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Engaging Insurers and Emerging Opportunities Presented on September 2, 2014 to AC Removing Barriers workgroup 1
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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
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CompanyEnrollment UnitedHealth Group36,545,000 WellPoint, Inc.31,300,156 Aetna, Inc.18,218,766 Health Care Service Corporation13,080,245 Cigna Corporation12,751,150 Humana, Inc.8,965,900 Kaiser Permanente8,850,587 Health Net, Inc.5,436,000 Highmark, Inc.4,679,777 Coventry Health Care, Inc.3,800,050 Independence Blue Cross3,670,899 Blue Cross Blue Shield of Michigan3,433,233 CareFirst BlueCross BlueShield3,344,971 BlueCross BlueShield of Tennessee3,135,209 Blue Cross and Blue Shield of Alabama2,985,515 Blue Shield of California2,973,604 Blue Cross and Blue Shield of Florida, Inc.2,914,226 Medical Mutual of Ohio2,812,186 Blue Cross Blue Shield of Massachusetts2,727,400 Centene Corporation2,503,000 Blue Cross and Blue Shield of Minnesota2,405,479 Blue Cross and Blue Shield of North Carolina2,286,882 EmblemHealth, Inc.2,251,733 WellCare Group of Companies1,972,427 Regence Group, The1,867,685 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 Health Plan Membership
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Plan Structure Alignment Clinical organization Business Structure Provider Partners Market Penetration 4
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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-Service- Payment/sharedsavingsprogram/Downloads/2014-ACO-Contacts-Directory.pdfhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/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 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
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Questions 6
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