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Insurers Reveal 2012 Roadmaps

 |  By Margaret@example.com  
   March 07, 2012

The major national health plans are each gravitating toward many of the same projects according to information revealed by executives during fourth-quarter earnings calls.

Look for accountable care organizations to play a growing role as health plans try to rein in costs and direct quality and clinical goals. Buoyed by new federal initiatives, health plans also see opportunities in managing care for Medicare and Medicaid dual eligibles. And technology investments will set the stage for more individualized care programs.

Here are some of the highlights gleaned from the latest round of earnings calls:

Aetna
Look for more expansion in the health plan's accountable care solutions business, which has nine contracts, including Carilion Clinic (Roanoke, VA), Sharp Community Medical Group (San Diego), and Cleveland Clinic (Cleveland), and six letters of intent in place. The relationships range from a collaboration that involves only Medicare patients, to co-branded health plans and new payment models with shared savings for meeting quality and clinical targets.

Effective July 1, Aetna has been awarded the administrative services contract for Maine's 33,000 employees and their dependents. It plans to develop a statewide accountable care network to service this membership.

The insurer is also developing managed care programs for high-acuity aged, blind and disabled, long-term care and/or dual eligible beneficiaries in many states.

CIGNA
CIGNA acquired HealthSpring, a Medicare plan, in 2011 and is incorporating the HealthSpring model, including physician partnering, targeted data exchanges, integrated care coordination and aligned incentives to help patients be healthier and lower their overall healthcare costs.

The insurer sees the dual-eligibles market as an opportunity and expects to pursue that market on a targeted basis. HealthSpring will play a role in positioning CIGNA to deliver the clinical quality and cost outcomes for that population.

Plans may include bidding with existing Medicaid contractors on a partnership basis. CIGNA also plans to pursue business on its own. The insurer just signed a contract to provide services to about 30,000 dual eligibles in Rio Grande Valley of Texas.

CIGNA is expanding its participation in accountable care organizations. It has 17 of these initiatives underway in 15 states.

Humana
In 2011 Human created a partnership and completed an acquisition that positions the insurer to use technology to develop rewards and incentives to foster behavior changes in its members. HumanaVitality, a partnership with Discovery Holdings Ltd. in South Africa, is an actuary-driven wellness and loyalty program that can be customized to individual needs.

The acquisition of Anvita Health will enable Humana to analyze data to develop clinical programs that improve care and lower costs for the Medicare population.

Humana wants to develop more partnerships to reach new consumers and advance its brand. In 2011 it developed a partnership with Reader's Digest that has produced a co-branded Medicare supplement product, as well as a guide for seniors on Medicare decision-making.

Humana has focused on developing a nationwide footprint for its Medicare Advantage and, according to company officials, faces little competition in many of its markets. The Medicare Advantage market is large enough that increasing membership doesn't involve taking members from other plans.

In some areas such as South Florida, however, the market is very competitive business and company officials expect that the time will come when membership growth will rely on taking somebody else's customer.

Like CIGNA, Humana intends to be a major player in the dual-eligibles market. Its strategy is to take a state-by-state approach to opportunities. In 13 states Humana is looking at procurement opportunities that would be individual duals or duals in combination with long-term care.

Humana sees partnering opportunities—not mergers or acquisitions—in eight states and is in the process of working through the relationships and contractual obligations.

UnitedHealth Group
UnitedHealth experienced increased utilization in the second half of 2011, especially outpatient and physician office settings. The insurer expects that trend to continue through 2012.

Company officials say employers are focused on value-based benefit design for employees and UnitedHealth has seen growing interest in its narrow-network value-based offerings. Its consumer-based health plans have done well in that marketplace, with about 15% of its membership in value-based products

The company has several pilots in place around bundled payments in its commercial and Medicare business. The focus is on aligning the bundles with the right clinical programs and the right incentives. The company declined to talk specifics, but says that it is seeing some interesting results around oncology bundles.

UnitedHealth expects unit costs on the hospital side to be stable in terms of year-over-year percentage increases. The dual-eligibles market is seen as a major opportunity.

WellPoint
In 2011 WellPoint launched it a value-based contracting initiative that links hospital payment increases to customer value. It introduced a similar program for physicians in 2012.

It has several ACO pilot and medical home programs that involve more than 100,000 members and more than $240 million in shared savings. The medical home program in Colorado posted an 18% decrease in acute inpatient admissions over the first 2 years and a 15% reduction in emergency room visits. In the first year of its ACO partnership with the Dartmouth-Hitchcock Medical Center in New Hampshire, inpatient admissions and avoidable ER visits declined.

WellPoint operates 29 CareMore care centers and expects to open several more this year to serve the acutely ill population.

The insurer's 2012 plan includes about $700 million of business investments, including medical management programs, payment reform models, and the IBM Watson initiative. Implementing ICD-10 will cost almost $100 million by itself. By the end of the year, WellPoint expects to have 96% of its membership on the platforms that will be ICD-10-compliant.

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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