This document summarizes key aspects of the Affordable Care Act and its implications for the pharmaceutical industry. It discusses how the ACA expands health insurance coverage but does not create a public option or directly set prices. It also explores the ACA's goals of expanding coverage, improving quality, and reducing costs. The document notes the ACA leads to evolution in the healthcare marketplace by bringing in new insured consumers and focusing on quality, outcomes, and cost. It identifies several drivers that will impact the pharmaceutical industry, including enrollment in new plans, potential erosion of commercial benefits, and growth of delivery and payment reforms.
Pediatric Dental Benefits Under the ACA - What Employers (and dentists) Need ...Spring Consulting Group
With the ACA requiring health plans to cover pediatric dental plans, a number of questions have arisen from both employers and dentists. Here are a few of the basics that both groups need to know. Please note, that this information is specific to the State of Massachusetts, and some details may change from state to state.
Across the United States, a legislative movement to mandate paid sick leave time for all employees has picked up significant momentum over the past couple of years. With a number of states, municipalities and even the President advocating for these new mandates, it is important that employers know how these changes impact them.
At a recent Disability Management Employer Coalition event, Spring partner Teri Weber gave the presentation below on paid sick leave laws with fellow industry experts Geoffrey Simpson from Presagia and Mike Soltis from jackson lewis.
We hope you find this deck helpful and please don’t hesitate to reach out to Teri using the form below with any questions about paid sick leave laws or anything related to leave management.
This session focuses on Ed Health, a medical stop loss group captive consisting of 11 Boston-area colleges that Spring assisted in the development of. It details Ed Health’s success to date and lessons learned through the development and ongoing management of a medical stop loss group captive.
Dr. Pam Silberman, President and CEO of the N.C. Institute of Medicine, provides an overview of the Affordable Care Act in North Carolina as part of a NCACC Annual Conference workshop on Aug. 24, 2013.
This gives a good base knowledge of where the current insurance industry is, a timeline of when certain mandates go into effect and a simplified description of the mandats being launched on Sept 23, 2010.
Pediatric Dental Benefits Under the ACA - What Employers (and dentists) Need ...Spring Consulting Group
With the ACA requiring health plans to cover pediatric dental plans, a number of questions have arisen from both employers and dentists. Here are a few of the basics that both groups need to know. Please note, that this information is specific to the State of Massachusetts, and some details may change from state to state.
Across the United States, a legislative movement to mandate paid sick leave time for all employees has picked up significant momentum over the past couple of years. With a number of states, municipalities and even the President advocating for these new mandates, it is important that employers know how these changes impact them.
At a recent Disability Management Employer Coalition event, Spring partner Teri Weber gave the presentation below on paid sick leave laws with fellow industry experts Geoffrey Simpson from Presagia and Mike Soltis from jackson lewis.
We hope you find this deck helpful and please don’t hesitate to reach out to Teri using the form below with any questions about paid sick leave laws or anything related to leave management.
This session focuses on Ed Health, a medical stop loss group captive consisting of 11 Boston-area colleges that Spring assisted in the development of. It details Ed Health’s success to date and lessons learned through the development and ongoing management of a medical stop loss group captive.
Dr. Pam Silberman, President and CEO of the N.C. Institute of Medicine, provides an overview of the Affordable Care Act in North Carolina as part of a NCACC Annual Conference workshop on Aug. 24, 2013.
This gives a good base knowledge of where the current insurance industry is, a timeline of when certain mandates go into effect and a simplified description of the mandats being launched on Sept 23, 2010.
A renowned expert on health care and health care law, Linda Rouse O’Neill, Vice President of Government Affairs at HIDA shared this presentation at AORN's 60th Annual Congress in early March 2013. These slides provide an overview of the current (and future) state of health care in the U.S. including the sequestration, the Affordable Health Care Act, and other pressing issues that affect the health care industry.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
Carrie Banahan, Kentucky Health Benefit Exchange, presented on KYNECT: Kentucky's Healthcare Connection at the State Legislative Conference on November 6, 2015.
