| With the health reform bill finally enacted, stakeholders on all sides of the health care industry are turning their attention to how the law will actually be implemented — and what impact the changes will have on them.
In Health Reform’s Impact on Commercial and Medicare Health Plans, insiders close to HHS and in leadership positions at health plans, provider organizations and PBMs spell out what form the rules might take — and who will be the winners and losers.
This report highlights administrative challenges posed by the reform law, and delves into the likely impact of the act on coverage, benefit designs, medical costs and pharmacy benefits. It also outlines how successful Medicare plans are preparing now for the plan payment provisions affecting service areas, provider contracting, care management strategies and Hierarchical Condition Category (HCC) coding that take effect in 2012.
2010 and 2011 deadlines are right around the corner, despite there being little concrete detail on how provisions such as medical loss ratio requirements, the essential benefits package or the exchange will work in practice. Health Reform’s Impact on Commercial and Medicare Health Plans addresses practical steps health insurers are taking to prepare for the radical changes ahead. Order your copy today!
Table of Contents
Reform Outlook
- Four Key Reform Provisions That Will Affect Insurers in 2010
- Blues Execs Interpret New Legislation, Ponder How to Reconcile With State Laws
- State AGs Turn to 10th Amendment In Challenging Health Reform Law
- HHS Creates Reform Office
Administrative Challenges
- Reform Law May Lead to Higher Enrollment, But Administrative Hurdles Will Boost Rates
- Not-for-Profit Health Plans Could Be Tapped to Run New Risk Pools
- Health Insurer CIOs Will Have to Split Resources Between ICD-10 and Reform
Coverage Issues
- Despite Financial Benefits, Employers Are Unlikely to Drop Coverage
- Majority of Employers Expect to Keep Benefits
- Federal Dependent Expansion May Be More Useful Than State Efforts
- Several States Have Expanded Coverage to Adult Dependents
- Health Insurers Agree to Early Dependent Eligibility Expansion
- Ounce of Prevention Will Boost Rates Now, May Cut Future Costs
Impact on Medical Costs
- Initial Benefit-Design Changes May Lift Medical Costs Slightly; Wild Cards Remain
- Will Insurance Exchanges, MLR Requirements Kill Individual Market?
- Blues Plans May Be Well-Positioned for MLR Floor Despite Short Time Frame
- MLR Provisions in Law Will Trigger Cost Reclassifications, Cuts; Regs Will Be Key
Impact on Pharmacy Benefits
- Reform Is Double-Edged Sword for Payers As More Patients Mean More Rx Controls
- New Law Creates, Funds CER Group, Accounts for Subpopulations
Impact on Medicare
- Reform Law’s Provisions on OEP and MLRs May Hurt MA Plans; SNPs Get Gains, Losses
- Health Reform Law Closes Medicare Part D Coverage Gap, But Effective Date May Change
- Tax on RDS Could Lead Employers to Move Retirees Into Part D
Impact on Medicaid
- New Medicaid Drug Rebate Provision Gives Health Plans Formulary, Utilization Control
- New Eligibility Rules Under Reform Prompt Insurers to Look to Medicaid for Growth
- Impact of Medicaid Expansion Opportunity for Plans
- Reform Law Includes Major Medicaid Integrity Provisions, Changes for Providers
- Medicaid and Medicare Program Integrity Provisions in the Health Reform Law
Issues Affecting Providers
- Reform Law Requires Overpayment Returns, Compliance Programs for All Providers
- Private, Public-Sector Programs Show What to Expect on ACO Rules
- For Some Hospitals, New Charity-Care Policies Already Took Effect
Written For
Managers at:
- Health plans
- Pharmaceutical companies
- Hospitals and health systems
- Other providers
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