Moving Forward with Reform: The Health Plan Pulse for 2012 and Beyond

The Managed Care Executive Group and HTMS Provide Health Plans With Critical Insights in Post-Reform Era

NASHVILLE, Tenn., Jan. 9, 2012 /PRNewswire/ -- The Managed Care Executive Group (MCEG) and HTMS, an Emdeon company, today jointly issued their third annual report examining critical issues, priorities and challenges for regional health plans in the post-reform era. The report, titled "Moving Forward with Reform: The Health Plan Pulse for 2012 and Beyond," is based on information gathered from a survey of 61 responding health plans.

Several survey respondents described 2012 as a "tactical year," because of the overwhelming list of priorities and the need to carefully allocate resources with which to accomplish them. Yet, despite the challenges facing the industry today—such as complying with specific provisions of the Patient Protection and Affordable Care Act (PPACA) and trying to anticipate what regulatory modifications may be on the horizon— survey results reveal that many payer organizations remain surprisingly optimistic about the future. The report captures the concerns and opportunities identified by health plans, and offers insight into actions payers may undertake to address pressing operational, strategic and legislative issues.

Survey results will be shared during a webinar, to be held at 1 pm ET on January 10, 2012. MCEG and HTMS executives will present findings such as how payers are handling new models of care, operational and administrative mandates, new models of insurance distribution such as health insurance exchange, and health information exchange. To register for the online event, visit

"One issue common among many of the survey respondents is the 'overflowing plate' challenge," says Vince Ferri, vice president and chief information officer for AvMed Health Plans and Chair of MCEG. "With so many priorities related to healthcare, payers find it increasingly difficult to accomplish all the goals set before them in a straightforward, efficient manner. It is good to see that, despite the torrent of changes, health plans largely remain upbeat."

Ninety- two percent of respondents reported that, despite a scarcity of resources and the "overflowing plate," challenge they were, at the very least, compliant with the various provisions of reform. Twenty-three percent of this group of respondents identified themselves as "leaders" and plan to use the changes associated with healthcare reform as a strategic differentiator. Survey results also demonstrated optimism by small and mid-size health plans - only 4 percent of respondents considered health reform and its impacts to be a threat. Comparatively, 94 percent considered reform to be either an opportunity or a "mixed bag," offering both opportunities and threats. Additionally, the majority of respondents expected to see growth in all sectors, with only a few anticipating expansion in the large group market.

"According to our research, health plans don't see PPACA as either all good or all bad," says Gary Stuart, executive vice president of payer services for Emdeon. "Respondents listed multiple opportunities—such as growth in the individual market due to health insurance exchanges—as well as hurdles, including the potential impact of uncertainties related to the Supreme Court's upcoming decision on the PPACA mandate that individuals must purchase health insurance and the outcome of the 2012 presidential race."

About The Managed Care Executive Group

The Managed Care Executive Group (MCEG) is a national organization that provides a forum for the open exchange of information, innovative ideas, and experience among senior health plan leaders. MCEG was formed in 1988 to create a comfortable forum for the exchange of ideas, the development of valuable peer relationships and the opportunity to explore the innovation that will transform organizations and the industry. Its 23rd Annual Forum begins March 25, 2012. Register at

About Emdeon

Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers and patients in the U.S. healthcare system. Emdeon's product and service offerings integrate and automate key business and administrative functions of its payer and provider customers throughout the patient encounter. Through the use of Emdeon's comprehensive suite of products and services, which are designed to easily integrate with existing technology infrastructures, customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle and clinical information exchange processes. For more information, visit