Three Cost-Saving Strategies to Reduce Healthcare SpendingHealth Catalyst
Health systems continue to face fiscal challenges and burdens due to changing reimbursement rates, COVID-19, and managing the aftermath of care disruptions from the pandemic. Operating on thin margins with limited resources means health systems need to adopt alternative cost-saving measures to maximize limited resources.
Comprehensive, reliable data increases visibility into expenses across the care continuum so that leaders can leverage new methods to save money, generate income, and accelerate cashflow to keep patients healthy and hospital doors open. With access to recent data, health systems can focus on three cost-saving strategies:
Increase physician engagement.
Predict propensity to pay.
Implement evidence-based standards of care.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
Presentation: The Business of Blogging (for Lawyers)
Presented by: Gene Quinn, Patent Attorney and Founder, IPWatchdog.com
One of the primary reasons for undertaking a blog is to engage in business development of one kind or another. People who will find you online are searching for answers. If you want to capitalize on this opportunity it will be necessary to provide intelligent, insightful information that the reader did not possess prior to visiting your website. Over time your job will be to provide lots of that information that ties together little by little to demonstrate that you have a deep level of understanding. The lesson is simple: It is far better for a prospective client or customer to come to the understanding that you know what you are talking about for themselves than it is for you to tell them you know what you are talking about directly. It should go without saying, that the plan requires that you are read by others, which means you absolutely, positively cannot write like a lawyer!
Presentation: Content is Still King: A look at best practices for creating and distributing quality Content
Presented by: Scott Mozarsky, President - Cross Platform Businesses , Bloomberg BNA
This session will focus on best practices for creating Content that will enable marketers to achieve strong ROI in their Content Marketing efforts. The session will also focus on the elements of a multi-faceted engagement and distribution strategy that will ensure that if you build it, they will come.
Presentation: Use Storytelling to Define Your Brand and Connect on Social Media
Presented by: Tammy Mangan, Director of Marketing, Sterne Kessler Goldstein & Fox
Storytelling is not just for campfires. Good stories compel action, change, even forge relationships. This presentation will cover the fundamentals of storytelling and the use of stories to create a connection with your brand and services and grow business.
Presentation: Combining Eyes and Ears: The Visual Search for Social
Presented by: Aaron Hayes-Roth, VP of Strategic Alliances, Brandwatch & Mary Tarczynski, CMO, Ditto Labs
Photo sharing on social media only continues to grow as people capture and share their passions on a daily basis. This often includes brands - but when 85% of images don’t reference the brand name in the text, how can brands and agencies accurately measure and engage with their audiences? This session will cover some of the most common use cases for social and visual measurement and explore the insights and benefits brands and agencies can gain from using social listening and analytics across visual platforms.
Presentation: Digital Marketing Strategies to Drive Enrollment
Presented By: Jon Fox, President,Flightpath &
Jon Wexler, Vice President of Enrollment Management, Fairleigh Dickinson University
Jon Fox founded the agency that would become Flightpath in his Greenwich Village apartment in 1994. A veteran of twenty years of digital marketing, he is a recognized leader in helping organizations of all sizes maximize their investments across the web and broader channels. Jon is an exceptional business analyst focused on achieving measurable results for his clients. In his role as president, Jon drives the overall direction of Flightpath, oversees/guides digital strategy for a number of key accounts and works hard to develop and mentor his talented staff. Jon recently completed his 11th NYC Marathon. He lives in Brooklyn with his wife, kids and dog.
As the vice president of enrollment management for Fairleigh Dickinson University, Jonathan Wexler is regularly traveling across the country and around the world representing FDU! Over the past four years, Wexler has worked to increase applications for freshman and transfer admissions by more than 65 percent — while collaborating on new education initiatives — including Silberman College of Business’s Saturday MBA Program and the University-wide Combined Degree Advantage Program. Wexler received his bachelor’s degree at Goucher College in Baltimore, Md. before completing a master’s in higher education administration at University of South Carolina. He joined FDU in 2008.
