Entries by Pamela Girardin

Oregon’s State-Based Health Insurance Marketplace – Well Prepared for October

The Oregon health insurance marketplace, named Cover Oregon, seems close to bringing a prediction to life. As one of the earliest states to adopt the health insurance marketplace concept, Oregon recently disclosed its proposed rates for operations beginning in 2014. The proposed rates highlight one primary prediction that has been highly debated – Health Insurance […]

Consumer Engagement & Mobile Tech: Picture Perfect for Payers?

What if your daily fitness goals were sent to your cell phone and achieving these goals made you eligible for premium discounts on your health insurance plan? What if payers were able to track your progress toward an illness and recommend tests via a mobile app? A few years ago, such scenarios might have seemed […]

Usable Electronic Health Records, a Stepping Stone to Effective Healthcare

Electronic Health Record (EHR) is a word that has been perplexing caregivers, physicians and hospitals for more than a decade. Simply put, an Electronic Health Record is a summation of medical records and history of a patient in electronic form, with information technology bolstering it from the core. However, this simple definition does not justify […]

Exploring Business Models in the Reformed Health Insurance Market

With the onset of healthcare reforms, the individual health insurance market is set for a major expansion. Insurers need to decipher whether they can profitably expand their presence into this segment. Obviously, making the transition is not going to be easy. Insurers have already realized that their overall profitability might be compromised by MLR restrictions […]

Three Lesser Discussed Strategies for Achieving Success in the Reformed Market

There have been a lot of opinions expressed about how the payer’s margin will be squeezed in the reformed health insurance market. This discussion focuses its attention on dealing with the situation, i.e. preparing a business strategy for survival in the new Exchange market. 1. Get Smart About It: There is Life for Plans off […]

Achieving Robust Data in Times of Changing Healthcare IT Trends

A robust, cost-effective and future-ready IT infrastructure is critical for healthcare organizations as they try to increase efficiencies and lower cost of ownership in the face of increasing competition and shrinking margins. In the changing healthcare landscape, organizations must have the ability to capture, index, save, report, understand, track and interpret data. Besides reporting, data […]

Healthcare Leaders: Getting Prepared for the Exchange Ecosystem (Part 2)

This is the second part of a discussion about how healthcare leaders should perceive the emerging Exchange marketplace and get ready to ensure survival and profitability in this fast changing domain. Healthcare leaders shouldn’t think they need to drastically reform their business model to survive in the reformed market. The better approach is to perceive […]

Latest from ACA: Clarification on Minimum Essential Coverage & Shared Responsibility Exemptions

With the goal of making the new healthcare system work for everyone, the PPACA as amended by the Health Care and Education Reconciliation Act created a requirement called Share Responsibility. This is applicable to individuals, insurance companies, medical device companies, medical providers, pharmaceutical companies, employers and the government. On January 30, 2013, the HHS and […]

Healthcare Analytics in the Reform Era: Part 2

This is the second part in our discussion about the increasing role of Analytics in the Healthcare industry. Here, we explore how Analytics offer irrefutable benefits to the insurers and try to derive a conclusion. (Please to view the first part of this discussion). For Payers: Analytics Eases Adaptation to Healthcare Reforms Payers can benefit […]

Healthcare Analytics in the Reform Era: Part I

This is the first of a 2-part discussion that explores the role Healthcare Analytics can play in the era of Health Reforms.  Here, we discuss the contemporary realm of Analytics and the challenges to its usage. Pharmaceutical companies are perhaps the most seasoned users of Analytics in the healthcare market since detailed analysis is central […]