Plan Analysis

Tue, 25 Nov 2008 00:00:00 GMT

Report Summary: Kansas City is the new home of a major pilot initiative for value-based insurance design, with major employers pulling together to gather and evaluate data needed to calculate results of VBID moves.
Kansas and Missouri health plans are using a mix of different cost-control methods to contain radiology costs and drug costs.
Missouri is considering expansion of its managed Medicaid program into Southwest Missouri, opening up a new potential region for insurers to capture some business. But other healthcare reform initiatives are likely sidelined by the economic crisis and pressures on state budgets.
The clinic business is still growing, and not just in drugstores and supermarkets.
Medicare drug plans are cutting their gap coverage and raising prices in order to maintain margins, with players retreating from auto-assigned low-income beneficiaries.

TriState | Fall | 2008 | Health Plan Analysis

Tue, 25 Nov 2008 00:00:00 GMT

Report Summary: Ground zero for job losses is the financial sector in New York, and insurers are bracing for membership declines. The jobless may have a difficult time finding low-cost individual policies in New York, although legislators are working on reforms to allow more people into the Healthy New York program. Both New York and New Jersey have community ratings on policies, meaning that an individual does not have to be medically underwritten-that is not the case in Connecticut. The stock market downturn will affect two large initial public offerings for TriState companies. EmblemHealth in New York and Horizon Blue Cross Blue Shield of New Jersey are still pursuing conversions to for-profit status, but it could be months before those happen. Meanwhile, Horizon is trying out a value-based pharmacy benefit design on its own employees who have diabetes. They will get free generics and half-off the cost of brand-name drugs in exchange for participating in the company's wellness program and filling out health risk assessments. In Connecticut, Aetna Better Health and AmeriChoice, a UnitedHealthcare company, are preparing to enroll Medicaid members in February of 2009 as they scramble to assemble adequate networks in the state. The Medicare Part D landscape will be altered in 2009 with a new line-up of insurers serving the low-income market. And in New Jersey, AmeriHealth is offering its PPO and point-of-service-plus members access to a national network of physicians and hospitals.

Oregon & Washington | Fall | 2008 | Health Plan Analysis

Mon, 24 Nov 2008 00:00:00 GMT

Report Summary: The Oregon Legislature will have a big task ahead as it considers how to implement a broad plan by Oregon's Health Fund Board to insure every resident of the state. The proposal is as ambitious in scope as Massachusetts' landmark reform, but comes at a time when state economies are more fragile. A draft proposal would pay for the program through provider taxes, a "pay or play" tax on employers and state and federal monies. In Washington, an effort to insure all children is bearing fruit with as many as 40,000 children getting on insurance rolls over the past year. In the commercial market, consumer-driven health plan designs have had a tepid response so far, but brokers predict more acceptance in a worsening economy as employers cope with runaway healthcare costs. There will be fewer private plans participating in the stand-alone Medicare Part D market in Oregon and Washington in 2009 as firms drop out of the segment of the program serving low-income seniors. Providence Health Plans, which has used a value-based insurance concept, is offering value-based benefit design options for prescription drugs and is targeting drugs for key chronic diseases. And research from Regence determined that health plan consumers know far less about their coverage than suspected - a development that may help insurers create products and benefits and communicate about them.

California | Fall | 2008 | Health Plan Analysis

Fri, 21 Nov 2008 00:00:00 GMT

Report Summary: The consumer-driven health plan movement is undergoing a shakeup in California with health plans passing along double-digit rate increases for renewing customers to make up for losses on the high-deductible designs with rich preventive benefits. Meanwhile, brokers believe there is some evidence CDHPs are beginning to gain more traction in a state known for its acceptance of the capitated HMO model. Medicare special needs plans are due for a shake-up following the passage of new legislation that requires SNPs to implement an evidence-based model of care with appropriate networks of providers. The new law is of special significance in California, which is home to the second-largest enrollment in SNPs. Plans in the Medi-Cal program will see only a 1 percent cut in reimbursement following passage of a new law signed by Gov. Arnold Schwarzenegger. At the same time, health plans avoided legislation that would have required them to spend at least 85 percent of their premium dollars on direct medical care. Aetna has become the latest major health plan in California to offer members access to a provider network in Mexico. And Blue Shield of California is proposing a group Medicare Advantage plan for CalPERS members.

Michigan | Fall | 2008 | Health Plan Analysis

Thu, 20 Nov 2008 00:00:00 GMT

Report Summary: The shift in employers' attitudes toward wellness and healthcare cost management has brought workplace health clinics back into vogue, mostly among large self-insured businesses, but also among some fully-insured employers.

Michigan's Medicare enrollees will have fewer and less-generous choices for their Medicare coverage in 2009, as plans trim benefits or hike prices in order to keep margins.

Michigan's most recent attempt to allow more flexible HMO designs appears to have fallen flat, with few companies offering the revised designs, and few customers signing up for them.

HAP has been the biggest winner in its use of the WeightWatchers program, documenting significant clinical improvements for those in the motivational weight loss program.

Iowa | Fall | 2008 | Health Plan Analysis

Thu, 13 Nov 2008 00:00:00 GMT

Report Summary: Iowa's dominant insurer, Wellmark Blue Cross Blue Shield of Iowa, has unveiled its new Blue Transitions product aimed at drawing more of Iowa's farmers into high-deductible health plans.

Humana continues to dominate Iowa's Medicare Advantage market, with more MA enrollees than the next three competitors combined. But there's still a lot of room to grow, with only 10 percent of Medicare-eligibles enrolled in MA plans.

Iowa's Medicaid plan has seen promising results from its disease management of congestive heart failure patients.

The state's health plans, like their cohorts across the country, are using various approaches to curb the growing cost of imaging.

Illinois | Fall | 2008 | Health Plan Analysis

Thu, 13 Nov 2008 00:00:00 GMT

Report Summary: Enrollment in Illinois HMOs continues to decline with the most recent data from HealthLeaders-InterStudy showing a 14 percent decrease from the year before. HMOs now comprise about 18 percent of the commercial market in the state, despite a steady HMO membership by Blue Cross Blue Shield of Illinois. UniCare Health Plans of the Midwest is launching a new HMO for small businesses in the Chicago region that prices premiums below $100 for healthy single men. On the Medicare front, UnitedHealth Group and smaller insurers in the Part D market stand to gain low-income members as a result of 2009 bidding that takes some insurers, such as Humana, out of that segment in some states. While the low-income market represents volume, it comes with more risk as the population tends to be sicker and not use as many generic drugs. In downstate Illinois, Health Alliance is growing with its decision to purchase Peoria-based HCH Administration, a third-party administrator. And Blue Cross Blue Shield of Illinois is showing that diabetes disease management and pay for performance are working for members enrolled in broader PPO networks, which typically do not have gatekeeper primary-care physicians.

Health Net | 3Q 2008 | Health Plan Earnings Summaries

Thu, 06 Nov 2008 00:00:00 GMT

HealthSpring | 3Q 2008 | Health Plan Earnings Summaries

Thu, 06 Nov 2008 00:00:00 GMT

Aetna | 3Q 2008 | Health Plan Earnings Summaries

Wed, 05 Nov 2008 00:00:00 GMT

CIGNA | 3Q 2008 | Health Plan Earnings Summaries

Wed, 05 Nov 2008 00:00:00 GMT

Centene | 3Q 2008 | Health Plan Earnings Summaries

Wed, 05 Nov 2008 00:00:00 GMT

Humana | 3Q 2008 | Health Plan Earnings Summaries

Thu, 30 Oct 2008 00:00:00 GMT

Texas | Fall | 2008 | Health Plan Analysis

Tue, 28 Oct 2008 00:00:00 GMT

Report Summary: Blue Cross Blue Shield of Texas is the immovable behemoth of the Texas market with more than 4.2 million members, but the race for second place is hotly contested, and Aetna has earned silver by leaping over UnitedHealthcare-the perennial Number Two. With a total membership of 1.92 million, Aetna's PPO gained more than 600,000 new members, adding validity to assertions by Aetna leadership that Texans prefer an open access design and no gatekeepers. CDHPs with health savings accounts are attracting a fast-growing number of employers. Texas is the top CDHP market for CIGNA, which boasts almost 65,000 CDHP members and for Aetna with almost 47,000 members. Meanwhile in the Medicare market, CIGNA and HealthSpring will expand into new territories and offer more Medicare Advantage products in Texas next year. HealthSpring is moving into north Texas to launch a new product, NTX Healthy/Advantage PPO. It will be offered in 13 counties including the Dallas/Fort Worth area. CIGNA is adding new plan options in almost every county in which it operates and moving into new territories.