Presentation: People are (S)Talking: How to Get Users to Participate, Not Just Spectate
Presented by: Donna Talarico-Beerman, Director of Integrated Communications, Elizabethtown College
Donna Talarico-Beerman has been helping tell the Elizabethtown College story since 2010. Her past experiences in radio, newspapers, eCommerce and education thrive together in happy harmony at E-town, where she is director, integrated communications. She manages the College’s official social media channels and is editor of Elizabethtown magazine and the online newsroom E-town NOW. She also collaborates with the rest of the award-winning marketing and communications team on marketing planning, media relations, copywriting and multimedia story-telling for a variety of projects.
http://www.bdionline.com/
Presentation: The Power of Social Listening
Presented by: Andrew Ruder,Senior Consultant & Social Business Intelligence, Brandwatch
Andrew Ruder is a senior consultant in social business intelligence for Brandwatch, one of the world’s leading social media monitoring providers, where he helps enterprise organizations develop strategies for solving business challenges using social media intelligence and analytics. A SaaS veteran, Andrew’s prior experience includes roles at companies including Cision/Radian6 and Sysomos, where he assisted both brands and agencies in implementing social media intelligence solutions. Andrew earned a bachelor’s degree in business administration from Marquette University and is a proud native of Chicago, where he lives with his wife and son.
http://www.bdionline.com/
Presentation: How Investors Will Communicate as the Internet Swallows Everything
Presented by: Leigh Drogen, Founder and CEO, Estimize
Collaboration between investors via the internet is changing the way investment decisions are made and critical research and data are sourced. In his talk, Leigh will provide an overview of how information flow between and amongst investors, companies, and the sell side is rapidly changing, the new platforms and philosophies which are facilitating this shift, and what it means for industry incumbents.
Presentation: The New Communications Paradigm in Financial Services: The Penn Mutual Case Study
Presented by: Kim Harmsen, Associate Vice President, Gregory FCA & Greg Matusky, President and Founder, GregoryFCA
Join Gregory FCA and The Penn Mutual Life Insurance Company as they present a blueprint for creating a best practice communications platform in a highly socialized, networked world. Penn Mutual provides a compelling blueprint for optimizing communication among media channels, both old and new. Their success serves as a shining case study for how long-term players in financial services can benefit from all that the new paradigm offers in communications, and now offers to financial service organizations.
http://www.bdionline.com/
Presentation: Social listening trends and the paradigm change in financial services
Presented by: Melissa King, Social Analytics Consultant, Brandwatch
Social media’s impact on the relationships between businesses and consumers has led to a defined shift in how the heavily regulated financial services sector interacts with customers. This session will address how FinServ professionals can leverage the insights uncovered via social listening tools (including ways to mitigate risk, what drives consumers’ decisions, and what motivates them to choose particular services) to make an impact, support customers, and generate revenue.
http://www.bdionline.com/
Presentation: Digital Financial Wellness: The Future of Money
Presented by: Mohamed Khalil, Head of Product, Data & Marketing, Moven
Mobile technology coupled with data and behavioral sciences now allow for highly personalized, real time interactions that alter consumer behaviors. This talk will examine how the retail financial services model must adapt to survive this digital disruption.
http://www.bdionline.com/
Presentation: Bitcoin & The Sharing Economy
Presented by: Nikos Bentenitis, Chair, Education Committee, Bitcoin Foundation, and Founder, CoinSimple
Bitcoin is a digital currency and payment network that has attracted significant attention recently. In his talk, Nikos will briefly describe Bitcoin and a few potential applications of the technology in financial services. The purpose of the talk is to provide you with a framework that you can use to think about the Bitcoin technology in your business.
http://www.bdionline.com/
Presentation: Hearts, Heads and Hands: How cupcakes, sidewalk chalk, and the story of a teen driver connected a CEO with his workforce and connected the workforce to the company strategy.
