How Vertical Integration Provides an Opportunity for Improved Member Engagement

Posted by Colin Russi on Thu, Jun 20, 2019

Vertical integration is a natural reaction from healthcare companies that face market uncertainty. A side effect of this integration is that these arrangements provide a unique opportunity to drastically improve the member experience. Historically, each link in the healthcare chain had built-in profit margins: The prescriber fee for service included a profit for the provider, the pharmacy captured its margin on any filled prescription, health plans attained their expected value in accordance with their medical loss ratio, etc. This easily managed system where each link generated a defined profit is changing due to market and public opinion, and regulatory forces. These forces, while numerous, originate from the reality that healthcare expenditure growth is unsustainable, growing from 12.5% of GDP to almost 17% of GDP in 15 years.


>
Read More

How AI Can Help Health Plans Become Member-Centric

Posted by Harbinder Raina on Wed, May 29, 2019

Improving the customer experience is no longer an idea that’s relegated to the retail or hospitality industries. Now, the idea has gained traction across many industries, including healthcare. For health plans, improving the customer experience and providing member-centric care helps drive member acquisition and retention and improve reimbursement (via a better STARS rating). 


>
Read More

How Health Plans Can Keep Members on Board in a Post-Safe Harbor World

Posted by Shreya Raghuraman on Wed, May 15, 2019

Peter Manoogian and Josh Lacey co-authored this blog post with Shreya Raghuraman.

The Department of Health and Human Services’ proposal to eliminate safe-harbor protection for drug discounts has prompted a fierce debate about how the healthcare value chain will weather a new world in which drug rebates are distributed at the point of sale. Now that the proposal’s comment period has closed, we’re left waiting with bated breath for the final ruling. As health plan leaders prepare for a potentially major transition, a key question arises: What should organizations do now to avoid unintended consequences to the member experience?


>
Read More

Three Key Takeaways From the RISE Nashville Conference

Posted by Josh Lacey on Wed, Apr 17, 2019

Florent Moise and Peter Manoogian co-wrote this blog post with Josh Lacey. 

The 2019 RISE Conference brought more than 1,000 leaders from health plans and provider organizations to Nashville to discuss a variety of topics impacting the delivery of healthcare today. Among these, risk adjustment was top of mind in many sessions, partly because it’s a relatively new endeavor and partly because it’s a key driver of plan revenue from CMS that requires focused inputs from providers. However, RISE wasn’t just a risk adjustment conference. Sessions also focused on member engagement, provider engagement and data integration. These three topics must be combined for successful risk adjustment, and they’re also critical for health plans in many other facets of how they operate:


>
Read More

How ACA Plans Can Stay Agile in a Tightening Market

Posted by Adam Chernew on Fri, Feb 22, 2019

Peter Manoogian and Josh Lacey co-wrote this blog post with Adam Chernew.

February marks the end of open enrollment on the federal and state health insurance exchanges created by the Affordable Care Act (ACA), and while a few state-based exchanges have yet to report their final numbers, it’s clear that 2019 enrollment (around 11.5 million people) on the ACA exchanges will fall just short of 2018 results (around 11.8 million people). Of course, this difference is minor compared to the difference between the Congressional Budget Office’s original 2019 enrollment projection (made in 2010) of 24 million.


>
Read More