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Payer Account and Contact Intelligence

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Latest Health Plan News:

Datapoint: InnovaCare Launches Smartphone for Dual-Eligible Members

July 14th, 2020

InnovaCare Health last week said it has introduced a new benefit that covers the monthly cost of a smartphone to its members that are eligible for both Medicare and Medicaid (or dual eligibles). The insurer says this move will ease access to telehealth benefits and improve care coordination for its most vulnerable members amid the COVID-19 pandemic. InnovaCare’s managed care subsidiary MMM Healthcare is currently the fifth-largest provider of dual eligible products in the U.S., with 127,881 members. The bulk of its members are located in Puerto Rico, with about 1,500 others living in Florida.

Datapoint: North Carolina Medicaid Transformation Set for Next Year

July 13th, 2020

North Carolina Governor Roy Cooper (D) on July 2 signed a bill that will allow the state’s long-awaited Medicaid transformation to begin no later than July 2021. The bill mandates that the state must finally begin transitioning its Medicaid beneficiaries from the fee-for-service system to managed care plans, a move that was originally set to begin in November 2019, then delayed to February 2020, then stalled again after Republican legislators staged a budget standoff. North Carolina serves 2,286,807 Medicaid beneficiaries as of June 2020.

Datapoint: Molina Completes YourCare Health Plan Deal

July 8th, 2020

Molina Healthcare last week completed its $40 million acquisition of certain assets of YourCare Health Plan, most notably its New York Medicaid plan, which currently serves 40,715 members. The deal brings a 59.7% enrollment boost to Molina’s New York Medicaid products. YourCare’s parent company, Monroe Plan for Medical Care, will shift its focus to providing integrated care for its members and providers, as well as administrative services.

Datapoint: Bright Health Plots 2021 Expansion

July 7th, 2020

Startup insurer Bright Health last week unveiled its 2021 market expansion plans. For the first time, the insurer will offer products to employer groups, including fully insured small group plans in Denver, Nashville, Memphis and Nebraska. In addition, the insurer will bring its individual and family plans to new markets in Florida and North Carolina, and expand to the Chicago area in Illinois. On the Medicare Advantage side, Bright Health will expand its Florida offerings to Fort Lauderdale. Bright Health currently enrolls 158,698 people in its individual commercial products, and 5,118 Medicare Advantage members.

Datapoint: Centene to Acquire Shuttered Illinois Medicaid Plan’s Membership

July 6th, 2020

Centene Corp. last week said that its Illinois Medicaid subsidiary, Meridian Health Plan of Illinois, Inc., will absorb about 56,000 members from the recently shuttered NextLevel Health Partners. The Chicago-based Medicaid plan closed its doors after a planned acquisition by Molina Healthcare fell through in April. Centene’s two Illinois subsidiaries, Meridian and IlliniCare, currently serve 344,365 Medicaid members in the state.

Datapoint: Oklahoma Voters Approve Medicaid Expansion

July 2nd, 2020

Voters in Oklahoma on Tuesday passed a ballot measure to bring Medicaid expansion to the state by July 2021. It was a slim victory, with 50.5% of voters approving the initiative, according to state election data. Oklahoma currently serves 765,411 Medicaid beneficiaries, the majority of whom are children.

Datapoint: Blue Cross NC Will Pay Docs to Switch to Value-Based Care

July 1st, 2020

Blue Cross and Blue Shield of North Carolina last week launched its Accelerate to Value program, an initiative that will incentivize independent primary care groups in North Carolina to transition to value-based care. Beginning in September, participating practices will receive direct payments from the insurer based on 2019 revenue, which will continue into 2021. By the end of 2020, the providers must join one of Blue Cross NC’s existing accountable care organizations or work with Aledade to transition independently. Blue Cross NC is currently the largest insurer in North Carolina, serving 2,593,316 members.

Datapoint: Cigna and Oscar Reveal First Cobranded Small Group Markets

June 30th, 2020

Cigna Corp. and Oscar Health last week revealed the first markets for their new cobranded fully insured commercial products for the small group market. The new plans, set to launch in the fourth quarter of 2020, will be available in the San Francisco Bay Area, Atlanta and four cities in Tennessee; Chattanooga, Knoxville, Memphis and Nashville. The products will integrate primary medical, behavioral health and pharmacy benefits, as well as a 24/7 telemedicine service, according to both companies. About 12 million people are currently enrolled in small group plans, with Cigna and Oscar both holding relatively small shares of the market, at 43,795 and 18,818 lives, respectively.