Presented by: Stephani Gordon, Internal Communications Business Partner to the CEO, Zurich Insurance Group
With an employee demographic that trends outside the ‘social’ scene, Zurich Insurance Group has achieved tremendous communications and engagement success by refreshing traditional marcomm channels with enticing storytelling, strong visual imagery, creative video and ‘social’ buzz. Stephani Gordon will share several executive communications project samples that include a strategy rap, a mobilization campaign built on the concept of graffiti tagging, and a CEO’s invitation to people to ‘walk away’ from their desks. This presentation is the story of coaching senior executives on what it means to connect in today’s world.
Presentation: Content is still King: A look at best practices for creating and distributing quality Content
Presented by: Scott Mozarsky, President - Cross Platform Businesses , Bloomberg BNA
This session will focus on best practices for creating Content that will enable marketers to achieve strong ROI in their Content Marketing efforts. The session will also focus on the elements of a multi-faceted engagement and distribution strategy that will ensure that if you build it, they will come.
Presentation: Developing and Sustaining an Effective Mobile Strategy
Presented by: Varun Parekh, Director, Sales Technology & Operations, Bankers Life and Casualty
A look into how Bankers Life has invested in an integrated and long term mobile strategy to grow business and reduce expense.
Presentation: Make Friends First, Do Business Last: Relationship Marketing Using Social Media & More
Presented by: Phil Gerbyshak, Director of Social Strategy, Actiance, Inc
Are you wondering how you can do social media the right way, without pushing your products and services? Do you want your company and your employees to be top of mind when people are thinking of where to go for what you offer? The key is making “friends” first, and doing business last. It's no longer enough to just BE on social media as a business. You need to be using it effectively, and you need to engage your employees to tell your stories and show you as the place to go in your community.
Presentation: The New Communications Paradigm in Financial Services: The Penn Mutual Case Study
Presented by: Joe Anthony, President, Financial Services, GregoryFCA
Join Gregory FCA and The Penn Mutual Life Insurance Company as they present a blueprint for creating a best practice communications platform in a highly socialized, networked world. Penn Mutual provides a compelling blueprint for optimizing communication among media channels, both old and new. Their success serves as a shining case study for how long-term players in financial services can benefit from all that the new paradigm offers in communications, and now offers to financial service organizations.
Presentation: Using Social Media Ethically
Presented by; Erin Wright Lothson, Corporate Counsel, Intellectual Property, Groupon, Inc.
This segment will briefly discuss the Illinois Rules of Professional Conduct and how these Rules apply to Illinois lawyers and their use of social media. We will review common issues that arise by using social media and will cover recommendations and best practices to mitigate the risks of an ethics violation.
Presentation: The Power of Social Media: Attracting the Next Generation of Clients
Presented by: Trevor Daughney, VP Marketing, Actiance, Inc
The most important thing sellers can do for their firm is bring in new clients. There is a major movement of wealth a foot: from Baby Boomers to Millennials. Financial advisers and wealth managers need to shift their focus to a younger generation. To be successful, they need to change how they communicate.
In this presentation, you’ll learn that:
These young people are increasingly on social networks and stepping away from email.
Financial firms need to adjust to this change.
Marketers, compliance officers and corporate counsel can overcome the challenges and lead their firms to make the switch.
Empowering your sellers to use social media can help close more deals.
The world of search engine optimization (SEO) is buzzing with discussions after Google confirmed that around 2,500 leaked internal documents related to its Search feature are indeed authentic. The revelation has sparked significant concerns within the SEO community. The leaked documents were initially reported by SEO experts Rand Fishkin and Mike King, igniting widespread analysis and discourse. For More Info:- https://news.arihantwebtech.com/search-disrupted-googles-leaked-documents-rock-the-seo-world/
Memorandum Of Association Constitution of Company.pptseri bangash
www.seribangash.com
A Memorandum of Association (MOA) is a legal document that outlines the fundamental principles and objectives upon which a company operates. It serves as the company's charter or constitution and defines the scope of its activities. Here's a detailed note on the MOA:
Contents of Memorandum of Association:
Name Clause: This clause states the name of the company, which should end with words like "Limited" or "Ltd." for a public limited company and "Private Limited" or "Pvt. Ltd." for a private limited company.
https://seribangash.com/article-of-association-is-legal-doc-of-company/
Registered Office Clause: It specifies the location where the company's registered office is situated. This office is where all official communications and notices are sent.