AMERIGROUP | 3Q 2008 | Health Plan Earnings Summaries

Fri, 24 Oct 2008 00:00:00 GMT

Molina | 3Q 2008 | Health Plan Earnings Summaries

Fri, 24 Oct 2008 00:00:00 GMT

UnitedHealth Group | 3Q 2008 | Health Plan Earnings Summaries

Fri, 24 Oct 2008 00:00:00 GMT

Coventry | 3Q 2008 | Health Plan Earnings Summaries

Fri, 24 Oct 2008 00:00:00 GMT

WellPoint | 3Q 2008 | Health Plan Earnings Summaries

Fri, 24 Oct 2008 00:00:00 GMT

Georgia, Alabama & Louisiana | Fall | 2008 | Health Plan Analysis

Fri, 24 Oct 2008 00:00:00 GMT

Report Summary: Blue Cross and Blue Shield of Alabama is Goliath in that state's insurance arena, but national plans are picking up Alabama members too. The insurance market is widening in Huntsville and Mobile to include big, high-tech businesses that are bringing hundreds of new employees accustomed to national health insurors with multiple offerings. In addition, plans such as CIGNA Healthcare are carving a niche with consumer-driven health plans and wellness programs. Also in Alabama, the state is embroiled in a series of court cases against 73 of the nation's pharmaceutical giants, claiming they overcharged Medicaid for prescription drugs. The companies are defending themselves in a variety of ways, saying the state claims are pre-empted by federal law or fall under the statute of limitations. So far, the court isn't buying these arguments and has found in favor of the state in the three suits heard thus far, awarding Alabama Medicaid $329 million in damages. Meanwhile, other states have brought similar suits. Healthcare spending is a big issue in Georgia and threatens to become even bigger next year as state officials consider putting a 3 percent premium tax on commercial health plans to help pay their Medicaid bills. With economic problems looming large, the state faces a $113 million Medicaid budget reduction. Meanwhile, Georgia plans to tie the results of an upcoming audit on disease management among its three care management organizations as factors in assigning new members to the plans.

Minnesota | Fall | 2008 | Health Plan Analysis

Wed, 22 Oct 2008 00:00:00 GMT

Report Summary: Minnesota is bucking the national trend with growing HMO enrollment while at the same time defying a national movement to significant growth in self-insured products. Market leader Blue Cross and Blue Shield of Minnesota has introduced a new product, called SureBlue, which offers a three-year rate guarantee to fully insured businesses with 51 to 249 members. The consumer-driven movement, which is already strong in Minnesota, is likely to get a boost with a decision by Gov. Tim Pawlenty to offer a $250 health reimbursement arrangement to state employees. On the disease management front, the Minnesota Blue plan made a significant decision to bring its DM services in house as part of a new internal effort combining wellness and disease management. Meanwhile, HealthPartners is taking its homegrown wellness program nationwide.

Nevada | Fall | 2008 | Health Plan Analysis

Thu, 09 Oct 2008 00:00:00 GMT

Report Summary: Anthem Blue Cross Blue Shield has pulled out of Nevada's Medicaid program, citing low reimbursements and little prospect of improvement given the state's strained budget. AMERIGROUP has jumped in to fill the void, though.

Nevada's recent economic growth has been choked off by the national economic downturn, and carriers have been busy creating and packaging individual products to meet demand from cost-conscious buyers.

Sierra Health, now owned by UnitedHealth, is offering a new value-based drug option in its popular Medicare Advantage plan, hoping to score with seniors who value a no-copay policy for the drugs that keep them stabilized.

Nevada's insurers are trying a range of different tactics to control costs of specialty drugs and the cost of radiology services.

Humana is moving aggressively to maximize its opportunities in Nevada as UnitedHealth has had to part from its Las Vegas MA business in order to merge with Sierra.

New England | Fall | 2008 | Health Plan Analysis

Thu, 09 Oct 2008 00:00:00 GMT

Report Summary: Massachusetts' health reform is running on all cylinders with 439,000 previously uninsured now covered in state or private plans. However, 2009 brings new challenges as the state mandates prescription drug coverage for individuals with health coverage and changes the rules on how businesses fund the program. Funding of the program is on solid ground for 2009, but long-term cost controls signed into law by Gov. Deval Patrick won't have time to take hold. In Maine, the troubled Dirigo Health program had another setback when voters on Nov. 4 rejected a funding proposal. Throughout the region, PPOs are making gains while HMOs lag in every state but Massachusetts where two out of three in the commercial marketplace are still enrolled in the more tightly controlled health plan designs. Medicare private fee-for-service plans are likely to survive in parts of the region, despite a new law that requires they convert to a network-based plan. A comprehensive medical home pilot involving all the major payors in Rhode Island is off the ground. And in Massachusetts, a growing number of cities and towns are opting for the Group Insurance Commission program, which means enrollment losses for Blue Cross Blue Shield of Massachusetts.

Ohio, Kentucky & Indiana | Fall | 2008 | Health Plan Analysis

Fri, 03 Oct 2008 00:00:00 GMT

Report Summary: The list of health plans leaving the Ohio Medicaid managed care program continues to grow with WellPoint Inc. leaving the program entirely and WellCare and Centene Corp. pulling their managed care organizations out of a portion of the eight Medicaid regions in the state. All three publicly held managed care companies said they had lost money on the program serving the aged, blind and disabled portion and WellPoint also attributed losses to the mothers-and-children portion of Medicaid. Commercial HMO enrollment, meanwhile, continues to tumble in Ohio, Kentucky and Indiana while managed care enrollment in state-sponsored programs is growing. Anthem Blue Cross and Blue Shield in Ohio, the Kroger grocery chain and the city of Cincinnati are participating in a pharmacist-centered disease management program targeted city employees who have diabetes. The program uses pharmacists employed at Kroger to help the diabetics better control their disease. In Indiana, a new Medicare HMO, Clarian Health Plans, is selling four plan designs in the Indianapolis area for 2009. Meanwhile, in Kentucky, the State Children's Health Insurance Program is more aggressively promoting the program to eligible families.

Tennessee | Summer | 2008 | Health Plan Analysis

Wed, 24 Sep 2008 00:00:00 GMT

Report Summary: Humana Inc.'s latest stop on its buying spree was in East Tennessee where the Kentucky-based insurer agreed to purchase Cariten Healthcare, a provider-owned company doing business in commercial, Medicare and Medicaid sectors. Although Humana inherits more than 34,000 fully insured commercial customers, it may be most interested in the 46,000 Medicare Advantage members on Cariten's books. The latest acquisition announcement makes the Tennessee health plan market even more consolidated with the PPO competition essentially between BlueCross BlueShield of Tennessee and national insurers - including Humana - while the HMO market is dominated by CIGNA HealthCare in the east and middle and UnitedHealthcare of the River Valley in the east. BlueCross has launched a new Web-based tool that provides quality indicators on the almost 4,000 of the company's contracted physicians. BlueCross and AmeriChoice are preparing to launch new at-risk managed care contracts in the TennCare program; the western portion of the state goes live with the managed care plans on Nov. 1 while the east is implemented on Jan. 1, 2009 - the middle region enrollees have been enrolled with either AmeriChoice or AMERIGROUP since 2007. Meanwhile, AMERIGROUP's rocky start in Tennessee may get smoother now that it renegotiated rates with the TennCare Bureau for home healthcare services, yet it still faces a lawsuit from a Chattanooga-based hospital system over the payment of services for AMERIGROUP's TennCare enrollees.

Mid-Atlantic | Summer | 2008 | Health Plan Analysis

Mon, 22 Sep 2008 00:00:00 GMT

Report Summary: Maryland regulators cited and fined Coventry Health Care after finding the carrier failed to comply with state laws regarding prompt payment of claims, appeals, greivances, and more. Meanwhile, AMERIGROUP has walked away from its Medicaid contract with the District of Columbia, even though the District has dropped its lawsuit against the company.

