NASHVILLE, Tenn., Jan. 10 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, announced its list of the ten most important managed health trends to watch in the coming year.
1. The year 2006 will mark the biggest change -- and biggest free-for-all
-- to hit the Medicare program since its inception -- Between 11 and 20
organizations are offering Medicare Prescription Drug Plans (PDPs) in
each Medicare-defined region. Nine organizations are offering PDP
coverage nationwide. In addition to PDPs, seniors face a huge range of
coverage choices, from Medicare Advantage PPOs and HMOs to private fee-
for-service plans. The Centers for Medicare & Medicaid is heavily
promoting regional PPOs as a way to extend access to rural areas, but
local health plans are still drawing the most interest.
2. Health plan mergers and acquisitions will continue -- In 2005, the
largest plans, UnitedHealth Group and WellPoint Inc., increased market
share through purchases of other health plans. Expect to see further
activity in 2006: CIGNA and Aetna have spare cash, and Coventry Corp.
seems ready for another acquisition.
3. Consumer-directed plans generate more media coverage than healthcare
coverage -- A lot of health plans and financial institutions like the
new Health Savings Accounts (HSAs) and their associated high-deductible
health plans. However, traditional first-dollar-coverage health plans
have loosened their restrictions in recent years and remain the first
choice among consumers. Despite a lot of discussion, this is unlikely
to change in 2006.
4. The uninsured remain uninsured -- Employers and government tried a
variety of innovative ways of getting healthcare coverage to the
uninsured in 2005. Attempts included "three-share" style plans in which
government, employers, and employees each kicked in a third of premium,
and Maine's launch of its Dirigo Health, but both saw poor uptake.
Small-scale attempts to deal with a large-scale problem are no more
likely to succeed in 2006.
5. Medicaid moves back toward managed care -- Texas, Ohio, and Georgia all
extended their managed care Medicaid programs in 2005, moving large
numbers of beneficiaries out of fee-for-service. This won't sweep the
country in 2006, but expect to see several companies, including Aetna,
extending their management of Medicaid.
6. Health plans continue their progress on encouraging electronic medical
records (EMRs), and 2006 could be a break-out year -- Health plans love
EMRs, which make tracking and quality checking of healthcare easier and
cheaper, and want providers to love them too. So the upgrading of
systems will continue, with dramatic initiatives by Kaiser, Blue Cross
and Blue Shield of Massachusetts, and others.
7. HMOs decline -- HMOs have been losing market share. A few bastion
states, like Michigan and Massachusetts, will have high HMO
participation, but, as employers move more and more to self-insurance,
HMO market share nationally will continue its decline.
8. Disease management expands -- Health plans will rely on disease-
management programs to attempt to control costs, and are beginning to
see results. The newest programs are in managing complex chronic
conditions such as hemophilia, scleroderma, and multiple sclerosis.
Such conditions are relatively rare, but greater oversight of each
expensive case can show good financial return.
9. Individual insurance plans with basic benefits increase market share --
As the cost of health insurance rises for employers of all sizes,
insurance is becoming more of an individual game. Health plans are
tapping into this market with basic-benefits plans for recent college
graduates, early retirees, and people between jobs.
10. Pay-for-performance shows its hand -- Health plans have been pushing
pay-for-performance measures on physicians for several years. 2006
will be a critical year for measuring return on investment now that
some P4P programs have several years' worth of data to evaluate. Does
P4P improve physician performance or pay already high-performing
physicians more for work they would do anyway? Results in 2006 will
help answer these questions.
NASHVILLE, Tenn., Jan. 10 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, announced its list of the ten most important managed health trends to watch in the coming year. 