Objective Clause: This clause delineates the main objectives for which the company is formed. It's important to define these objectives clearly, as the company cannot undertake activities beyond those mentioned in this clause.
www.seribangash.com
Liability Clause: It outlines the extent of liability of the company's members. In the case of companies limited by shares, the liability of members is limited to the amount unpaid on their shares. For companies limited by guarantee, members' liability is limited to the amount they undertake to contribute if the company is wound up.
https://seribangash.com/promotors-is-person-conceived-formation-company/
Capital Clause: This clause specifies the authorized capital of the company, i.e., the maximum amount of share capital the company is authorized to issue. It also mentions the division of this capital into shares and their respective nominal value.
Association Clause: It simply states that the subscribers wish to form a company and agree to become members of it, in accordance with the terms of the MOA.
Importance of Memorandum of Association:
Legal Requirement: The MOA is a legal requirement for the formation of a company. It must be filed with the Registrar of Companies during the incorporation process.
Constitutional Document: It serves as the company's constitutional document, defining its scope, powers, and limitations.
Protection of Members: It protects the interests of the company's members by clearly defining the objectives and limiting their liability.
External Communication: It provides clarity to external parties, such as investors, creditors, and regulatory authorities, regarding the company's objectives and powers.
https://seribangash.com/difference-public-and-private-company-law/
Binding Authority: The company and its members are bound by the provisions of the MOA. Any action taken beyond its scope may be considered ultra vires (beyond the powers) of the company and therefore void.
Amendment of MOA:
While the MOA lays down the company's fundamental principles, it is not entirely immutable. It can be amended, but only under specific circumstances and in compliance with legal procedures. Amendments typically require shareholder
Kseniya Leshchenko: Shared development support service model as the way to ma...Lviv Startup Club
Kseniya Leshchenko: Shared development support service model as the way to make small projects with small budgets profitable for the company (UA)
Kyiv PMDay 2024 Summer
Website – www.pmday.org
Youtube – https://www.youtube.com/startuplviv
FB – https://www.facebook.com/pmdayconference
RMD24 | Debunking the non-endemic revenue myth Marvin Vacquier Droop | First ...BBPMedia1
Marvin neemt je in deze presentatie mee in de voordelen van non-endemic advertising op retail media netwerken. Hij brengt ook de uitdagingen in beeld die de markt op dit moment heeft op het gebied van retail media voor niet-leveranciers.
Retail media wordt gezien als het nieuwe advertising-medium en ook mediabureaus richten massaal retail media-afdelingen op. Merken die niet in de betreffende winkel liggen staan ook nog niet in de rij om op de retail media netwerken te adverteren. Marvin belicht de uitdagingen die er zijn om echt aansluiting te vinden op die markt van non-endemic advertising.
Personal Brand Statement:
As an Army veteran dedicated to lifelong learning, I bring a disciplined, strategic mindset to my pursuits. I am constantly expanding my knowledge to innovate and lead effectively. My journey is driven by a commitment to excellence, and to make a meaningful impact in the world.