The Virginia Business Coalition on Health is starting its own version of a pharmacist-led diabetes management program in Chesapeake. Mid-Atlantic health plans, meanwhile, are using various approaches to tame specialty drug costs. Maryland has begun a small business insurance subsidy program, with four insurers offering plans for the program. Medicare Advantage law changes look like they'll favor XLHealth, which offers special needs plans in six states under the Care Improvement Plus name. Meanwhile, CareFirst is seeking to offer Mid-Atlantic physicians extra payment in return for setting up "medical homes" for CareFirst members. Kaiser is preparing to offer self-insured plans as part of its effort to move beyond the HMO model it made famous.

Pennsylvania | Summer | 2008 | Health Plan Analysis

Fri, 19 Sep 2008 00:00:00 GMT

Report Summary: Radiology and imaging costs have begun to climb again, and health plans in Pennsylvania are employing various measures to control that growth.

Geisinger Health Plan seems to have found success with the little-used Medicare MSA, with 12 percent of the US market for that product.

The state's new mandate for autism services is likely to raise insurance costs, and perhaps rates as well.

Health plans selling CDHPs are crying foul when employers are too generous in funding accounts, and some are taking steps to limit account size.

Highmark is rolling out a new niche product to cover those needing short-term insurance coverage.

North & South Carolina | Summer | 2008 | Health Plan Analysis

Fri, 19 Sep 2008 00:00:00 GMT

Report Summary: More than 37 percent of Medicaid beneficiaries in South Carolina who could join a managed care plan in the state's Healthy Connections program have done so by August of 2008. Eight health plans are enrolling members, but the competition has not diminished the growth of First Choice, the senior member of the Medicaid managed care club in the state, which has grown to 110,000 members, a nearly 47 percent increase since mid 2007. In two unrelated developments on the pharmacy front, South Carolina's Medicaid agency is sending out pharmacists to physicians to promote the use of generics, and Blue Cross and Blue Shield of North Carolina is upping the ante on electronic prescribing by offering a free Web site where physicians can access software for e-prescribing. Meanwhile, BlueCross BlueShield of South Carolina has launched a new product line geared to small businesses that include some options with increased pharmacy controls. The North Carolina State Health Plan is trying to work through a budget shortfall with cuts to some programs but is holding off on premium increases for now.

Michigan | Summer | 2008 | Health Plan Analysis

Thu, 18 Sep 2008 00:00:00 GMT

Report Summary: Blue Cross Blue Shield of Michigan has made its own in-house provider portal into the go-to site for Medicare elibibility and benefit information, even for those who are not its customers.

In Michigan, an attempt to dilute the healthcare purchasing power of the large public employee unions has not brought the desired result, at least not yet. The legislation designed to enable creation of smaller insurance purchasing pools has resulted in a fight over claims data that has stalled changes for now.

HMOs in Michigan are holding onto their members, but medical loss ratios are on the rise and margins are relatively low compared to national plans. But at least two HMOs are investing and expanding into new territory.

WellPoint | 2Q 2008 | Health Plan Earnings Summaries

Fri, 05 Sep 2008 00:00:00 GMT

Molina | 2Q 2008 | Health Plan Earnings Summaries

Fri, 05 Sep 2008 00:00:00 GMT

Wisconsin | Summer | 2008 | Health Plan Analysis

Thu, 04 Sep 2008 00:00:00 GMT

Report Summary: When Congress passed the Medicare Improvements for Patients and Providers Act this summer, health plans operating in the Medicare arena began to brace for the changes. Wisconsin health plans operating special needs plans are giving the new law favorable reviews while eyeing expansion plans. Commercial health plans in Wisconsin are seeing HMO enrollment continue to decline in pockets of the state, while the larger national insurers concentrate their efforts on PPO offerings. Wisconsin's local provider-owned plans, centered mostly around the Madison area, are still seeing strong HMO enrollment, retaining their traditional business. The first significant data is coming in reflecting the success of a partnership between Humana and the Business Health Care Group in the southeastern Wisconsin market. The partnership has produced a slowdown in medical-cost trends for members and boosted transparency and competition in the highly competitive Milwaukee-area market. Network Health Plan is launching a new wellness suite that offers premium rate relief and guaranteed caps on rate increases for employers.

Kansas & Missouri | Summer | 2008 | Health Plan Analysis

Tue, 02 Sep 2008 00:00:00 GMT

Report Summary: The end of private fee-for-service Medicare plans by 2011 has health plans moving to re-shape their Medicare Advantage strategies, building networks where it makes sense to do so, or retreating from some areas.

Several Kansas cities are considering building "three-share" arrangements to support limited health plans for employees of small businesses, while the healthcare issue continues to be a major theme in Missouri's governor's race.

Mental health advocates are objecting to Kansas' proposed formulary for behavioral health drugs.

American Community has re-vamped its Coverage On Demand product and is selling in Missouri.

Florida | Summer | 2008 | Health Plan Analysis

Thu, 28 Aug 2008 00:00:00 GMT

Report Summary: Florida insurers are seeing a marked movement toward self-insured health benefit designs, and the worsening economy in the state could keep the momentum toward self insurance under way for some time. Blue Cross and Blue Shield of Florida is responding to the market's call for affordable products by developing a new limited-benefit product called GoBlue that requires no medical underwriting and with premium costs of $16 to $64. A limited benefits package is at the core of the upcoming Cover Florida program, which is Gov. Charlie Crist's plan to eat into the 3.8 million-person uninsured rate in the Sunshine State. Nine insurers have made applications to offer products in Cover Florida, which gets under way in January 2009. The managed Medicaid sector, meanwhile, is booming with a recent expansion by AmeriChoice in the Florida Health Kids program and an enrollment of more than 200,000 in the state's Medicaid Reform plan in five counties. Electronic prescribing is picking up steam in Florida, which is ranked 19th nationally in the percentage of prescriptions that are transmitted electronically. On the Medicare front, Humana is increasing its market share in the lucrative Medicare Advantage market even more with its purchase of Metcare Health Plans in the Treasure Coast region.

Oregon & Washington | Summer | 2008 | Health Plan Analysis

Thu, 28 Aug 2008 00:00:00 GMT

Report Summary: The managed care market in Oregon will be shaken up with the awarding of contracts for the Oregon Educators Benefit Board. Winning three-year contracts for medical and pharmacy coverage were Providence Health Plans, Kaiser Northwest and ODS Health Plans, with the huge Regence BlueCross BlueShield of Oregon failing to win a bid. In Washington, Group Health Cooperative is expanding its out-of-network product options to those purchasing insurance in the individual market. The so-called Balance plans have deductibles ranging from $1,000 to $5,000 for individuals. Disease management is taking on new wrinkles in the region with Regence expanding an integrated program for complicated medical conditions by offering it to small employers while Providence Health Plan is introducing a "patient activation" plan. Health insurers are honing their strategies to deal with the rising costs of specialty drugs by placing the drugs on benefit tiers that require coinsurance and equalizing plan designs for copayments for specialty drugs considered medical and pharmacy purchases.

TriState | Summer | 2008 | Health Plan Analysis

Tue, 26 Aug 2008 00:00:00 GMT

Report Summary: Horizon Blue Cross Blue Shield's planned conversion to for-profit status stands a markedly better chance this time, as it would raise $1 billion or more that New Jersey could use to launch proposed healthcare reforms. The Medicare landscape is already shifting in response to Congressional action against no-network private fee-for-service Medicare plans, and TriState will be a major battleground as plans try to pick up market share. Connecticut has stumbled in its attempt to combine its Medicaid program with its health plan for the uninsured, but all three states are working with changes in insurance regulation and various reforms designed to extend coverage.

Texas | Summer | 2008 | Health Plan Analysis

Mon, 25 Aug 2008 00:00:00 GMT

Report Summary: PPOs may come under more regulatory scrutiny from the Texas Department of Insurance. Proposals being floated would require PPOs operating in Texas to have a certificate of authority and allow the TDI to act against plans engaging in illegal practices. HMOs are more highly regulated in Texas than PPOs, but PPOs make up a much larger part of the market. At the same time, Texas physicians are lobbying for tighter regulations of so-called "silent" PPOs that sell, resell or lease physician contracts without physician authorization.

