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Top 10 Health Plan Stories of 2011

Margaret Dick Tocknell, for HealthLeaders Media, December 19, 2011

2.Four Health Plans Agree to Share Information
In September Aetna, Humana, Kaiser Permanente, and UnitedHealth Group launched the Health Care Cost Institute and agreed to provide 10 years of information on more than five billion claims representing more than $1 trillion in healthcare spending to qualified researchers.

The treasure trove means that for the first time, researchers will have extensive access to private health insurance data, including utilization and patient outcomes, and its impact on healthcare delivery.

Previously, researchers have had to make do with Medicare data, which covers only 30% of the insured population and is limited to beneficiaries over age 65. Early research projects are focused on how economic conditions and population aging affect costs, and how policies like price disclosure requirements affect costs.

3.Aetna and Carillion Form an ACO
Back in March, before HHS first presented its proposed Medicare shared savings ACO rules, Aetna and Roanoke, VA-based Carilion Clinic announced their collaboration on a commercial ACO featuring co-branded commercial health insurance plans for individuals and businesses as well as new payment models with rewards for meeting quality targets and shared cost savings.

The announcement caused a stir because although healthcare stakeholders were talking behind closed doors and off the record about the possibility of commercial ACOs, few had taken the plunge. Now it seems almost every day there's another announcement about hospitals, health plans, or physicians creating an ACO and developing their own rules for meeting quality standards, cutting costs and earning bonus payments.

4. New Medical Loss Ratio Requirement Takes Effect
Beginning Jan 1, 2011 health plans are required to spend 80 cents to 85 cents of every premium dollar collected on member medical care. Health plans that don't meet the standard may have to rebate millions of dollars back to their members. Health plans are not amused.

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