LA HUG - Video Testimonials with Chynna Morgan - June 2024Lital Barkan
Have you ever heard that user-generated content or video testimonials can take your brand to the next level? We will explore how you can effectively use video testimonials to leverage and boost your sales, content strategy, and increase your CRM data.🤯
We will dig deeper into:
1. How to capture video testimonials that convert from your audience 🎥
2. How to leverage your testimonials to boost your sales 💲
3. How you can capture more CRM data to understand your audience better through video testimonials. 📊
RMD24 | Retail media: hoe zet je dit in als je geen AH of Unilever bent? Heid...BBPMedia1
Grote partijen zijn al een tijdje onderweg met retail media. Ondertussen worden in dit domein ook de kansen zichtbaar voor andere spelers in de markt. Maar met die kansen ontstaan ook vragen: Zelf retail media worden of erop adverteren? In welke fase van de funnel past het en hoe integreer je het in een mediaplan? Wat is nu precies het verschil met marketplaces en Programmatic ads? In dit half uur beslechten we de dilemma's en krijg je antwoorden op wanneer het voor jou tijd is om de volgende stap te zetten.
Implicitly or explicitly all competing businesses employ a strategy to select a mix
of marketing resources. Formulating such competitive strategies fundamentally
involves recognizing relationships between elements of the marketing mix (e.g.,
price and product quality), as well as assessing competitive and market conditions
(i.e., industry structure in the language of economics).
Putting the SPARK into Virtual Training.pptxCynthia Clay
This 60-minute webinar, sponsored by Adobe, was delivered for the Training Mag Network. It explored the five elements of SPARK: Storytelling, Purpose, Action, Relationships, and Kudos. Knowing how to tell a well-structured story is key to building long-term memory. Stating a clear purpose that doesn't take away from the discovery learning process is critical. Ensuring that people move from theory to practical application is imperative. Creating strong social learning is the key to commitment and engagement. Validating and affirming participants' comments is the way to create a positive learning environment.
Implications of the Affordable Care Act to the Pharmaceutical Industry - BDI 2/25/14 Future of Healthcare Communications Summit
1. Affordable Care Act: Implications for
the Pharmaceutical Industry
February 2014
Kirsten Axelsen, Vice President Worldwide Policy Pfizer
kirsten.axelsen@pfizer.com
2. Affordable Care Act: Does and Doesn’t
Does
Doesn’t
Reduce the number of uninsured Provide universal coverage
Expand coverage in private
plans and Medicaid
Operate a government run public
plan
Raise taxes and fees to pay for
expanding coverage
Set prices directly
Experiments with how the health Lower the cost of healthcare
care system is organized
Encourage prevention through
grants and reimbursement
Increase the number of primary
care physicians
Fund research on comparative
effectiveness
Set formulary directly
Expand access to medicines
Create a financial windfall for
pharmaceutical companies
2
3. Goals of The Affordable Care Act, Implications
Expand
Coverage
• Minimal near term for
pharma
Improve
Quality
• Depends on what is
measured and reimbursed
Reduce
Cost
• Depends on balance of cost
vs. quality & value
3
5. Key drivers
Enrollment in Insurance Coverage
• Health plans leverage
• Risk pool
Commercial benefit erosion
• Spillover of restrictive benefits
• Employers continue or drop coverage
Delivery/payment reform
• Cost vs. quality
5
6. Key drivers
Enrollment in Insurance Coverage
• Health plans leverage
• Risk pool
Commercial benefit erosion
• Spillover of restrictive benefits
• Employers continue or drop coverage
Delivery/payment reform
• Cost vs. quality
6
7. Benefit Design Parameters For Exchanges, Small
and Individual Group Markets
Deductible
Limits
Out of
Pocket
Limits
Actuarial
Value
Essential
Health
Benefits
7
8. Health Plans Leverage Tools to Constrain Costs
Networks
Access restricted certain physicians and hospitals
Formulary
Utilization management and tight controls
Cost-Sharing
High patient responsibility, particularly for
specialty
8
9. Tools are Available to Help Use Exchanges
Calculator Tool
Available
Link to Formulary/
Formulary Tool
Available
Link to Provider
Network Tool Available
FFE
ü
ü
ü
California
ü
Colorado
ü
ü
ü
Connecticut
ü
ü
ü
DC
ü
Hawaii
ü
Kentucky
ü
Exchange
ü
ü
ü
ü
Maryland
ü
ü
Massachusetts
ü
ü
ü
ü
ü
ü
ü
ü
Minnesota
ü
Nevada
New York
ü
Oregon
Rhode Island
ü
Vermont
ü
Washington
ü
Source: Avalere State Reform Insights, December 16, 2013.
