2.8 Trillion U.S. Healthcare Market Threatened By Disruptive New Entrants Like Those That Reshaped Retail, Banking and Travel, According To PwC’s Health Research Institute

NEW YORK, April 10, 2014 /PRNewswire/ — New entrants are poised to draw tens of billions of dollars in revenue from traditional healthcare’s $2.8 trillion revenue pie as these market disruptors rapidly develop

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 products and services like the innovations that transformed banking, entertainment and publishing, according to Healthcare’s New Entrants: Who will be the industry’s Amazon.com?, a new report released today by PwC’s Health Research Institute (HRI). HRI found that consumers are ready to embrace new options being developed by new entrants from the retail, technology and telecommunications sectors, from smartphone otoscopes to online evaluations of digital photos of rashes. Continue reading

CVS Looks to Carve Out More Healthcare Delivery Space

WOONSOCKET, R.I., Dec. 18, 2013 /PRNewswire/ — At its annual Analyst Day in New York City today, CVS Caremark (NYSE: CVS) outlined its strategies to drive long-term enterprise growth.

“CVS Caremark has an in-depth understanding of the changing health care landscape, including the challenges and opportunities that lie ahead,” said Larry J. Merlo, president and chief executive officer of CVS Caremark.  “These changes in the environment are creating opportunities for the company, and our unique combination of ability and agility positions us to capitalize on these opportunities – however they take shape.” Continue reading

PwC’s Health Research Institute Identifies the Top 10 Health Industry Issues for 2014

NEW YORK, /PRNewswire/ — Implementation of the Affordable Care Act (ACA) is only one of the factors forcing a rapid reshaping of the $2.8 trillion U.S. healthcare industry in 2014 according to PwC’s Health Research Institute (HRI). In its annual report on the Top Health Industry Issues for 2014, PwC’s HRI identifies the top 10 issues facing the U.S. health sector this year, including the need to adjust to empowered consumers, rapid innovation, and increasing competition from non-traditional players. The report includes the results of a survey of 1,000 U.S. consumers and interviews with health industry leaders that provide insights into the emerging new health economy.

The report notes that much of the health industry has accepted that reform is here to stay – and forward-looking executives are making decisions based on a post-ACA landscape that has altered the provision of insurance and the delivery of care. Continue reading

New Research Shows ACA Exchanges Will Compete with Private Insurers; None are Easy

CHANGE SCIENCES HEALTH INSURANCE INFOGRAPHICNEW YORK, /PRNewswire/ — Web researchers Change Sciences Group released new data this week comparing the insurance shopping experience on public health exchange web sites, including the new HealthCare.gov site, with the shopping experience on private health insurance sites. According to the research, the new HealthCare.gov site (released on November 30) offers an insurance shopping experience which is now on par with leading private insurer web sites such as Aetna, eHealth and Kaiser Permanente. Continue reading

BCBSM Give Michigan Consumers Option to Text to Determine ACA Subsidy Qualification Status

Blue Cross Blue Shield of Michigan says it is first health plan to give Michigan consumers the ability to determine eligibility for ACA subsidies through text messaging.

Under Blue Cross’ “Text for Subsidy” program, people can text “4Subsidy” to 222-752 to initiate a back and forth exchange, detailing their eligibility. Normal data plan charges will apply. The consumer will be asked to provide their zip code, age, income and number of dependents. Blue Cross will respond with whether or not they are eligible for a subsidy. – For more information see BCBSM.com.

 

 

Will ACOs Usher in a New Era of HMO-Style Managed Care?

Amber May has published an article on BenefitsPro.com that recalls a time in the 1990s when HMOs were the biggest thing in health care. She points out that the most obvious benefit of an HMO system is the coordination of care the organizations facilitate and how, since 1995, the National Health Insurance Law in Israel made participation in one of the four Israeli HMOs compulsory for all Israeli citizens.

May points out that once again the United States is experimenting with managed care. She notes that the Patient Protection and Affordable Care Act (PPACA) is attempting to address the lack of care coordination that’s developed in the American health care system by creating provisions for accountable care organizations (ACOS), coordinated groups of health care providers that provide care for specific populations of patients and are accountable for the quality, cost and outcomes of that care.

She notes that through PPACA, ACOs are tied to Medicare and speculates that a universal managed care system similar to Israel’s may be a long way off for the U.S. – To learn more see benefitspro.com.

Medical Home Common Theme in ACA State Grant Programs

We have been tracking some of the health plan innovations that are being funding as part of the Affordable Care Act. (ACA). Stateline, the daily news service of the Pew Charitable Trusts, has published an article that looks into the progress states are making in their efforts to grapple with the relatively high cost and low quality of U.S. health care.

Stateline notes that out of the $1.8 trillion the ACA is projected to cost over the next decade, $10 billion is dedicated to innovation programs. Susan Dentzer of the Robert Wood Johnson Foundation, a nonprofit group that promotes improvements in the U.S. health care system told Stateline, “The idea is to take governors up on their claim that states are the laboratories of democracy where meaningful innovations can occur.”

So far, Stateline reports, Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont have applied for funds under the under an ACA program called the State Innovation Models Initiative, and this year, they began testing new health care financing models. Another 19 states are in various stages of developing similar experiments. Continue reading

Blue Cross Blue Shield of Michigan and Munson Healthcare Embrace New Approach to Reimbursement

Nov. 12, 2013 – TRAVERSE CITY, Mich. — Munson Healthcare and Blue Cross Blue Shield of Michigan say they are launching a new value-based hospital reimbursement agreement in northern Michigan designed to improve patient care and medical outcomes while also enhancing efficiency and holding down the cost of care.

According to a press release posted on BCSCM.com, their agreement provides a fair base-rate increase in reimbursement from BCBSM to the hospital. In addition Blue Cross will reward the hospitals with a share of the savings achieved when hospitals and physicians coordinate the delivery of efficient and effective care, eliminate reuse and overuse of care, and prevent re-hospitalizations. Continue reading

CMS to Providers Looking to Support ACA Premiums: Not so Fast!

On November 4, 2013, the Department of Health & Human Services, Centers for Medicare & Medicaid Services issued a Q&A warning hospitals, other healthcare providers, and other commercial entities that it had “significant concerns” about those entities  supporting premium payments and cost-sharing obligations with respect to qualified health plans purchased by patients in the Marketplaces.

The guidance stated that HHS has significant concerns with this practice because it could skew the insurance risk pool and create an unlevel field in the Marketplaces. HHS said it discourages this practice and encourages issuers to reject such third party payments. The agency said it intends to monitor this practice and to take appropriate action, if necessary. – See the Q&A at cms.gov.

Most Health Insurers will Pursue Multi-Channel Strategy with Private Exchanges Within the Next Six Months: Survey

A post over on the Acclaris Blog this morning breaks down the results of a survey conducted late this summer by Array Health to find out what health industry leaders are predicting to be the future for private exchanges and defined contribution health plans.

The survey reports that almost 80% of respondents believe that within the next six months health insurers will participate in private exchanges and 70% believe that insurers will participate in both private and public exchange models.

See more at Acclaris.com/blog.