Health Insurance Exchange

August 26, 2014 | Anthony Brino

An insurance industry veteran who managed one of the few well-functioning state exchanges in the first open enrollment period is taking a key federal post.

August 20, 2014 | Michelle Andrews

What's in a name? When it comes to health plans sold on the individual market, these days it's often less than people think. The lines that distinguish HMOs, PPOs, EPOs and POS plans from one another have blurred, making it hard to know what you're buying by name alone -- assuming you're one of the few people who know what an EPO is in the first place.

August 19, 2014 | Anthony Brino

The idea of a new "copper" tier of health plans is being pitched for the most healthy and cost-conscious consumers.

August 19, 2014 | Anthony Brino

One of the most acrimonious disputes of the insurance exchange debut is coming to a close, in a testament to the market influence some providers now have.

August 15, 2014 | Anthony Brino

In the debate over provider networks, broad access has been the goal of many patient advocates, but some are also warning of unintended consequences of over-regulation.

August 13, 2014 | Anthony Brino

In the new health insurance economy, where individual consumers have more and more choices, a health plan's brand is one of its biggest asset. Sometimes it has to be changed.

August 1, 2014 | Anthony Brino

Premiums for exchange plans in California are looking pretty affordable. Is this because insurers are fearful of a rate review process that might be approved by voters in the fall, or a large, diverse market spreading out risk?

July 30, 2014 | Anthony Brino

A new portrait of the uninsured and newly-insured is emerging, with a confluence of factors shaping who is and isn't enrolling in Medicaid or private plans.

July 29, 2014 | Anthony Brino

Among the many challenges in year two of federal exchanges, the process of auto re-enrollment is bringing the potential of convenience and disruption, for both consumers and insurers.

July 28, 2014 | Anthony Brino

Insurers trying to ride the wave of private exchanges need to be careful not to get swept up or knocked overboard amid varying business models and high customer expectations.

July 25, 2014 | Anthony Brino

While some state exchange executives exited their exchanges amid foundering technology and low public esteem, the director of one successful state HIX has landed in the growing private exchange unit of a large national insurer.

July 25, 2014 | Anthony Brino

Ahead of the next open enrollment period, federal regulators are trying to clarify rules for member non-payment and grace periods, but insurers and providers may still have lingering concerns about getting paid.

August 27, 2014 | White Papers
New Bedford Corporation was expending too much time and staff manually entering medical charges generated by 50 of its healthcare provider customers into its practice management application. The back-office services provider deployed EnableSoft's Foxtrot to automate the billing data entry process, which resulted in the reduction of data entry time by 5.6 hours per 1,000 records and a savings in human resources equal to two FTEs.

August 27, 2014 | White Papers
Care1st Health Plan experienced a 20,000-member increase as a result of county expansion and the potential for even more members as the new third-party administrator for Arizona's insurance cooperative. In order to automate and expedite burdensome data-entry processes, the health plan implemented EnableSoft's Foxtrot software, which ultimately saved valuable and human resources.

August 27, 2014 | White Papers
Scott & White Health Plan and Insurance Company foresaw increased manual data-entry processes required to accommodate an influx of new members under the Affordable Care Act. The nationally rated health plan's implementation of EnableSoft's Foxtrot software helped to reduce new network set-up time and time to establish new pay classes, while at the same time increasing productivity and scaling operations without increasing staff.

May 19, 2014 | White Papers
If your organization enters or changes data manually, or is using a series of macros cobbled together to automate enrollment, claims reprocessing, or panel updates, you’re probably losing time, money, and risking data quality. This study explores the causes, prevalence, and repercussions of these traditional data practices for payers, then shares innovative ways to conquer inefficiency with automation technology.

March 11, 2014 | White Papers
For health insurers, data integrity and visibility are key to successful integration with the Federal Marketplace. However, complex processes and trivial errors can lead to data gaps that impact revenue, profitability and member satisfaction. Adopting a standarized approach to data integrity early in the process is critical to succesfully adapting to the technologies and processes of the Affordable Care Act.

October 30, 2013 | White Papers
This visual industry primer answers key questions about health insurance exchanges and includes data points from leading consulting firms. Read this piece to get grounded on the new world of health insurance marketplaces, and gets answers to some basic industry questions including: 1) How will people buy health insurance in the post-reform landscape? 2) What’s the difference between defined contribution and defined benefit? 3)How do public and private exchanges differ? 4) How does a single-insurer private exchange work?

October 30, 2013 | White Papers
This summer with the October 1 launch of public health exchanges looming, Array Health surveyed health insurance executives to get their perspective on the changing marketplace. Read this report to discover their opinions on key questions surrounding exchanges including: 1) What percentage of insurers will participate in both private and public exchanges? 2) How aware are employers of the defined contribution funding model? 3) How many “young invincibles” will comply with the ACA individual coverage mandate?

October 17, 2013 | White Papers
For a company that provides medical, dental, and vision coverage to more than 25 million people nationwide and processes over 50 million claims every year ensuring call resolution is key to organizational performance. Thanks to healthcare reform and an anticipated increase in calls from both members and providers, this organization needed to streamline the cost of new customer service representatives. See how training helped streamline the onboarding process by 30% and save over $500,000 annually.

October 9, 2013 | On Demand Webinars
The healthcare sector is going through massive transformation. Payers have to invest in readiness around data delivery to federal and state or multiple health insurance exchanges before Jan 1, 2014 deadline. While the ICD-10 adoption deadline has been pushed back due to industry pressures on regulator - it is still a huge undertaking for any healthcare entity that touches diagnostic or procedural codes. These are just some of the projects that are converging on healthcare IT teams this year. For healthcare CIOs and IT teams and especially application development teams this project overload translates into a cascading capital and operational cost burden. Learn how Presbyterian reduced storage, operational costs and realized significant productivity benefits around critical business processes.

October 9, 2013 | White Papers
Healthcare reform is transforming the US medical insurance sector - creating a dynamic and competitive new market with compelling opportunities for growth. But do you have the necessary responsiveness to capitalize on these opportunities? Here are the five compelling ways technology investment delivers agility you need - and how.

July 1, 2013 | White Papers
The launch of new Health Insurance Marketplaces in all 50 states on October 1 accelerates an ongoing transition from the employer-driven payer model of U.S. healthcare toward a new era of consumerism. Health plans will be required to treat customers as individuals and use multiple channels to take their products to market. This paper will explore how Dell’s proven expertise in building and managing Health Insurances Exchanges can help you succeed in this new world.

April 4, 2013 | White Papers
Accountable care offers the nation’s ailing health care system new hope — but it isn’t a new idea. For the past decade, health systems, payers, and providers across the country have been practicing accountable care principles through initiatives such as the Collaborative Payer™ Model, a care delivery innovation jointly developed by a payer and provider that approximates an accountable care organization.


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