Datapoint: Aetna Inks Deal to Expand Illinois Provider Network

June 29th, 2020

CVS Health’s Aetna on June 19 inked a deal with DuPage Medical Group, a physician group serving more than 100 locations in the greater Chicago area, to expand its provider network for select Medicare Advantage members. Aetna currently serves 113,089 Medicare Advantage members in Illinois, but the deal only applies to about 50,000.

Datapoint: Cigna Expands Michigan Network With Priority Health Deal

June 24th, 2020

Cigna Corp. and Priority Health on Monday said they have formed a strategic alliance to offer a more comprehensive provider network to Michigan employer groups. Beginning January 1, 2021, Cigna’s employer groups will have access to Priority Health’s provider network, and Priority Health’s members will be able to use Cigna’s network when travelling outside of the Priority Health service area. Priority Health is currently the second-largest insurer in Michigan, with 842,565 members. Just over 40% of its members are enrolled in a group risk plan. Cigna currently serves 120,639 members in Michigan, with 6,456 enrolled in a group risk plan.

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Use Cases:

MMIT REACH                                                                                                         

How can I define, segment and engage with payer decision-makers with targeted messaging?
> How can I segment my buyer universe by their job function?

> How can I track people when they are promoted or move companies?

> Most of the lists I buy have junk email addresses or general inboxes that never get to the right people. How do I validate the information we have is legitimate?

How can I reduce the amount of time my sales & marketing team researches contacts online?
> My team is spending an exorbitant amount of time researching people on LinkedIn. How can I beef up my contact universe available in my CRM?

> Can I automate a monthly process to refresh my business contacts to keep my teams selling efficiently?

How can I make sense of health system decision-making to prioritize specific individuals?
> How can I segment my buyer universe by their job function?

> How can I track people when they are promoted or move companies?

> Most of the lists I buy have junk email addresses or general inboxes that never get to the right people. How do I validate the information we have is legitimate?

DIRECTORY OF HEALTH PLANS                                                                     

How can I segment payers by market share and geography for my marketing & sales strategy?
> How many members are enrolled in Medicaid plans in the Northeast of U.S.?

> What is the enrollment breakdown across commercial, Medicare, Medicaid and HIX for the State of Texas?

> Nationally, what percent of lives are enrolled in an ACO plan?

> What percent of members are enrolled in national plans vs regional plans?

> How many people in the U.S. are enrolled in a Blue Cross Blue Shield sponsored plan? How does that breakdown look across states?
How can I get a view into parent/child relationships and affiliations by payer?
> I need to understand the level of influence a PBM has in working with a payer?

> How many payers contract for pharmacy services with CVS? ESI? Optum Rx?

> When do payers merge their plan offerings in times of M&A?

> What is the hierarchy of plans in my state?

> What is the corporate affiliation of small regional plans in the South?
How can I build and feed a competitive intelligence strategy around other payers?
> My business operates in three states, I need to understand the market share breakdown of each insurer for my services areas?

> Which PBMs are being utilized by each health plan? How will I know when those relationships change?

> I am interested in top plans in the country and understanding a view of the breakdown of their business to better understand their focus areas?

PAYER LANDSCAPE                                                                                             

How can I get hyper-targeted in my analysis of payer enrollment by geography?
> How many members are enrolled in Medicaid plans in the Northeast of U.S.? How about specifically in Philadelphia vs Boston?

> What is the enrollment breakdown across Commercial, Medicare, Medicaid and HIX for the State of Texas? Can I get an enrollment breakdown for all zip codes within Texas by channel?

> Nationally, what percent of lives are enrolled in a HMO vs PPO? How about Medicare Advantage vs Part D Prescription Drug Plan?

> What percent of members are enrolled in national plans vs regional plans? How about major metropolitan areas?

> How many people in the U.S. are in enrolled in an employer-sponsored plan? How does that breakdown look across states and regions?

Where can I go to understand the specific relationships between MCOs, PBMs and employers?
> I need to understand who is the ultimate decision maker when it comes to formulary decisions?

> How many payers contract for pharmacy services with CVS? ESI? Optum Rx? Which employers use which PBMs?

> When do payers merge their plan offerings in times of M&A?

> What is the hierarchy of plans managed nationally, by managed care organization in a particular state?

> What is the corporate affiliation of small regional plans in the South?

> How much influence does a PBM have over a particular health plan?
How can I map out key payer attributes to support targeted segmentation?
> How many members are enrolled in Medicaid plans in the Northeast of U.S.?

> What is the enrollment breakdown across Commercial, Medicare, Medicaid and HIX for the State of Texas?

> How many people in the Midwest are enrolled in a Blue Cross Blue Shield sponsored plan? How does that breakdown look across states?