Texas' first 3-share plan became active July 1, extending health benefits to small businesses in Galveston County. Under the 3-share model, employers, employees and an outside source such as an endowment or local government share the cost of health plan premiums. On the IT front, one-third of physicians responding to a Texas Medical Association survey in 2007 said they use electronic medical records, up from 27 percent in 2005.

Georgia, Alabama & Louisiana | Summer | 2008 | Health Plan Analysis

Thu, 14 Aug 2008 00:00:00 GMT

Report Summary: Hurricane Katrina may have shaken up the hospital and physician supply in New Orleans in 2005, but the disaster has not had a long-term negative effect on health plans in the region. Health plans have recovered most, if not all, of their covered lives as they capture business from different industries, such as construction. In Georgia, changes in the State Health Benefit Plan will shake up the insurance market, with Kaiser Permanente and Blue Cross Blue Shield in Georgia losing contracts with the state. Meanwhile, in Alabama, the agency that administers health insurance for more than 400,000 employees, retirees and teachers is considering extending a wellness program with a focus on obesity management. Alabama also has a new law that provides a tax break to small businesses that purchase health insurance. In the Medicare market, insurers who participate in Medicare Advantage in the New Orleans are among the big winners for rate increases from the federal government for 2009. Doctors in all three states are part of a demonstration project from the U.S. Department of Health and Human Services to move them toward electronic health records for Medicare patients. Finally, Humana is launching a medical home model in Atlanta in conjunction with WellStar Health System.

Coventry | 2Q 2008 | Health Plan Earnings Summaries

Fri, 08 Aug 2008 00:00:00 GMT

Health Net | 2Q 2008 | Health Plan Earnings Summaries

Thu, 07 Aug 2008 00:00:00 GMT

CIGNA | 2Q 2008 | Health Plan Earnings Summaries

Wed, 06 Aug 2008 00:00:00 GMT

Aetna | 2Q 2008 | Health Plan Earnings Summaries

Tue, 05 Aug 2008 00:00:00 GMT

HealthSpring | 2Q 2008 | Health Plan Earnings Summaries

Tue, 05 Aug 2008 00:00:00 GMT

Humana | 2Q 2008 | Health Plan Earnings Summaries

Tue, 05 Aug 2008 00:00:00 GMT

New England | Summer | 2008 | Health Plan Analysis

Tue, 05 Aug 2008 00:00:00 GMT

Report Summary: Tufts Health Plan wants to compete in the Rhode Island market, setting the stage for a showdown with Blue Cross & Blue Shield of Rhode Island, the state's no. 1 insurer, and UnitedHealthcare of New England. The expansion is not a done deal, since Tufts Health Plan officials are still negotiating provider networks. Tufts Health Plan pulled out of the Rhode Island market in the late 1990s and fellow Massachusetts health plan Harvard Pilgrim Health Care exited around 2000 amid financial troubles.

Also in Rhode Island, the Rhode Island Department of Human Services, with the backing of Gov. Donald Carcieri, has submitted a proposal to the Centers for Medicare & Medicaid Services to operate the state's Medicaid program under what is known as a "global cap." Under this scenario, the state would receive a defined financial contribution from the federal government, and would be solely liable for any amount spent over that pre-determined cap. In return, the Rhode Island would be granted complete flexibility to manage the Medicaid program.

Throughout New England, insurers are looking for ways to better control the costs of specialty drugs.

In Vermont, uptake has been slow in the state's program for the uninsured. As of the end of May, fewer than 4,000 were enrolled in the subsidized part of the program, compared to the original estimate of 6,000.

AMERIGROUP | 2Q 2008 | Health Plan Earnings Summaries

Tue, 29 Jul 2008 00:00:00 GMT

California | Summer | 2008 | Health Plan Analysis

Fri, 25 Jul 2008 00:00:00 GMT

Report Summary: While all the major insurers in California now have electronic personal health records in place, only about 5 percent of health plan members are taking advantage of them and the industry is struggling with issues of records portability. The average profit margin for multi-line HMOs in California in 2007 was 5.6 percent, according to data compiled by HealthLeaders-InterStudy, with the highest margin belonging to Blue Shield of California at 8.9 percent. Average premium rates for members of CalPERS will increase by an overall 4.3 percent for 2009 - the lowest increase in more than a decade. The CalPERS board praised Blue Shield of California for sharing with members its savings achieved from lower medical cost trends, but it chastised Kaiser Foundation Health Plan for refusing to budge from its 8.1-percent rate hike. By January 2009, HMOs will have to comply with regulations mandating interpretation services in any language in which the member of a commercial plan requests it. A California-based Medicare plan, SCAN Health plan, is looking to expand into new markets beyond California and Arizona. Finally, while the legalization of gay marriage in California will have little effect on insurers that have already insured domestic partners through group plans, the law could have more far-reaching impact on health benefits in other states.

UnitedHealth Group | 2Q 2008 | Health Plan Earnings Summaries

Fri, 25 Jul 2008 00:00:00 GMT

WellCare | 2Q 2008 | Health Plan Earnings Summaries

Fri, 25 Jul 2008 00:00:00 GMT

Centene | 2Q 2008 | Health Plan Earnings Summaries

Thu, 24 Jul 2008 00:00:00 GMT

Arizona | Summer | 2008 | Health Plan Analysis

Thu, 24 Jul 2008 00:00:00 GMT

Report Summary: The state agency that manages the Medicaid managed care program is keeping seven of its current managed care plans in its latest procurement, and it will add a subsidiary of Centene Corp. to its line-up. However, the service areas are shifting dramatically with a number of current plans set to lose members in key counties. The state legislature passed a comprehensive bill mandating coverage of autism while the agency coordinating small business coverage hung on in the session, despite attempts to end the program. Aetna and CIGNA HealthCare have launched plan designs in Arizona geared to the small-business sector, while UnitedHealthcare will offer a fully insured product option to small school districts in the state for 2009-2010. Finally, Blue Cross Blue Shield of Arizona has launched its first-ever campaign targeting Hispanics, who account for 30 percent of the state's population while other insurers and providers wrestle with how to reach and insure immigrants.

Illinois | Summer | 2008 | Health Plan Analysis

Mon, 21 Jul 2008 00:00:00 GMT

Report Summary: Blue Cross Blue Shield of Illinois is adding a new twist to its HMO product, in the form of a new offering in the Blue Edge suite pairing the HMO with a Health Reimbursement Arrangement. Illinois' Medicare Advantage plans have reimbursement rates running at about $20 per member per month lower than the national average, and that may mean changes for the market. The Illinois Blue plan so dominates its market that its competitors are scrambling to get a foothold as the economy, and the prospect of organic membership growth, heads downward. Illinois plans are enhancing their dental benefit options as they angle for a reliably profitable supplemental business line.

Ohio, Kentucky & Indiana | Summer | 2008 | Health Plan Analysis

Thu, 10 Jul 2008 00:00:00 GMT

Report Summary: Healthy Indiana Plan, which was created in 2007, is experiencing one of the fastest launches of any Medicaid-expansion program in the country. By mid-2008, the program had more than 14,000 Hoosiers enrolled and another 7,400 applications pending; it offers medical and pharmacy benefits along with a medical savings account for those with incomes up to 200 percent of the federal poverty level. Meanwhile, Ohio's Medicaid managed care program continued to unravel as three of the eight plans serving beneficiaries have decided to drop out because reimbursement rates are not covering medical costs. Hospitals and health plans are at odds over how hospitals are reimbursed for Medicaid services. Aetna has taken the lead in Medicare Advantage enrollment in Ohio, and nearly all of it is from the company's private fee-for-service plan-a product line that has an uncertain future. Nearly all HMOs in Kentucky, Ohio and Indiana posted healthy profit margins in 2007, according to the latest data from HealthLeaders-InterStudy. In the Indiana commercial market, approximately 80,000 members of the M-Plan HMO are now booked by Anthem Blue Cross and Blue Shield in Indiana, and a health plan in northern Indiana, Physicians Health Plan, has been selling a suite of individual products called Indigo.

