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New Jersey State Health Plan Data and Analysis


Description: Information on benefit designs, contracting strategies, financial performance, and enrollment information by state and MSA

Health Plan Data & Analysis identifies key health plan trends, allowing you to create comprehensive strategic plans and sales strategies at state and local levels. Its data on every aspect of HMO, POS, PPO, Medicare, and Medicaid plan enrollment and financial performance, and its detailed analysis of market developments allows you to:

- Understand the complete financial picture of each HMO, from per-member-per-month (PMPM) medical expenses to year-over-year change in medical loss ratio and profit margin.
- Know the competitive environment, on a state-by-state basis, for each health plan of interest.
- Assess competitive vulnerabilities as well as merger and acquisition opportunities.

Who Uses Health Plan Data & Analysis?

These detailed data and analyses allow pharmaceutical companies to assess market and sales opportunities with specific health plans in specific states; managed care organizations to gain understanding of competitors, and make partnership and acquisition decisions; consultants to evaluate health plans for employers and as potential clients, and to gain understanding of the competitive environment; and financial organizations to manage their exposure in the managedcare market. Get enrollment and physician numbers, HMO financial information, hospital participation, and contact information for HMOs and PPOs in your target state

For each state with data you get

- Enrollment numbers for every health plan that operates in the state, including commercial, Medicare, and Medicaid.
- Financial information for each HMO that operates in the state.
- Preferred provider organization (PPO) information.
- Hospitals that participate in HMO and PPO networks, organized by MSA with bed counts.
- Contact and vendor information for HMOs and PPOs active in the state.

For each state with analysis you get information on recent changes in

- Benefit design
- Financials
- Mergers
- State employee benefits
- Uninsured initiatives
- Health plan developments
- Healthcare information technology
- Consumer-driven plans
- Medicare
- Medicaid
- Pharmacy benefit design
- Legislation affecting health plans

as well as plan profiles of each plan licensed to operate in the state.

Product Details

- Provides data and analysis for 35 states and Washington, D.C.
- Provides financial data for 49 states and Washington, D.C., Alaska excepted.
- Each analysis comes as a PDF, also accessible online.
- Each data set is accessible online.
- Enrollment data is updated twice a year, HMO financial data four times a year, contact data twice a year, and hospital data once a year.

Methodology:

The analysts interview 20 to 30 healthcare executives, consultants and policymakers for each quarterly report. They also scrutinize our data on health plan enrollment and financials to write analyses on those areas.


Contents: Data Table of :
HMO & PPO Enrollment (January data-point)
Year-end HMO Financials
Health Plan Contacts (most recent available)
Hospital Affiliations (most recent available)

Analysis Table of :

HMO and PPO Enrollment Analysis
This section looks at health plan enrollment trends, including whether HMOs and PPOs are losing or gaining market share, what kinds of products are doing the best and how health plans see the enrollment shifts.

HMO Financial Analysis
This section takes a look at the latest quarterly HMO financial filings within the region, examining which plans are making/losing money, what kind of medical-loss ratio they are reporting, and how their income and premiums break down per member, per month.

Regional Medicare Update
This section provides detailed information on the major Medicare players in the region, what new products they’re offering, their marketing strategy, enrollment and product details.

State Medicaid Update
This section provides updates on the state’s (or states’) Medicaid program, including reimbursements, level of managed care, Medicaid HMOs, reimbursements to providers, eligibility, federal waivers and enrollment.

Health Plan News on New Products, Benefit Design, Contracting, Pay for Performance, Disease Management
This section details health plans’ benefit designs, marketing strategies, leadership changes and product launches. It also discusses whether plans are offering disease management programs or pay-for-performance programs for providers.

State Legislative Initiatives Affecting Health Plans
The HPAs’ state legislative coverage includes information on all healthcare legislation affecting the health insurance industry, including benefit mandates, Medicaid reform, Children’s Health Insurance Program (CHIP) developments and eligibility changes, health plan regulations, malpractice tort reform, certificate-of-need measures and initiatives to cover the uninsured.

Uninsured
This section discusses what products health plans are offering to try to enroll the uninsured, what strategies the plans are taking, and how the state is handling this issue.

Consumer-driven plans
This section provides updates on the development and enrollment of consumer-driven plans, including information on what types of employers are using CDHPs and what kind of reception they are getting. It also discusses which banks health plans are partnering with and how they are structuring their consumer-driven plans.





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