Health Insurance Exchange

April 18, 2014 | Anthony Brino

The Obama administration is boasting that 8 million Americans, including a good number of young people, have enrolled in public exchange plans. The big question now is how will new members fit into the risk adjustment puzzle?

April 17, 2014 | Array Health

How the small employer market has a lot to gain by from private exchanges.

April 15, 2014 | Anthony Brino

The Congressional Budget Office has revised its estimates of the Affordable Care Act's costs, with results favorable to the Treasury. However, it also now predicts more premium and network turmoil.

April 10, 2014 | Anthony Brino

Stuck with exchange software too flawed to fix, Maryland Health Connection leaders are choosing a novel solution that paves the way for other beleaguered state exchanges to seek help from their better performing peers.

April 9, 2014 | Anthony Brino

The market for commercial full-risk insurance is slowly declining amid the rise of self-insurance, but a few large nationals, the Blues and some integrated care plans are still seeing healthy business.

April 9, 2014 | Anthony Brino

New public insurance exchange enrollees are starting to use their prescription drug benefits, and so far their per-member costs are looking higher than in the average commercial plan.

April 4, 2014 | Mary Mosquera

Health plans must calculate what they will charge for 2015 exchange plan premiums despite the lack of detailed data from the just-ended enrollment window. Rate filing deadlines are fast approaching: May for some states and June for those using the HealthCare.gov marketplace.

April 3, 2014 | Anthony Brino

The Obama Administration may be cheering the landmark enrollment number of 7.1 million, but insurers selling public exchange plans and operating Medicaid organizations should be prepared for a fair amount of turnover.

March 28, 2014 | Karen Appold

As the Affordable Care Act continues to disrupt the health insurance industry, health plans must broaden their definition of risk as they calculate rates and attempt to better understand their members' needs.

March 27, 2014 | Anthony Brino

The many moving parts in the government's ACA plan transition policies are creating a range of new complexities for premium pricing, member pools and the new risk-sharing programs.

March 26, 2014 | Anthony Brino

The federal government is promising that anyone who wants to buy subsidized insurance will be able to as long as they try to enroll before March 31. But insurers should expect more surprises and lingering work from complex cases.

March 24, 2014 | Anthony Brino

Health insurers can expect an increasing number of consumer education challenges around prescription drug management, as utilization controls are more prevalent in public exchange plans than in typical group insurance.

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.

June 20, 2012 | White Papers
Insurers are efficiently and accurately paying millions of claims that they should never pay at all. In this white paper we define state-of-the-art prepayment analytic strategies and explain how they differ from both claims edit and postpayment detection systems.

June 20, 2012 | White Papers
In this case study, you’ll learn how Highmark dramatically reduced losses with a new analytic approach to preventing and detecting fraud, waste and abuse in submitted claims. Learn how this approach enabled Highmark to identify hundreds of new pursuable cases in the first year over and above cases identified through other methods.

January 9, 2012 | White Papers
As healthcare payers prepare for an undefined future, they can benefit by looking at their technology infrastructure and IT systems, and examining how well these systems can support change. Healthcare payers can leverage technology to provide the flexibility and agility they need to manage change, without even knowing what that change will be. In particular, a modern, rules-based billing system can help payers be ready to support new market segments, products, services and regulations as reform continues to evolve. Learn more about how to manage the uncertainty around reform, and how billing can help.

January 9, 2012 | White Papers
As legislators continue to wrangle and court challenges loom, the final shape of U.S. healthcare reform may not be known for months or even years to come. Many payers are asking: how do we prepare for change in such an uncertain environment? The answer is, “By being prepared for anything.” Adaptive, flexible systems can help healthcare payers to become more adaptive themselves, ready to change their business processes to comply with new regulations — and with new market opportunities — as they arise. Learn more about how to prepare for change in an uncertain future.

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