Colorado | Summer | 2008 | Health Plan Analysis

Mon, 07 Jul 2008 00:00:00 GMT

Report Summary: Kaiser Permanente of Colorado has agreed to provide $155 million in premium credits to Colorado consumers, translating to a $287 credit to individual and family plan members in 2009 and 2010. The agreement settles concerns by regulators that the company was sending too many financial reserves to California, where Kaiser has its headquarters. At the same time, Kaiser said it would invest more resources into the Western Slope region of Colorado. State lawmakers have beefed up regulation of commercial health plans' rate setting but backed off a proposal to limit insurers' profits. Colorado Access has won a contract to administer benefits for the State Children's Health Insurance Program while also agreeing to be a case management vendor for the aged, blind and disabled portion of Medicaid in six counties. The Colorado Business Group on Health has expanded the Bridges to Excellence pay-for-performance program in the state to include cardiac care after starting P4P with diabetes care. Meanwhile, San Luis Valley HMO may have only 5,500 fully insured lives, but it's entrenched in its home region of southwest Colorado and is expanding into eight new counties.

Iowa | Spring | 2008 | Health Plan Analysis

Tue, 01 Jul 2008 00:00:00 GMT

Report Summary: Iowa's governor has signed a healthcare reform law that increases coverage for children with family incomes up to 300 percent of the federal poverty level. The legislature also expanded the ability of insurers to offer health insurance to dependent children until they are 25. A statewide electronic medical records system became closer to a reality, meanwhile, thanks to a $17 million federal grant. Farm Bureau of Iowa and Wellmark Blue Cross and Blue Shield of Iowa have begun a statewide wellness program that they believe could be modeled across the nation. At the same time, Wellmark is putting emphasis on the health coach in its wellness program

North & South Carolina | Spring | 2008 | Health Plan Analysis

Mon, 30 Jun 2008 00:00:00 GMT

Report Summary: Health plans in the Carolinas are managing specialty pharmacy costs at virtually every step of the process, from negotiating prices with manufacturers to creating special convenient networks. Blue Cross and Blue Shield of North Carolina has developed its own specialty pharma network and is aligning specialty reimbursement with the actual time and expertise needed to process and store the drugs. Medical Mutual continues to expand its footprint in South Carolina with the acquisition of a PPO work. CMS is piloting personal health records for Medicare members in South Carolina. In the North Carolina legislature, most healthcare bills are taking a back seat to mental health care reform, while South Carolina lawmakers kept the state's cigarette tax at the lowest level in the nation.

Pennsylvania | Spring | 2008 | Health Plan Analysis

Thu, 19 Jun 2008 00:00:00 GMT

Tennessee | Spring | 2008 | Health Plan Analysis

Thu, 19 Jun 2008 00:00:00 GMT

Report Summary: TennCare, the large Medicaid managed care program, recently awarded two new contracts to health plans to manage the care for enrollees in west and east portions of the state. The contracts went to AmeriChoice, a unit of UnitedHealth Group, and to BlueCross BlueShield of Tennessee. The contract were awarded at an awkward time, however, as one of the existing TennCare health plans, AMERIGROUP, reported that runaway costs for home healthcare services will prompt it to report lower profits for 2008 than anticipated. Meanwhile, TennCare has a new contract to manage its pharmacy benefits that includes unusual risk and reward provisions. The report also delves into the entrance into Tennessee by Bluegrass Family Health, a Kentucky-based provider-owned health plan, which is selling HMO, PPO and consumer-driven plan designs. Finally, the report examines specialty drug cost management and includes comments from the manager of the specialty pharmacy program for BC/BS of Tennessee, who details what that company is doing to manage that segment of drug costs

Wisconsin | Spring | 2008 | Health Plan Analysis

Wed, 18 Jun 2008 00:00:00 GMT

Report Summary: Wisconsin is joining the ranks of states who are carving out the pharmacy benefits in their Medicaid and other health programs in an attempt to maximize rebates from drug manufacturers. And though the state says it hopes to save $26 million by taking on management of the pharmacy operations, there’s some concern that the carve-out might hurt MCOs’ ability to manage patient care effectively. Commercial plans in Wisconsin are also tightening their focus on pharmacy cost, with even more emphasis on generic utilization, and targeted use of value-based design for certain chronic illnesses. Plans are paying attention to the Wisconsin Pharmacy Quality Collaborative and its efforts to use targeted intervention and pharmacy counseling for certain patients. Wisconsin lawmakers are still working on efforts to broaden health coverage in the state, this time focusing on a possible purchasing pool for small businesses, and on changing state law to limit risk-based underwriting of small groups.

Mid-Atlantic | Spring | 2008 | Health Plan Analysis

Fri, 13 Jun 2008 00:00:00 GMT

Report Summary: Maryland has become one of the first states to pass laws regulating the licensing and transparency of pharmacy benefits managers operating in the state. The bills were supported by the Pharmaceutical Care Management Association, which represents PBMs. The Maryland General Assembly also considered yet another attempt to legislate a single-payor system for healthcare, but it was defeated. Proponents vow to bring it back in 2009. Medicaid in the District of Columbia has been in turmoil with structural changes to its agency and two lawsuits against former and current managed care organizations. However, the District is looking to the future with new contracts with three MCOs serving some 135,000 beneficiaries. Anthem Blue Cross and Blue Shield in Virginia is launching its Lumenos plan in Virginia. Meanwhile, Aetna is piloting a new partnership with a Utah-based company that bulks up customer service in consumer-driven plans.

Michigan | Spring | 2008 | Health Plan Analysis

Thu, 05 Jun 2008 00:00:00 GMT

Report Summary: Blue Cross Blue Shield of Michigan got only a portion of the insurance reforms it sought in the Michigan legislature, at least in part because of opposition from its competitor health plans. But the changes will have effects on Michigan's healthcare market going forward.

One of the Blues' major initiatives was to reform regulation of individual health plans, reasoning that with so many auto industry workers and retirees losing group coverage, the market for those plans is likely to grow exponentially.

Health Alliance Plans is seeing dramatic results in a back pain disease management program initiated with Henry Ford Medical Center and Chrysler.

Primary Care Case Management is emerging as a potential cost-saver for chronically ill members, with two Michigan plans exploring the idea.

Kansas & Missouri | Spring | 2008 | Health Plan Analysis

Wed, 04 Jun 2008 00:00:00 GMT

Report Summary: Summary Healthcare reform fizzled out in both Kansas and Missouri in the past legislative sessions. A legislative revolt from his own party forced Missouri Gov. Matt Blunt to back off his Insure Missouri plan. And what few pieces from the Kansas Health Policy Authority proposal survived went largely unfunded. On the pharmacy benefit front, insurers are pushing expensive specialty drugs to high tiers, moving them from medical benefits to drug coverage and increasing copays or requiring coinsurance. Meanwhile, HMO enrollment continues to decline in both states with PPO market share growing; Preferred Health is moving into rural areas of Kansas and outside its home base of Wichita.

Florida | Spring | 2008 | Health Plan Analysis

Wed, 28 May 2008 00:00:00 GMT

Report Summary: Passage of the state's new Cover Florida program is likely to put some of the 3.8 million uninsured residents into health insurance, but critics question how much help the low-premium/limited benefits plan can provide given the wide variety of low-cost designs already available on the market. Medicare Advantage insurers in Miami/Dade County once again will receive the highest reimbursement increase from the federal government in the United States for 2009. Florida's largest health insurers failed to increase their premiums enough in 2007 to keep pace with rising prescription drug costs. Lawmakers in the Sunshine State refused to extend the five-county pilot program for Medicaid reform that allows health plans and provider-sponsored networks to design their own Medicaid benefit packages. And health plans are using a variety of strategies to manage the high costs of specialty drugs.

TriState | Spring | 2008 | Health Plan Analysis

Tue, 27 May 2008 00:00:00 GMT

Report Summary: New York's proposal to curb "fourth tier" drug pricing has health plans alarmed that lawmakers might curb their ability to structure health benefits, particularly in cost-sharing for expensive medicines. Electronic prescribing has brought a new tool to health plans' efforts to keep members on essential medications, and Horizon's e-prescribing data suggests the problem of non-compliance with heart meds is much worse than previously thought. Emerging research is serving as a wake-up call to health plans. New York's statewide, $10 million pay-for-performance program is designed to change physician behavior towards ten long-accepted benchmarks for quality care, along with a second quality reporting program sponsored by the New York Business Group on Health. In Connecticut, health plans are battling a measure that would allow municipalities, government contractors, nonprofits and small businesses to join the state employee health plan. At the same time, the state is having trouble finding health plans that want to bid on its new combined Medicaid and low-cost insurance plan for the uninsured. And HMOs are not extinctÂ in New York-Aetna has just birthed a new one.

