Health Plans Building Networks and Offering New Products, According to New Report from HealthLeaders-InterStudy NASHVILLE, Tenn., Sept. 10
NASHVILLE, Tenn., Sept. 10 /PRNewswire/ -- HealthLeaders-InterStudy, a
leading provider of managed care market intelligence, reports that over the
next three years the TriState area (Conn., N.J., N.Y.) will become a
battleground for Medicare Advantage membership. Private fee-for-service plans
have been popular in this region, and now health plans must adjust their
contracting efforts following the Congressional action against no-network
private fee-for-service Medicare plans. According to the latest TriState
Health Plan Analysis, plans with large networks in place should easily be able
to shift existing private fee-for-service members to HMO or PPO plans, while
other companies must work harder to establish networks to prepare for the new
requirement.
In the six months between December 2007 and May 2008, membership in
private fee-for-service products in the TriState area increased by 47 percent
to nearly 59,000. The bulk of this enrollment, about 47,000 members, came from
New York.
The new requirement requires private fee-for-service operators to create
networks in counties where another network-based plan exists by 2011, and is
expected to drive the development and expansion of PPO network products.
Companies operating in multiple states with significant private fee-for-
service membership, such as Humana, anticipated the change and have been
building networks across the country. In Humana's case, filing is already
underway to offer local PPOs in some states. It is expected that Humana will
face significant competition in Upstate New York where there are regional
carriers with existing strong networks. Many regional carriers have launched
new PPO and HMO products to address the anticipated regulation.
"Private fee-for-service plans have been popular in the TriState,
particularly in Upstate New York where there are a number of Medicare
Advantage plans competing for enrollment," said Chris Lewis, analyst with
HealthLeaders-InterStudy and author of the report. "Some health plans
anticipating the end of private fee-for-service plans have been working to get
networks in place through HMO and PPO models. However, other private fee-for-
service operators with little or no managed care presence may decide it's not
worthwhile to spend additional resources to develop networks in areas where
they don't already have established relationships with providers."
About Health Plan Analysis
Health Plan Analysis identifies key health plan trends, allowing
healthcare businesses to create comprehensive strategic plans and sales
strategies at state and local levels. Updated quarterly, Health Plan Analysis
provides a detailed look at plan design and financials, as well as information
about mergers, legislation and other influencers driving healthcare in a
particular region.
About HealthLeaders-InterStudy
HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the
authoritative source for managed care data, analysis and news. For more
information, please visit www.HealthLeaders-InterStudy.com.
About Decision Resources, Inc.
Decision Resources, Inc. is a cohesive portfolio of companies that offers
best-in-class, high-value information and insights on important sectors of the
healthcare industry. Clients rely on this analysis and data to make informed
decisions. Please visit Decision Resources, Inc. at
www.DecisionResourcesInc.com.
All company, brand or product names contained in this document may be
trademarks or registered trademarks of their respective holders.
For more information, contact:
Lisa Osgood Elizabeth Marshall
HealthLeaders-InterStudy Decision Resources, Inc.
781-296-2606 781-296-2563
losgood@hl-isy.com emarshall@dresources.com
SOURCE HealthLeaders-InterStudy
