Business Strategy

Measurement tools used by state regulatory bodies evaluate MCO capitalization and investment

While numbers show less growth, the $2.2 trillion spent on healthcare is still exceptionally high

Big name insurers are getting smacked with fees and penalties for dropping the ball

ASCs are gaining in popularity due to their convenience, but acute-care hospitals are losing patients and profits.

Pharmacogenomics offer value measures to MCOs as specialty drug costs skyrocket.

As cancer emerges as world's top killer by 2010, MCOs will need to offer targeted education and outreach programs.

Critical information doesn't follow an elderly patient from one point of care to the next. CMS is looking at the issues via a pilot project will examine readmission rates of elderly patients to hospitals, especially within 30 days, from the same diagnosis.

As a compromise effort for individual insurance reform dies in Michigan, BCBSM is left with tough options.

A Mercer survey of benefits programs in 48 countries shows that there are global concerns about retirement and the cost of healthcare. The concept of retirement is changing so that more workers will be forced to postpone it and be covered longer by employer-sponsored plans.

PQC report shows that we cannot look at expanding access to care or decreasing costs in a vacuum?improving quality of care is key.

Health plans have been hit hard by major reductions in their investment incomes. Case-in-point: Los Angeles-based HealthNet, which announced changes in the responsibilities of senior executives after reporting lower-than-anticipated earnings for the third quarter.

BlueCross BlueShield Venture Partners makes its first investment in a identity and data management software vendor. The venture fund was created to finance technologies that will improve health informatics, health wellness and disease management means, back-office tools and transparency processes.

In the past year, more employers asked for benefit plans that cover medical care overseas in order to rein in costs.

Health coverage is typically gender-balanced, but in some states, women are paying higher premiums that simply cannot be justified actuarially, according women's groups and some Congressional leaders.

In the midst of current financial turmoil, the industry entrusted with the greatest accumulation of funds is the insurance industry. MCOs and HMOs should expect greater scrutiny of their finances.

Johnson & Johnson?s acquisition of HealthMedia Inc., a provider of Web-based behavioral interventions, speaks to the critical need for a dramatic shift in focus toward wellness and prevention.

Consumer-directed health plans (CDHPs) can achieve significant cost savings for employers because these plans encourage employees to take advantage of the preventive benefits offered through these plans, according to a WellPoint study.

Unfortunately, healthcare's complex business model, dynamic technology and regulatory changes, and potential for market disruptions render conventional strategic planning processes and financial decision-making tools less effective.

Insurers are not immune to the financial crisis, but because of a positive cash flow and liquidity, they are stillattractive to investors

As goes the national economy, so goes healthcare. Unemployment will cause a rise in uninsured and Medicaid enrollment with higher spending ahead.

In light of the recent NCQA report, plans should consider adopting emerging collaborative models

A survey by Aon Consulting indicates double-digit increases in claims costs for 2009 but employers can reduce costs with new strategies

If there was a way to accurately and consistently predict which patients were likely to use the emergency room in the upcoming year or incur a preventable chronic disease in the next 10 years, how would such a capability impact patient care?

More insurers are establishing operations in China, with Aetna being the latest to join the forces. Opening business in China involves substantial international expertise and patience with investments.

Many brochures and ads issued by health plans to promote Medicare drug benefits to seniors fail to meet standards. Centers for Medicare and Medicaid Services seeks to stem the criticism by tightening up the rules governing such marketing plans.

A national approach to healthcare requires equal access, medical homes and quality and performance regulation.

The weak economy has hit the pocketbooks of health plans as reflected in their top two challenges for 2009: competing in the marketplace (27.7%) and enduring national economic lows (20.8%).

Chronic conditions, medical advances and consumerism are among the factors contributing to premium trends in 2009, experts say.

Moving forward, the challenge for health plans and their clients will be to create value as opposed to simply shifting costs to enrollees. Creative solutions abound.

Among the top emerging issues in 2009 is increasing consumer engagement, which comes as no surprise considering their increasing amounts of skin in the game.