Oregon & Washington | Spring | 2008 | Health Plan Analysis

Fri, 16 May 2008 00:00:00 GMT

Report Summary: Aetna is among national insurers working to chip away at the market dominance of the Regence Group and Premera Blue Cross in Oregon and Washington. Oregon's Medicaid expansion program, called Oregon Health Plan Standard, is expanding the program to about 10,000 new enrollees - the first expansion since 2004 when enrollment was frozen. The Washington Legislature approved changes to a law that sets up a connector for health insurance for small businesses. At the same time, the Legislature failed to pass a bill that would have forbid data mining, a practice in which health information companies pinpoint the prescribing patterns of doctors. Meanwhile, Medicare Advantage enrollment is growing rapidly in Oregon with a lot of activity in the private-fee-for-service sector.

Texas | Spring | 2008 | Health Plan Analysis

Mon, 12 May 2008 00:00:00 GMT

Report Summary: Texas' health plans have long benefitted from the Lone Star State's mandatory generic dispensing law, but have gone beyond that to achieve significant generic utilization and subsequent savings from that. Texas has never been a big HMO state, but the players will keep going because the winnings are substantial, with all but one posting improved profits in 2007. More plans are moving to integrate dental and medical health information, with the Texas Blue plan, Humana and Aetna leading the charge. And Texas is moving into the forefront of the telehealth movement, led by the University of Texas Medical Branch. And in a state where the gulf is huge between the wealthy and the poor, plans are struggling to deal with the new trend of "concierge medicine," for those who can afford to "retain" doctors.

New England | Spring | 2008 | Health Plan Analysis

Fri, 09 May 2008 00:00:00 GMT

Report Summary: Massachusetts is at a crossroads with its Commonwealth Care and Choice programs with enrollment exceeding expectations but costs coming in over earlier estimates. The Massachusetts Legislature is considering a number of measures to better control medical costs in the state. In addition 2009 should be a boon year for pharmacy benefits as the state will require anyone in the state with a creditable health insurance plan to also have a prescription drug benefit. While enrollment was growing in the Bay State, the new HealthPact product for small businesses had attracted fewer than 1,000 members as of May 1, 2008. Fallon Community Health Plan created a division for senior care while Blue Cross Blue Shield of Massachusetts developed a new payment option for providers. Finally, the Maine Health Management Coalition is set to transition to the national Bridges to Excellence platform.

CIGNA | 1Q 2008 | Health Plan Earnings Summaries

Thu, 08 May 2008 00:00:00 GMT

Molina | 1Q 2008 | Health Plan Earnings Summaries

Thu, 08 May 2008 00:00:00 GMT

HealthSpring | 1Q 2008 | Health Plan Earnings Summaries

Thu, 08 May 2008 00:00:00 GMT

Health Net | 1Q 2008 | Health Plan Earnings Summaries

Tue, 06 May 2008 00:00:00 GMT

Humana | 1Q 2008 | Health Plan Earnings Summaries

Tue, 06 May 2008 00:00:00 GMT

WellPoint | 1Q 2008 | Health Plan Earnings Summaries

Tue, 06 May 2008 00:00:00 GMT

Centene | 1Q 2008 | Health Plan Earnings Summaries

Tue, 06 May 2008 00:00:00 GMT

Coventry | 1Q 2008 | Health Plan Earnings Summaries

Tue, 06 May 2008 00:00:00 GMT

Georgia, Alabama & Louisiana | Spring | 2008 | Health Plan Analysis

Tue, 06 May 2008 00:00:00 GMT

Report Summary: Two Louisiana-based health plans - Peoples Health and Vantage Health Plans - are succeeding in the Medicare Advantage space despite competition from larger, national plans. The three managed care health plans providing benefits to Georgia Medicaid beneficiaries received $63 million in retroactive reimbursement payments from the state. The agency overseeing Medicaid in Louisiana is providing devices to physicians to jumpstart electronic prescribing for Medicaid enrollees. In legislative news, Georgia voted to allow an income tax deduction for individuals who purchase a high deductible health plan paired with a health savings account. Meanwhile, in Alabama, bills designed to create tax deductions for small businesses that provide health insurance for their employees were foundering in the final days of the session.

Minnesota | Spring | 2008 | Health Plan Analysis

Tue, 29 Apr 2008 00:00:00 GMT

Report Summary: If being Number Two means you try harder, then that explains the expansion and new product efforts by Medica and Health Partners, the second- and third-place health plans in Minnesota respectively. Both plans have unveiled a raft of new products, both have national partners and have plans to expand into neighboring Wisconsin. Health Partners has been picked as the preferred vendor for a major union in Minnesota, realizing the first benefits of having been vetted for quality and price by the Labor/Management Health Care Coalition/Upper Midwest. And Minnesota, a progressive state with the lowest level of uninsurance in the continental US, has not been able to agree on a major health care expansion. Several Minnesota counties are seeking to set up their own managed Medicaid programs in order to compete with private MCOs.

Nevada | Spring | 2008 | Health Plan Analysis

Mon, 28 Apr 2008 00:00:00 GMT

Report Summary: UnitedHealth Group finally prevailed in its yearlong quest to purchase Sierra Health Services of Las Vegas, but the deal came with a price. UnitedHealth must divest its Medicare Advantage operations in Las Vegas and is selling to Humana Inc. It must also form a physicians' council to address provider concerns, agree not to use its Ingenix database system in Nevada and invest up to $15 million into state healthcare programs. Health benefits are being re-engineered for non-state workers who are part of the Public Employees Benefit Program in Nevada. Budget concerns have derailed a pilot program to put the aged, blind and disabled portion of Medicaid into managed care. And Nevadans are feeling friendlier to PPOs, while competitors to UnitedHealthcare are planning to take advantage of the recent merger with Sierra Health to tout their products and pricing.

AMERIGROUP | 1Q 2008 | Health Plan Earnings Summaries

Fri, 25 Apr 2008 00:00:00 GMT

Aetna | 1Q 2008 | Health Plan Earnings Summaries

Fri, 25 Apr 2008 00:00:00 GMT

UnitedHealth Group | 1Q 2008 | Health Plan Earnings Summaries

Fri, 25 Apr 2008 00:00:00 GMT

California | Spring | 2008 | Health Plan Analysis

Wed, 23 Apr 2008 00:00:00 GMT

Report Summary: Kaiser Permanente is preparing to make a huge strategic leap beyond its gatekeeper HMO roots by rolling out an administrative services only (ASO) product offering to large employers. The Department of Managed Care in California is completing new regulations to set parameters on the growing discount health-card industry. Worries are mounting in California over the effect of 10 percent cuts in reimbursement for providers serving Medi-Cal enrollees. Meanwhile, Molina Healthcare is encouraged by a recent test over whether its Medicaid enrollees stayed in the health plan long enough for members and the plan to benefit from predictive modeling. The research disproved the hypotheses that Medicaid members' length of enrollment was too brief to justify predictive modeling.

Ohio, Kentucky & Indiana | Spring | 2008 | Health Plan Analysis

Wed, 09 Apr 2008 00:00:00 GMT

Report Summary: Managed care plans participating in one of the nation's largest Medicaid managed care programs - in Ohio - are experiencing difficulties in maintaining their profit margins, highlighted by the departure of WellPoint's Anthem Blue Cross and Blue Shield subsidiary from the state's program serving mothers and children. Molina Healthcare is undertaking an unusual program that uses pharmacists inside physicians' offices to help improve the quality of care for its Medicaid enrollees. A new physician-owned health plan is opening this year in the Columbus, Ohio, area. Indiana-based Welborn Health Plans has moved into 10 counties of Kentucky with its commercial product. And Medicare Advantage local PPOs are the fastest-growing Medicare managed care products in both Kentucky and Indiana.

