Managed Care - January 2008 - (Page 27) The Managed Care Forecast Here are some of the challenges that health insurers face this year By Peter Kongstvedt, MD n the for-profit sector in particular, pressure to grow is intense, and many of the leading national payers reported less than forecasted enrollment. Pressures on growth exist in the notfor-profit sector as well, but the focus may be different. In some cases — a single-state Blue Cross & Blue Shield plan with a formidable existing market share, for example — growth may be less important than preventing erosion of that market position. Payers know that growth must be intelligent. Growth must be profitable and manageable. Payers continue to maintain pricing discipline, avoiding growth through subsidization that can negatively affect the bottom line. Offerings in Medicare Advantage (MA) and Medicare Part D are at the forefront of payers’ growth strategies. Given the wide variety of types of Medicare Advantage plans allowed under the Medicare Modernization Act, payers can expand this product in several directions. Medicaid, a market that has traditionally been served primarily by companies that specialize in that segment, has also become more attractive to commercial payers seeking growth. Medicare Part D substantially overhauled how payers serve the senior population through MA health plans. Payers have moved strongly into these markets, offering both new MA plans and free- I Peter Kongstvedt, MD, a member of MANAGED CARE’s Editorial Board, is senior executive at Accenture Health & Life Sciences Consulting and a nationally known expert on health insurance. Commercial plans face daunting challenges The total pool of commercial covered lives is decreasing and is likely to continue to do so. Employers with fewer than 200 employees that offer health benefits 80% 75% 70% 65% 60% 1.3 55% 50% 2001 Health savings High-deductible High-deductible account-qualified health plans/ health plans/ HDHP health savings health reimburseaccount ment account Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits Adding to revenue growth pressures is the increase of various forms of high-deductible health plans. Because of their associated lower total premiums, revenue can actually decrease even in the face of enrollment gains if growth has been primarily in high-deductible plans. Number of covered workers in highdeductible health plans with a savings option In millions 2006 2007 1.9 1.4 1.9 3.8 2.7 2002 2003 2004 2005 2006 2007 Source: National Survey of Employer-Sponsored Health Plans, Mercer JANUARY 2008 / MANAGED CARE 27
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