New England Managed Care Organizations Look to Differentiation and Expansion for Growth Opportunities
<0> HealthLeaders-InterStudyKristi Guillemette, 781-993-2618orDecision Resources GroupElizabeth Marshall, 781-993-2563 </0>
HealthLeaders-InterStudy, the leading provider of managed care market intelligence, finds that managed care organizations in New England face little organic growth in the commercial market and are turning to product differentiation and innovative plans that incorporate limited or tiered network designs.
With top carriers across the region firmly entrenched, especially in states with low uninsured rates (Massachusetts) or smaller geographies (Rhode Island), organic growth is often difficult, fueling competition and development of new plan designs to help employers control costs. Insurers are working to influence consumers to choose less costly healthcare providers and these new product designs are gaining traction and enrollment.
Limited and tiered networks are helping insurers maintain enrollment in Massachusetts. These smaller networks could help pharma to target the physicians and groups that could have the greatest influence over regional prescribing patterns.
“As provider networks become narrower, the care of patients will become more concentrated among a smaller pool of physicians,” said HealthLeaders-InterStudy New England Analyst Ric Gross. “However, the continued consolidation of power could impede access by pharmaceutical company sales representatives, and there will be continued focus on cost that emphasizes generics.”
With Rhode Island’s economy still struggling, commercial insurers are working to roll out products that appeal to cost-conscious employers. Blue Cross & Blue Shield of Rhode Island has been pushing a revamped product portfolio for small businesses that include value-based benefit options, which waive or reduce copays or coinsurance for prescription drugs treating chronic diseases such as diabetes, asthma and chronic obstructive pulmonary disease.
Massachusetts’ Boston Medical Center HealthNet (BMC HealthNet), a Medicaid-only plan, is looking outside state borders for growth opportunities. The company is one of three new health plans to be awarded Medicaid managed care contracts in New Hampshire. The carrier has formed an alliance with Harvard Pilgrim Health Care in New Hampshire and is looking at Maine for future expansion, if that state eventually transitions to Medicaid managed care.
Generic prescribing is strong in New England states Maine, Massachusetts, New Hampshire, Rhode Island and Vermont, putting pressure on drug companies to emphasize the value proposition of branded drugs.
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