Illinois | Spring | 2008 | Health Plan Analysis

Tue, 01 Apr 2008 00:00:00 GMT

Report Summary: Humana's purchase of OSF Health Plans will likely beef up the plan's presence in downstate Illinois, where Blue Cross Blue Shield and UnitedHealth dominate. Illinois health plans are adopting some aspects of value-based pharmacy design-which uses drug tiering and cost-sharing techniques to push members to the most cost-effective treatments rather than the cheapest drugs-as more research supports its cost-savings potential with certain drugs and conditions. Illinois is considering tax credits to encourage more wellness programs in the state. Illinois seniors are warming up to Medicare Advantage plans, particularly to the private-fee-for-service plans that have mushroomed across the state. Between December of 2007 and March 2008, enrollment is up 7.4 percent, with PFFS plan growth up 16 percent in the same period.

Tennessee | Winter | 2008 | Health Plan Analysis

Mon, 31 Mar 2008 00:00:00 GMT

Report Summary: Cariten Healthcare, a small provider-owned health plan based in Knoxville, walked away from the crowded field of contenders for the east Tennessee region TennCare contract, a contract viewed as highly lucrative for deep-pocketed national Medicaid players. In walking away, Cariten has opted to lose its 14-year involvement in the TennCare program and the chance to almost double its membership, in favor of pursuing its Medicare and commercial insurance lines.

Tennessee collected bids for both east and west Tennessee regions, with roughly 350,000 enrollees in each region to be split between two vendors. All the major national Medicaid plans were expected to bid, even though the winners of the middle Tennessee contract have so far suffered multi-million-dollar losses on the business.

HealthSpring, Tennessee's largest Medicare HMO, has created a new select provider network in middle Tennessee, continuing its focus on pay-for-quality and other initiatives to control costs while enhancing care.

The state's e-prescribing initiatives have yet to move large numbers of prescriptions away from the doctor's trusty pen-and-pad, but backers of the efforts say they're making headway, one practice at a time....

And while BlueCross BlueShield of Tennessee remains the enrollment leader in the state by far, Aetna appears to be gaining ground, with premium increases holding at a moderate 6-10 percent.

Mid-Atlantic | Winter | 2008 | Health Plan Analysis

Fri, 21 Mar 2008 00:00:00 GMT

Report Summary: A much-awaited bidding process for managed care plans to serve Medicaid beneficiaries in Washington, D.C., resulted in the selection of its three existing MCOs, as well as Unison Health Plan, which is set to be purchased by UnitedHealth Group. Mid-Atlantic health plans are working to maintain or grow their enrollment bases through new products - Virginia-based Optima Health has introduced new group and individual products, and Kaiser Permanente is seeing results from its Flexible Choice product giving clients access to a broader network. Medicare managed care plans are seizing opportunities in the private fee-for-service market with UnitedHealth Group targeting Virginia and the District of Columbia and Aetna expanding into Richmond and Tidewater areas of Virginia.

Pennsylvania | Winter | 2008 | Health Plan Analysis

Mon, 17 Mar 2008 00:00:00 GMT

Report Summary: Pennsylvania health plans have seen great success in managing their pharmacy costs - through encouraging the use of generics, aggressive formulary management, and copay structures. But the conundrum presented by high-cost biologic specialty drugs is being met with varying approaches whose outcomes bear watching.

Small businesses in Pensylvania are seeing sharp premium increases in 2008 as more plans turn to predictive modeling to set rates. Meanwhile, the HMO appears to be going the way of the dodo in the state, as cost differentials vanish.

Meanwhile, the state of Pennsylvania is expanding its use of managed care in its Medicaid program, but has carved out its pharmacy benefit in order to capture rebate income from pharmaceutical companies. The extent to which rebate-chasing might change the state's formulary is an open question. The state is also in the midst of forming a huge new plan covering all 230,000 public school employees across the stateÂ-an action that will erase dozens of small and medium-sized accounts and combine them into one large group with a lot of market clout.

North & South Carolina | Winter | 2008 | Health Plan Analysis

Thu, 13 Mar 2008 00:00:00 GMT

Report Summary: Blue Cross and Blue Shield of North Carolina is upping the ante on transparency with its new Health Cost Estimator by offering contracted prices instead of provider charges, and by estimating the cost of the entire course of treatment for members. A subsidiary of BlueCross BlueShield of South Carolina has expanded its international provider network in an effort to make medical tourism more attracted to self-insured clients. In another move toward value-based pharmacy benefit design, insurers are moving prescription drugs to lower copays to increase compliance. Meanwhile, HMO enrollment continued to decline in North and South Carolina while Aetna increased its PPO market share.

WellPoint | 4Q 2007 | Health Plan Earnings Summaries

Tue, 11 Mar 2008 00:00:00 GMT

Wisconsin | Winter | 2008 | Health Plan Analysis

Mon, 10 Mar 2008 00:00:00 GMT

Commercial plans in Wisconsin are also tightening their focus on pharmacy cost, with even more emphasis on generic utilization, and targeted use of value-based design for certain chronic illnesses. Plans are paying attention to the Wisconsin Pharmacy Quality Collaborative and its efforts to use targeted intervention and pharmacy counseling for certain patients.

Wisconsin lawmakers are still working on efforts to broaden health coverage in the state, this time focusing on a possible purchasing pool for small businesses, and on changing state law to limit risk-based underwriting of small groups.

Kansas & Missouri | Winter | 2008 | Health Plan Analysis

Thu, 06 Mar 2008 00:00:00 GMT

Report Summary: Consumer-driven health plans are beginning to make inroads in the small-group market of Kansas-Missouri. The largest plan in Missouri, Anthem Blue Cross and Blue Shield, has a significant portion of its small-group business booked on high deductible health plan platforms while national insurers such as Aetna are seeing CDHP enrollment gains in major markets such as St. Louis. Both Kansas and Missouri continue to search for ways to insure more residents as a once-promising program called Insure Missouri may be in jeopardy with the state's governor agreeing to delay implementation. Meanwhile, Blue Cross and Blue Shield of Kansas plans to shut down its HMO after the state of Kansas switched its employees to a PPO - that account had been one of the major foundations of the HMO business.

Florida | Winter | 2008 | Health Plan Analysis

Fri, 29 Feb 2008 00:00:00 GMT

Report Summary: The rapid growth of Florida's population is creating opportunities for the state's health insurers, who are targeting second-tier metropolitan regions such as Naples and Marco Island for new products and sales efforts. The commercial group-health HMO continues to decline in Florida as Medicare and Medicaid plans take on greater importance. Medicare Advantage HMO enrollment in the Sunshine State increased by 8.5 percent from December 2007 to February 2008, with Humana and WellCare Health Plans solidifying their positions as the top plans in that state. Meanwhile, health plans are re-engineering their formularies in light of the huge influx of drug patent expirations.

Molina | 4Q 2007 | Health Plan Earnings Summaries

Tue, 26 Feb 2008 00:00:00 GMT

HealthSpring | 4Q 2007 | Health Plan Earnings Summaries

Thu, 21 Feb 2008 00:00:00 GMT

AMERIGROUP | 4Q 2007 | Health Plan Earnings Summaries

Thu, 21 Feb 2008 00:00:00 GMT

Michigan | Winter | 2008 | Health Plan Analysis

Thu, 21 Feb 2008 00:00:00 GMT

Report Summary: The Michigan health insurance industry has been preoccupied with a legislative battle over the individual health insurance market that pits Blue Cross Blue Shield of Michigan against other health plans. An activist group called Health Care for Michigan is working to gain an amendment to the state constitution that would require universal healthcare coverage in the state. The state remains a stronghold for local health plans even though national insurers are pouring resources into building market share - one of those local plans, a for-profit Medicaid plan, is getting national attention with its focus on information technology, cost control and enrollment growth.

TriState | Winter | 2008 | Health Plan Analysis

Fri, 15 Feb 2008 00:00:00 GMT

Report Summary: Anthem Blue Cross and Blue Shield in Connecticut, Aetna, AmeriHealth Mercy and UnitedHealth Group plan to submit bids for the care management contracts for residents eligible for Medicaid and the Children's Health Insurance Program in Connecticut. In New Jersey, more children will be getting coverage thanks to a new contract with Horizon Blue Cross Blue Shield. The NJ FamilyCare program will be available to low-income families that don't qualify for Medicaid.Two of New York City's oldest health insurers--Group Health Inc. and Health Insurance Plan of Greater New York--are eyeing the New Jersey HMO market for expansion. New York, meanwhile, is considering carving out pharmacy benefit management from the MCOs that manage care for Medicaid beneficiaries. In other pharmacy benefit news, UnitedHealthcare has wrested away one of the country's largest pharmacy benefit management accounts from rival WellPoint Inc. in coordinating care for 1.2 million New York public employees and retirees.

