Session highlights from the Managed Markets Summit in Orlando, FL, February 25-27.
Health Insurance Exchanges: Challenges and Opportunities for Pharma
Dennis M. Falci, MBA, director, Sanofi-Aventis SA, says it’s no secret—Health Insurance Exchanges (HIEs) are a hot topic in health news.
HIEs are mandated as part of the Affordable Care Act (ACA), providing coverage to nearly 44 million people in the United States. Likening the exchanges to consumer tools such as Expedia, Mr Falci says insurance marketplaces function as a “one stop shop for healthcare,” helping Americans to find health plans that “meet their needs and reflect their eligibility.”
Once consumers are logged on a HIE web portal, they can choose from a variety of health plans. Levels of coverage include:
The Current State of Our Nation's Public Exchange Programs and the Rise of Private Exchanges
In a panel discussion moderated by Neil Minkoff, MD, CEO of FountainHead HealthCare, panelists examined the current state of healthcare exchanges, both public and private. Panelists included Dennis Falci, MBA, director, US managed markets training, sales training and leadership development, Sanofi-Aventis SA; Thomas Kaye, director of consulting pharmacy, Prescription Formulary Exchange, LLC; and Sheri Sellmeyer, vice president, market analysis, HealthLeaders-InterStudy, a Decision Resources Group Company. They analyzed the current benefit models required by public exchanges, and the rising popularity of the private counterparts, offering a glimpse into the new healthcare marketplace now unfolding.
One of the major topics of discussion was resistance to mandatory health coverage, particularly among younger Americans. Falci, drawing on his own experiences, surmised that many of those who are young and in good health do not want to "overinsure" themselves with insurance plans that cover services generally utilized by older participants, especially when those plans come with high deductibles. Similarly, high co-pays and costly treatments could sway people to voluntarily decline pharmaceuticals and could promote non-compliance. Read more here: http://bit.ly/1o8L5N5
Continuing conference coverage and exclusive interviews from The Managed Markets Summit are available here: http://www.ajmc.com/conferences/mms2014
AI in Health Care: Closing the Revenue Cycle Gap
April 1st 2025This commentary explores the current state, challenges, and potential of artificial intelligence (AI) in health care revenue cycle management, emphasizing collaboration, data standardization, and targeted implementation to enhance adoption.
Read More
Managed Care Reflections: A Q&A With Hoangmai H. Pham, MD, MPH
April 1st 2025To mark the 30th anniversary of The American Journal of Managed Care® (AJMC®), each issue in 2025 will include a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The April issue features a conversation with Hoangmai H. Pham, MD, MPH, a member of AJMC’s editorial board and the president and CEO of the Institute for Exceptional Care (IEC).
Read More