ü
ü
ü
10. On Average, Silver Deductibles are More Than
$2,500
Average Deductibles by Metal Level
$5,000
$4,500
$4,343
Medical Deductible
$4,000
$3,500
$3,000
$2,567
$2,500
$2,000
$1,500
$932
Avg. Employer-Sponsored
Plan Deductible = $1,135*
$1,000
$500
$167
$Bronze
N=175
Silver
N=207
Gold
N=160
Platinum
N=61
Source: Avalere PlanScape, updated November 1, 2013. Avalere collected plan information from both federally-facilitated and state-based exchanges.
Average deductibles represent the medical-only deductible for plans with separate medical and drug deductibles and the total deductible for those plans with
integrated deductibles.
*Among covered workers with a general annual deductible, the average deductible amount for single coverage is $1,135.
Source: Kaiser Family Foundation Employer Health Benefits 2013 Annual Survey.
11. State Standardized Benefit Designs
Tier 4
Inpatient
Specialist
OOP Max
for Drugs2
Standard Silver
Tier 3
CT
Tier 2
Silver
Coinsurance3
Tier 1
CA
Drug
Deductible
Silver Copay3
Overall
Deductible
State Plan Type
Drug Formulary
Emergency
Room
Primary
Care
Physician
Benefit Cost-Sharing Parameters1
Medical:
$2,000
$2504
$19
$50
$70
20%
20%
$250
$45
$65
N/A
$2504
$19
$50
$70
20%
20%
$250
$45
$65
N/A
$400
$10
$25
$40
40%
$5005
$150
$30
$45
N/A
Medical:
$2,000
Medical:
$3,000
MA6 Silver
$2,000
N/A
$20
$40
$70
N/A
$1,000 $350
$30
$50
N/A
NY6 Silver
$2,000
N/A
$10
$35
$70
N/A
$1,500 $150
$30
$50
N/A
$0
$15
$50
50%
50%
30%
30%
$35
$70
N/A
$1004
$12
$50
50%
N/A
40%
$250
$20
$40
$1,250
$1,2507
$10
$40
50%
N/A
20%
20%
10%
20%
$1,250
OR
VT
Silver
Silver
Silver- HDHP
Medical:
$2,500
Medical:
$1,900
$1,550
Source: State Reform Insights, September 16, 2013
1. Benefit cost-sharing parameters are specific to individuals. Deductibles and OOP max may be higher for family coverage.
2. All exchange plans must comply with the annual limitation on OOP maximums for medical and drug benefits ($6,350 in 2014).
3. California’s silver copay and coinsurance plan designs vary in cost sharing for advanced imaging and home health care services as well as in the
accumulation of certain cost sharing towards the deductible.
4. For brand drugs only.
5. Per day to a maximum of $2,000 per admission.
6. Drug formulary tiers 1-3 cost-sharing parameters vary for mail-order pharmacies.
7. Integrated with overall deductible; of the overall deductible, up to $1,250 of drug spending may count as the drug deductible.