Texas | Winter | 2008 | Health Plan Analysis

Thu, 14 Feb 2008 00:00:00 GMT

Report Summary: Medicare Advantage special needs plans are popping up like wildflowers after a rain in Texas, growing in membership and diversity as plans tailor themselves to local and regional needs. Texas' businesses are targeting diabetes control as a health issue, publishing a study on the disease's prevalence and costs. Five Texas regions are working together to try to form three-share programs to help low-income employees of small businesses afford insurance. And with commercial insurance membership flat in Texas, the only real growth area for plans is in public sector programs - Medicaid and Medicare.

Centene | 4Q 2007 | Health Plan Earnings Summaries

Thu, 14 Feb 2008 00:00:00 GMT

Aetna | 4Q 2007 | Health Plan Earnings Summaries

Wed, 13 Feb 2008 00:00:00 GMT

CIGNA | 4Q 2007 | Health Plan Earnings Summaries

Mon, 11 Feb 2008 00:00:00 GMT

Coventry | 4Q 2007 | Health Plan Earnings Summaries

Mon, 11 Feb 2008 00:00:00 GMT

Health Net | 4Q 2007 | Health Plan Earnings Summaries

Thu, 07 Feb 2008 00:00:00 GMT

Oregon & Washington | Winter | 2008 | Health Plan Analysis

Thu, 07 Feb 2008 00:00:00 GMT

Report Summary: Washington's individual health insurance market is growing, but medical cost trends have resulted in double-digit premium increases. As a result, the state's insurance commissioner is backing legislation to regulate rate increases for this segment of the market. Meanwhile, some Washington physician groups are urging their patients to bypass fee-for-service Medicare in favor of physician-owned Medicare Advantage plans. A chronic disease management program for Medicaid beneficiaries in Washington has netted strong financial returns in its final year. Finally, Regence - which operates Blue Cross and Blue Shield plans in both Oregon and Washington - has interesting results from a survey on consumers' online behavior as it relates to healthcare.

Humana | 4Q 2007 | Health Plan Earnings Summaries

Wed, 06 Feb 2008 00:00:00 GMT

Illinois | Winter | 2008 | Health Plan Analysis

Tue, 05 Feb 2008 00:00:00 GMT

Report Summary: Illinois' healthcare industry may see CIGNA HealthCare emerge as a more formidable player in the ASO and small group sectors thanks to its purchase of Great-West Healthcare. While Great-West was not a large player in terms of market share, the company does present some growth opportunities for CIGNA, whose PPO is a third-tier player in the Illinois market.

As an Illinois court holds forth on Gov. Rod Blagojevich's attempts to unilaterally enact portions of his healthcare reform package, the unpopular governor is continuing to push for additional regulatory changes affecting insurers. The governor's bull-in-a-china-shop style isn't winning any points, and few believe he's likely to win approval of much of his agenda.

Illinois' promising e-prescribing effort has the new backing of UnitedHealthcare, whose participation will strengthen Illinois' financially self-sustaining e-perscribing experiment.

New England | Winter | 2008 | Health Plan Analysis

Tue, 05 Feb 2008 00:00:00 GMT

Report Summary: Massachusetts' health reform program got off to an encouraging start in 2007 with more than 300,000 previously uninsured residents receiving health benefits; however, problems loom with higher-than-expected healthcare costs that threaten to undermine Commonwealth Care and Commonwealth Choice. Medicare private-fee-for-service plans continue to grow in Massachusetts, although they are still a fraction of the overall Medicare Advantage market. Maine has implemented a new disease management program for its Medicaid beneficiaries, while New Hampshire is taking stock of its several-year disease-management contract with McKesson Health Solutions. And the Massachusetts eHealth collaborative is preparing for its next phase of allowing physicians to share patient electronic health records.

Georgia, Alabama & Louisiana | Winter | 2008 | Health Plan Analysis

Wed, 30 Jan 2008 00:00:00 GMT

Report Summary: Atlanta's health insurance market continues to be one of the most competitive in the country, and certainly in the South. And as major regional employers like Delta Airlines talk of a potential merger and exit from the market, the competitive focus is shifting to the small-group segment in what is still a fast-growing urban center. Meanwhile, CIGNA HealthCare's purchase of Great-West's health insurance business improves its footprint in the region, and may signal a push into the small-group segment.

UnitedHealth Group | 4Q 2007 | Health Plan Earnings Summaries

Mon, 28 Jan 2008 00:00:00 GMT

Arizona | Winter | 2008 | Health Plan Analysis

Fri, 25 Jan 2008 00:00:00 GMT

Report Summary: Arizona's mid-sized health plans grew substantially last year, with enrollment up 24 to 30 percent for several players. The state is also becoming a popular proving ground for insurers piloting Medicare special needs plans for chronic conditions; pay-for-performance programs are getting a tepid response; and Arizona's state-run plan for small businesses faces an uncertain future.

California | Winter | 2008 | Health Plan Analysis

Wed, 16 Jan 2008 00:00:00 GMT

Report Summary: California employers are hitting the wall on insurance premium increases and seeking cheaper plans that streamline benefits or shift more of the cost burden onto employees. Meanwhile, the state's healthcare reform legislation is still in limbo, San Francisco is going ahead with its employer mandate for contributing to healthcare coverage, and providers and health plans have become odd bedfellows in their quest to stop state regulators from setting an interim base rate for services.

Ohio, Kentucky & Indiana | Winter | 2008 | Health Plan Analysis

Thu, 10 Jan 2008 00:00:00 GMT

Report Summary: Health plans operating in the Toledo area largely have deserted a holdover of 1980s managed-care contracts by eliminating "steerage," which sent patients to a single, large hospital system. A new state-funded program, called Healthy Indiana Plan, has begun providing health insurance for poor residents of that state, and it features a consumer-driven account providing up to $500 a year in free preventive care. In Kentucky and Ohio, Anthem Blue Cross and Blue Shield is introducing a new Medicare product called SmartSaver that functions like a consumer-driven plan, except it is targeted to seniors. And Kaiser Permanente's Ohio region has become the last of the Kaiser Permanente markets to bring the nonprofit insurer's personal health record system online. The system allows members to send secure e-mails to physicians, set appointments and view laboratory tests online.

Colorado | Winter | 2008 | Health Plan Analysis

Thu, 03 Jan 2008 00:00:00 GMT

Report Summary: Colorado legislators will consider five different proposals for covering the uninsured this year, but health plans are leery of possible coverage mandates and restrictions on public spending could limit progress. In addition, CIGNA is buying Great-West's healthcare business, UnitedHealthcare and Kaiser are leading the Medicare Advantage market, and Humana has picked up an important employee contract it its deal with HCA-HealthOne.

Humana | 3Q 2007 | Health Plan Earnings Summaries

Fri, 09 Nov 2007 00:00:00 GMT

Health Net | 3Q 2007 | Health Plan Earnings Summaries

Wed, 07 Nov 2007 00:00:00 GMT

Molina | 3Q 2007 | Health Plan Earnings Summaries

Wed, 07 Nov 2007 00:00:00 GMT

CIGNA | 3Q 2007 | Health Plan Earnings Summaries

Wed, 07 Nov 2007 00:00:00 GMT

HealthSpring | 3Q 2007 | Health Plan Earnings Summaries

Thu, 01 Nov 2007 00:00:00 GMT

UnitedHealth Group | 3Q 2007 | Health Plan Earnings Summaries

Wed, 31 Oct 2007 00:00:00 GMT

WellPoint | 3Q 2007 | Health Plan Earnings Summaries

Wed, 31 Oct 2007 00:00:00 GMT

AMERIGROUP | 3Q 2007 | Health Plan Earnings Summaries

Wed, 31 Oct 2007 00:00:00 GMT

Coventry | 3Q 2007 | Health Plan Earnings Summaries

Wed, 31 Oct 2007 00:00:00 GMT

Centene | 3Q 2007 | Health Plan Earnings Summaries

Wed, 31 Oct 2007 00:00:00 GMT

Aetna | 3Q 2007 | Health Plan Earnings Summaries

Wed, 10 Oct 2007 00:00:00 GMT