Twenty-Three New Insurance Carriers Hit The National Payer Scene In One Year, Changing The Managed Care Landscape Through Competition

BURLINGTON, Mass., Sept. 2, 2014 /PRNewswire/ -- Decision Resources Group finds that analysis on the Year One performance of Consumer Operated and Oriented Plans (CO-OPs) generates insights into related market access opportunities, which are key decision inputs for pharmaceutical account managers in planning season.  These new nonprofit insurers are competing alongside much bigger health plans—and they span the country, from Maine to Oregon. While it is true that CO-OPs had mixed results in 2014, there were some notable successes—like New York—that enrolled more members than their competitors.  Decision Resources Group's newest Executive Briefing describes the dynamics of CO-OPs going into 2015.

Key Facts:

• The Executive Briefing, entitled CO-OPs: Key Pieces of the Puzzle + the New Landscape They Create, leverages state-specific Exchange Profiles and interviews with CO-OP and pharmacy benefit executives.
  • More than 460,000 people in 23 states picked a CO-OP during open enrollment.
  • Two CO-OPs, Health Republic Insurance of New York and CoOportunity Health in Iowa and Nebraska, account for about 40 percent of those lives.
  • Network strategy in 2014 was a game-changer for some CO-OPs—and the narrow-versus-broad decision is not just regarding hospitals and physicians. 
  • Drug formularies for CO-OPs are all over the board, with the list of Pharmacy Benefit Managers (PBMs) used by the 23 CO-OPs looking similar to the broader universe of health plan/PBM partnerships.
  • More than one CO-OP executive cited the need to have 50,000 members to ensure survivability.
• Download the Executive Briefing here.

Quotes:

• Bill Melville, Senior Analyst for Decision Resources Group, said: "CO-OPs that priced competitively, had strong in-state relationships and built attractive provider networks tended to do well in 2014. In markets from South Carolina to New Mexico, CO-OPs have emerged as a player on and off the exchange. Maine Community Health Options drew 80 percent of exchange enrollees in its state, fending off Anthem Blue Cross and Blue Shield in Maine, the state's biggest insurer."
• Jane DuBose, Senior Director for Decision Resources Group, adds: "Account planning season for those in biopharma takes on particular difficulty in 2014. CO-OPs should not be ignored, but it will be important to understand just how they fit into the long-term puzzle of health benefits and the public exchanges. One of the big questions is how CO-OPs will manage drug and medical benefits for the newly insured."

About Health Plan Data & Analysis

NEW: The "Exchange Profile" report series, which includes state-specific enrollment projections, is now part of Health Plan Data & Analysis.

Health Plan Data & Analysis is the tool for understanding the competitive managed care organization landscape, providing state health plan information that drives meeting preparation, strategic planning, and sales strategy development. It provides event-driven insights into the latest state health plan trends that drive local-level sales and planning strategy development and includes updates on:

• Commercial Carriers
• Managed Medicare Markets
• Managed Medicaid Markets
• Pharmacy Benefits
• Patient Care Management
• Legislation
• Healthcare Reform
• Key Market Events

Find out more at http://www.hl-isy.com/HPDA.

About Global Consulting Services
DRG's Global Consulting Services partners with leading life science companies across the product lifecycle to evaluate and position products and achieve market access. Visit http://www.pharmastrat.com/services for more information.

About Decision Resources Group
Decision Resources Group offers best-in-class, high-value information and insights on critical issues within the healthcare industry. Clients rely on this analysis and data to make informed decisions. Find out more at www.DecisionResourcesGroup.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:

Chris Comfort
Decision Resources Group
781-993-2597
[email protected]

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SOURCE Decision Resources Group

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