11
12. To Date, 26 States & DC Plan to Expand Medicaid
Eligibility in 2014
State Commitment to Expand Medicaid Eligibility in 2014
WA
ME
MT
ND
VT
NH
MA
CT
MN
OR
ID
WI
SD
NY
MI**
WY
PA*
IA*
NE
IL
IN***
WV
UT*
CA
CO
KS
MO
OK
NM
NC
SC
AR*
MS
TX
AK
VA
DE
MD
DC
KY
TN*
AZ
NJ
OH
NV
RI
AL
Will Expand (26 + DC)
GA
Leaning Yes (1)
Leaning No (2)
LA
FL
Will Not Expand (21)
HI
Source: Avalere State Reform Insights, Updated January 23, 2014
*Denotes states pursuing premium assistance models using exchange plans for part of their expansion populations: AR and IA have received waiver
approval; PA released a draft waiver for a plan using premium assistance that would likely not take effect until mid/late 2014;TN’s governor continues
to voice support for a premium assistance approach; if UT expands, it is likely to pursue a premium assistance approach
**MI’s expansion will begin in April 2014
***IN’s expansion would require CMS approval to leverage the state’s Healthy Indiana Program
12
13. Key drivers
Enrollment in Insurance Coverage
• Health plans leverage
• Risk pool
Commercial benefit erosion
• Spillover of restrictive benefits
• Employers continue or drop coverage
Delivery/payment reform
• Cost vs. quality
13
14. New Lives = New Market Pressures
Benefit Design
Less Generous
More Generous
Medicaid
Commercial
Exchange
Individual /
Catastrophic
Lives Served by Market Today
Anticipated Future Market
Medicare part D not included, it is not an integrated health but a stand-alone drug benefit
14
15. Newly Insured Entering Markets With More
Government Oversight and Subsidy
EXPECTED COVERAGE NON ELDERLY (MILLIONS)
300
0
250 36
25
200
7
43
13
23
23
46
22
24
25
25
24
45
45
45
45
47
22
22
22
22
22
Government
Responsible
for Growing
Share of the
Marketplace
Exchanges
150
158
157
100
Medicaid & CHIP
157
155
158
158
159
160 Non-Group
Employer
Uninsured
50
55
43
37
0
2013
31
31
30
30
31
2014
2015
2016
2017
2018
2019
2020
Source: Congressional Budget Office May 2013 Projection of Coverage Effects
15
16. Key drivers
Enrollment in Insurance Coverage
• Health plans leverage
• Risk pool
Commercial benefit erosion
• Spillover of restrictive benefits
• Employers continue or drop coverage
Delivery/payment reform
• Cost vs. quality
16
17. Healthcare System Challenges Impetus for
Payment and Delivery Reform
Siloed Payment Systems
Lack of Care Coordination and Transition
Management
Poor Outcomes, Such as Re-hospitalizations
Increased Costs
17
18. Care and Delivery Reforms
Delivery
Reform
• Accountable Care
Organizations
Payment
Reform
• No payment for
avoidable
conditions
• Quality Measures
Encourage
Innovation
• Center for
Medicare and
Medicaid
Innovation
18
21. Health Expenditure Growth Continues
Health Expenditure Relative to 2009
2.5
2.0
1.5
National Health
Expenditure
Out of Pocket
1.0
Private Insurance
0.5
Medicare
0.0
National Health Expenditure Projection, accessed October 2013 Center for Medicare and Medicaid Services
21
22. Statins Save Lives and Money
Adapted from: Grabowski, David C., et al. (2012); Gotto Jr., AM., et. al. (2000)
23. Cancer Treatments Increase Life Expectancy
Share of Life-Expectancy Gain Attributable to Improved Treatment vs. Improved
Detection, 1980–2000*
Asterisk (*) indicates Life Expectancy gains from 1990–2000 because 1980 data was not available for these conditions.
Table adapted from: E. Sun et al. (May 2008) “The Determinants of Recent Gains in Cancer Survival: An Analysis of the
Surveillance, Epidemiology, and End Results (SEER) Database,” Journal of Clinical Oncology.
25. Prescription Drug Spending Growth is Low
Year over year change in spending
12%
10%
8%
6%
4%
2%
Prescription Drugs
Hospitals
Physicians
National Health
Spending
0%
-2%
National Health Expenditures, accessed October 2013 Center for Medicare and Medicaid Services
26. Realize the Value of the Investment in the
Coverage Expansion
• Easily comparable benefits with clear information
• Clearly defined exception and appeals processes
• Limit excessive cost sharing for or exclusion of specialty
treatments and providers
• Broaden access to data, and link it
• Payment for value rewards attributes important to patients
26