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Publication Details
- Pub Code: GHPF16-11WEB
- Pages: 499
- ISBN: 978-1-936230-14-3
- Copyright 2011
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Health Plan Facts, Trends and Data: 2011-2012
A best-selling annual book packed with insights into important trends that are re-shaping the health care industry. This one-of-a-kind resource contains reliable data, directories and other valuable resources you can put to work today. Written and organized by AIS's experienced health reporting staff.
Get the perspective you need to make sense of the state of the health plan industry with Health Plan Facts, Trends and Data
Health Plan Facts, Trends and Data is a one-of-a-kind resource packed with insights into important trends that are re-shaping the health care industry. It contains reliable data, directories and other valuable resources you can put to work today.
Functioning like a “state of the industry” report, this resource includes in-depth coverage of: insurance exchanges, Medical Loss Ratio (MLR) regulations, accountable care organizations (ACOs) and the use of social media tools.
In 18 chapters, organized so that the exact information you want is easy to find, Health Plan Facts, Trends & Data includes in-depth information about:
- Financial Performance — with annual results from 2009, 2010 and 2011 to date; plus 2011 projections; stock market projections and analysts’ insight; key financial data, and more
- Strategies and Markets — looking at product launches and coverage expansions, individual (non-group) markets, Blue Cross Blue Shield market share, employer strategies, retail sales outlets, and broker relationships
- Current Issues — including rate-setting practices, provider contracting, records security and data protection, grandfathering, and disease management and wellness initiatives
- Business Developments — with data on company news and events — including mergers and acquisitions, enrollment trends and market share, legal issues, and executive compensation
- Pharmacy Strategies — details about benefit design, genetic testing, e-prescribing, medication therapy management (MTM), and incorporating OTC medications
Order your copy of Health Plan Facts, Trends and Data: 2011-2012 now!
Also Available on CD: For an additional $150, you can order the convenient CD version of Health Plan Facts, Trends and Data. The CD contains all of the information in the print version and you’ll find what you need instantly with the user-friendly, searchable PDF format. Plus, all CD purchasers receive a free copy of the print version!
Table of Contents
Chapter 1: Health Plan Enrollment Trends and Market Share
- Health Plan Enrollment Trends and Data
- Health Plan Enrollment Data
- Employer-Sponsored Enrollment Data
- FEHBP, TriCare and Other Federal Programs
Chapter 2: Health Plan Organizational Structure and Leadership
- Executive and Board Member Compensation Trends
- Work Force Issues
- Lobbying and Donations
- Leadership Changes and Appointments
Chapter 3: Health Plan Growth and Consolidation
- Mergers, Acquisitions and Divestitures
- Market Moves, Expansions and Contract Awards
- Product Launches and Coverage Expansions
- The Individual Market
- Retail Insurance Outlets
Chapter 4: Blue Cross Blue Shield Plan Trends and Data
- Enrollment and Market Share for BCBS Plans
- Factors Affecting Market Share and Competition
- Blue Cross Blue Shield Conversions and Nonprofit Issues
- Most-Favored Nation Clauses
- Directory of Blue Cross and Blue Shield Organizations
Chapter 5: Health Plan Financial Results
- Costs and Profitability
- 2009 Annual Results
- 2010 Annual Results
- First Quarter 2011 Results
- Annual 2011 Projections
- Stock Market Performance
- Key Financial Data
Chapter 6: Medical Loss Ratios
- Regulations
- Compliance and Calculation Strategies
- Impact on Sales and Marketing
- Impact on Individual and Small-Group Markets
- State Waivers
Chapter 7: Rate Setting and Premiums
- Causes of Rate Increases
- Increases, Decreases, Denials and Delays
- Oversight and Regulation of Rate Increases
Chapter 8: Insurance Exchanges
- Effect of Exchanges on Health Plans and Other Stakeholders
- Benefit Design and Product Offerings
- Adverse Selection
- State Legislation and Activities
- HHS Initiatives
Chapter 9: Benefit Design
- Design Strategies
- HSAs, Debit Cards and Other Financial Products
- ‘Mini-Med’ Plans
- Child-Only Coverage
Chapter 10: Employer Strategies and Challenges
- Benefit Design Strategies
- Controlling Coverage Costs
- Grandfather Status
- Taxation Issues
- Comparative Effectiveness Research
Chapter 11: Pharmacy Strategies for Health Plans and Employers
- Pharmacy Benefit Design
- Market Moves
- Genetic Testing
- e-Prescribing
- Medication Therapy Management (MTM)
- Over-the-Counter Medications
- Off-Label Usage
Chapter 12: Provider Network Administration, Reimbursement and Contracting Issues
- Network Administration and Reimbursement
- Quality Initiatives
- Never-Events and Other Medical Errors
Chapter 13: Accountable Care Organizations
- ACO Components
- ACO Pilots, Programs and Product Development
- Implications for Providers
- Regulations and Legal Concerns
Chapter 14: Health Promotion, Wellness and Disease Management Strategies and Challenges
- Health Management and Utilization
- Strategies for Specific Health Conditions
- Wellness Programs and Initiatives
- Medical Home Models
Chapter 15: Social Media Tools and Other IT Communications Strategies
- Social Media Tools
- Online Tools for Consumers
- Applications and Services for Mobile Communications
- Telemedicine
Chapter 16: Records Security, Coding and Data Protection Issues
- Data Management Strategies
- Data Security Challenges
- Disaster Recovery
- Coding
- Personal Health Records
Chapter 17: Health Plan Legal Challenges
- False Claims and Fraud and Abuse Issues
- Health Plan Liability and Legal Actions
- Consumer-Related Violations and Communications Issues
- Explanation of Benefit (EOB) Forms
- Health Plans’ Quality Assessments
- HIPAA Regulations
- Mental Health Parity Regulations
- State-Level Legislation
Chapter 18: Health Plan Resources and Directories
- Directory of Federal and Regional Medicare Directors
- Directory of Health Plan Associations
- Directory of Health Plan Trade Associations
- Directory of Health Plan Accrediting Bodies
- Directory of State Insurance Commissioners
- Directory of State Medicaid Directors
- Directory of State Medicaid Pharmacy Directors
- State Health Officials
Written By
Health Plan Facts, Trends and Data was written and edited by the editorial staff of Atlantic Information Services.
Written For
- Managers of HMOs, PPOs, POS plans and PSOs
- Hospital managers and health system executives
- Group practice managers
- Managers of IDSs
- Insurance executives
- Employee benefits managers
- Consultants and attorneys
AIS Guarantee
Order Health Plan Facts, Trends and Data for a 30-day risk-free inspection and test for yourself the value of this highly practical resource. If within 30 days you're not interested in keeping it, just return it to AIS and we will send you a prompt, full refund or credit. For CD purchasers, refunds will not be made once the seal on the CD package has been broken. Please review your copy of the print version prior to breaking the seal.
Shipping Information
This item is shipped via UPS. Please give us your street address when you order (UPS does not deliver to PO boxes.) You should receive your order within 5-7 business days. Shipping and handling cost is $12 per item.
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Health Plan Facts, Trends and Data: 2011-2012
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