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Top 3 Health Plan Game Changers of 2013

Margaret Dick Tocknell, for HealthLeaders Media, December 11, 2013

The landscape is changing rapidly for payers. To be successful, insurers must adapt to new reimbursement models and forge new partnerships with providers.

It is that time of the year when we like to take measure of where things stand.

For health plans this year has been something of a mixed bag. Many of them have posted big profits, but there's no disguising it—healthcare is in the midst of a major shift from an emphasis on volume to value and that is affecting the health insurance industry.

The new focus in healthcare is on care coordination and population health. To be successful insurers must adapt to new reimbursement models and forge new partnerships with providers. Opportunities abound, but competition is getting tighter.


See Also: 1 in 5 Health Systems to Become Payers by 2018


Here are three key ways the health plan game is changing:

1.New Competitors
Hospitals and health systems are beginning to launch their own health plans. Sure, they've tried this before and failed, but this time healthcare reform and the emphasis on the care continuum and population health have created a perfect storm of opportunity.

Tufts Medical Center in Boston, Catholic Health Partners in Cincinnati, North Shore-Long Island Jewish Health System in New York, and Piedmont Healthcare and WellStar Health System, two powerful Atlanta-based health systems, are among the hospitals and health systems preparing to or already competing with the likes of Aetna and WellPoint.

Their niches are local, small employer groups and their networks are narrow—typically their own hospitals and physicians, who can be easily managed to control costs and outcomes.

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