Engaging Insurers and Emerging OpportunitiesPresented on September 2, 2014 toAC Removing Barriers workgroup

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Health Plan Landscape• Background • Geography

• National, Regional and local • Customers

• Federal• State• Funding : Self Insured/Fully Insured

• Initiatives • Models of care ACO’s PCMH’s• Contracting

• Community Connections

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Company Enrollment

UnitedHealth Group 36,545,000WellPoint, Inc. 31,300,156Aetna, Inc. 18,218,766Health Care Service Corporation 13,080,245Cigna Corporation 12,751,150Humana, Inc. 8,965,900Kaiser Permanente 8,850,587Health Net, Inc. 5,436,000Highmark, Inc. 4,679,777Coventry Health Care, Inc. 3,800,050Independence Blue Cross 3,670,899Blue Cross Blue Shield of Michigan 3,433,233CareFirst BlueCross BlueShield 3,344,971BlueCross BlueShield of Tennessee 3,135,209Blue Cross and Blue Shield of Alabama 2,985,515Blue Shield of California 2,973,604Blue Cross and Blue Shield of Florida, Inc. 2,914,226Medical Mutual of Ohio 2,812,186Blue Cross Blue Shield of Massachusetts 2,727,400Centene Corporation 2,503,000Blue Cross and Blue Shield of Minnesota 2,405,479Blue Cross and Blue Shield of North Carolina 2,286,882EmblemHealth, Inc. 2,251,733WellCare Group of Companies 1,972,427Regence Group, The 1,867,685

Top 25 U.S. Health Plans: Ranked by Total 2012 Medical EnrollmentIncludes medical enrollment in all models of fully insured and self-insured health plans; does not include specialty benefit enrollment. Note: End of Year 2012 Data Source: AIS’s Directory of Health plans 2013. Retrieved from http://www.mcol.com/top_plans

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Health Plan Membership

Plan Structure

• Alignment • Clinical organization• Business Structure • Provider Partners • Market Penetration

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Partners to Consider • Accountable Care Organizations

• eHealth Initiatives Directory of Accountable Care Organizations access from http://www.ehidc.org/issues/accountable-care/aco-directory

• Medicare Shared Savings Program Accountable Care Organizations Start Date: January 1, 2014 access from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2014-ACO-Contacts-Directory.pdf

• Accountable Care Organizations (ACOs): General Information access from http://innovation.cms.gov/initiatives/aco/

• Patient Centered Medical Homes • Patient-Centered Medical Home Recognition access from National Committee for Quality

Assurance http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspx

• Other PCMH resources accessed from http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/DuringEarnItPCMH/OtherPCMHResources.aspx

• Employers in your geographic area

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Questions

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