Engaging Insurers
and Emerging
Opportunities
Presented on September 2, 2014 to
AC Removing Barriers workgroup
1
Health Plan Landscape
• Background
• Geography
• National, Regional and local
• Customers
• Federal
• State
• Funding : Self Insured/Fully Insured
• Initiatives
• Models of care ACO’s PCMH’s
• Contracting
• Community Connections
2
Health Plan Membership
Company
Enrollment
UnitedHealth Group
WellPoint, Inc.
Aetna, Inc.
Health Care Service Corporation
Cigna Corporation
Humana, Inc.
Kaiser Permanente
Health Net, Inc.
Highmark, Inc.
Coventry Health Care, Inc.
Independence Blue Cross
Blue Cross Blue Shield of Michigan
CareFirst BlueCross BlueShield
BlueCross BlueShield of Tennessee
Blue Cross and Blue Shield of Alabama
Blue Shield of California
Blue Cross and Blue Shield of Florida, Inc.
Medical Mutual of Ohio
Blue Cross Blue Shield of Massachusetts
Centene Corporation
Blue Cross and Blue Shield of Minnesota
Blue Cross and Blue Shield of North Carolina
EmblemHealth, Inc.
WellCare Group of Companies
Regence Group, The
36,545,000
31,300,156
18,218,766
13,080,245
12,751,150
8,965,900
8,850,587
5,436,000
4,679,777
3,800,050
3,670,899
3,433,233
3,344,971
3,135,209
2,985,515
2,973,604
2,914,226
2,812,186
2,727,400
2,503,000
2,405,479
2,286,882
2,251,733
1,972,427
1,867,685
Top 25 U.S. Health Plans: Ranked by Total 2012 Medical Enrollment
Includes medical enrollment in all models of fully insured and self-insured health plans; does not include specialty benefit enrollment. Note: End of Year 2012 Data Source: AIS’s Directory
of Health plans 2013. Retrieved from http://www.mcol.com/top_plans
3
Plan Structure
• Alignment
• Clinical organization
• Business Structure
• Provider Partners
• Market Penetration
4
Partners to Consider
• Accountable Care Organizations
• eHealth Initiatives Directory of Accountable Care Organizations access from
http://www.ehidc.org/issues/accountable-care/aco-directory
• Medicare Shared Savings Program Accountable Care Organizations Start Date: January 1,
2014 access from http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/sharedsavingsprogram/Downloads/2014-ACO-Contacts-Directory.pdf
• Accountable Care Organizations (ACOs): General Information access from
http://innovation.cms.gov/initiatives/aco/
• Patient Centered Medical Homes
• Patient-Centered Medical Home Recognition access from National Committee for Quality
Assurance
http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.a
spx
• Other PCMH resources accessed from
http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/
DuringEarnItPCMH/OtherPCMHResources.aspx
• Employers in your geographic area
5
Questions
6