Presentation on theme: "What’s Included in AIS’s Directory of Health Plans?"— Presentation transcript:
1 What’s Included in AIS’s Directory of Health Plans? Episode IWhat’s Included in AIS’s Directory of Health Plans?
2 The Directory comes in 2 versions… A printed book versionA CD database version, which comes with a free copy of the printed bookALL the information in the book is on the CD. The CD has the data in Excel, Access, CSV andASCII file formats.The CD also has some additional data not found in the book (more on that later).
3 Two Data Sets Health Plans Preferred Provider Networks The Directory includes databases on two types of organizations —Health PlansAll insurance carriers, or managed care organizations, in the U.S. that offer fully insured health plans based on a regional network. Includes primary medical insurance only. The latest edition of the Directory has 493 Health Plan records.Preferred Provider NetworksOrganizations that offer primary medical networks to self-insured plans or insurance carriers via a fee or lease agreement. These companies do not offer insurance products. The latest edition of the Directory has118 Network records.This slide presentation focuses on the Health Plan data sets only.
4 Overview of Health Plan Data Fields Company Data:Company NameCompany Address — street, city, state, zipTelephone Numbers — corporate business phone, automated number for members and claims info, corporate fax numberCompany Owner — with Owner ID to link plan to other subsidiaries of the same parent companyCompany URLProfit Status of CompanyPrivate/Public Status of CompanyStock SymbolState Service Area (states in which company operates)Contracted Pharmacy Benefit Manager(s)Aliases — a list of subsidiaries, product names, former names and other names by which this organization may be known in various marketsPublication Notes — additional information about the company (e.g., recent mergers, name changes) or about the enrollment data in the recordAll applicable fieldsare populated for all493 health plans
5 Overview of Health Plan Data Fields Key Executives Up to 17 names per company — First Name, Last Name — Listed by Job FunctionCEOPresidentOperations ExecutiveFinance ExecutiveMedical ExecutiveLegal ExecutiveProvider Relations ExecutiveMarketing ExecutiveMember Relations ExecutivePharmacy ExecutiveSpecialty Pharmacy ExecutivePublic Relations ExecutiveInformation Systems ExecutivePurchasing ExecutiveClaims Management ExecutiveReimbursement ExecutiveDisease Management/Wellness ExecutiveMORE THAN 3,300HEALTH PLAN EXECUTIVES
6 Overview of Health Plan Data Fields Key Executives Up to 17 names per company — First Name, Last Name — Listed by Job FunctionThe CD offers complete mailing lists, with phone numbers, in convenient Excel, Access, CSV and ASCII formats.Data can be imported into your sales force software.Your purchase of the CD entitles you to unlimited use of these mailing lists.Names are collected/verified by AIS editorial staff with knowledge of each health plan’s structure and organization, job functions, etc.Mailing lists include the MCO ID field —a unique identifier that links each executive with the full company record. So you can sort and filter the names by geography, type of plan model, membership, job function, etc.
7 Overview of Health Plan Data Fields Enrollment Data (aka Membership or Covered Lives) We count members enrolled in primary medical products only — not specialty benefits like pharmacy, vision, dental, etc.Starting with:Total Medical Enrollment — the total number of members in medical plans (risk and non-risk) nationally, for the whole companyUp to 24 different types of enrollment data collected for each companyTotal Medical Enrollment is then broken down into 2 main categories:Fully Funded (Risk-Based)Self-Funded (ASO)Which are further broken down…
8 Overview of Health Plan Data Fields Enrollment Data (aka Membership or Covered Lives) Members enrolled in primary medical products only — not specialty benefits like pharmacy, vision, dental, etc.This is how enrollment is broken down into subsets:Total Fully Funded (Risk) EnrollmentTotal Commercial Risk EnrollmentHMOPOSPPOFFS/indemnityMedicare Supplement (Medigap)Total Public Sector Risk EnrollmentMedicare Enrollment (Part C)Medicare (coordinated care)Medicare PFFSPACE ProgramMedicaid HMOMedicaid FFS (state agencies)SCHIP/other local enrollmentTotal Self-Insured (Non-Risk/ASO) EnrollmentTotal Commercial Non-Risk EnrollmentTotal Public Sector Non-Risk EnrollmentAlso provided:Number of lives in Individual (non-Group) plans,Number of lives in FEHBP plans, andEnrollment specific to each State, plus DC and Puerto Rico
9 Overview of Health Plan Data Fields Enrollment Data (aka Membership or Covered Lives) Members enrolled in primary medical products only — not specialty benefits like pharmacy, vision, dental, etc.This is what it looks like in the book:Zeros (0’s) indicate that AIS has confirmed the health plan has no membership in products of that type/ model or market sector.
10 Overview of Health Plan Data Fields Health Plan Enrollment fields and definitions of health plan models can be confusing
11 Overview of Health Plan Data Fields Health Plan Enrollment fields and definitions of health plan models can be confusingAIS offers full support to make sure you understand the data accurately and use it appropriately for your specific projects.AIS’s Directory of Health Plans provides thorough explanations of each type of enrollment in the Introduction section of the book (also in PDF on the CD).Our knowledgeable editorial staff is available to answer any questions this material doesn’t cover.
12 Highlights and Analysis of the Health Plan Industry Highlights — Chapter 1 offers many tables, charts and calculations that have been performed for you by AIS editorial staff, to answer such questions as:Which health insurer is the largest by membership?Where does my insurer rank by enrollment?Who has the largest Medicare membership?Which are the top 10 companies by HMO enrollment?What % of U.S. covered lives are enrolled in for-profit plans?Individual (non-group) plans? Risk-based plans? POS plans?Non-risk (ASO) plans? Public-sector plans? Medicaid HMOs?Commercial PPOs? Publicly traded corporations…AIS’s Directory of Health Plans is the foremost authority on health plan enrollment statistics
13 Special Features of the CD Version The CD version of AIS’s Directory of Health Plans offers many special features and capabilities:Electronic files allow you to sort, filter and export the data for your specific purposesA PDF version of the book allows for fast keyword searchingYou get a free copy of the paper book, so you’re not giving up anythingFree Copy!
14 Special Features of the CD Version Files are in regular Windows formats — no special software to learn
15 Special Features of the CD Version Spreadsheets Developed for the CD OnlySubsidiary Addendum Excel workbook with:Worksheets featuring enrollment details for 18 large national companies with multi-state service areasLines for distinct subsidiaries/units by state, with enrollment breakdowns by type of productMore than 2,000 additional data points
16 Special Features of the CD Version Spreadsheets Developed for the CD OnlySubsidiary Addendum Excel workbook with:Worksheets featuring enrollment details for 18 large national companies with multi-state service areasLines for distinct subsidiaries/units by state, with enrollment breakdowns by type of productMore than 2,000 additional data pointsParent Organizations spreadsheet with:Total enrollment, by product type, for all subsidiariesCorporate address, phone and CEO for 31 large national organizations
17 Special Features of the CD Version Spreadsheets Developed for the CD Only (continued)Convenient mailing listsTotal enrollment by company by stateEnrollment breakdowns, rolled up by parent organizationANDSpreadsheets for specific market sectors:Breakdowns by company, by state, of commercial enrollment onlyBreakdowns by company, by state, of Medicare Advantage enrollment onlyBreakdowns by company, by state, of Medicaid HMO enrollment onlyBreakdowns by company, by state, of FFS Medicaid enrollment onlyAll of the above enrollment types, broken down by company, by stateAdditional Data Fields Included on the CD OnlyCheckbox indicating whether a company is a Blue Cross and Blue Shield affiliateTotal number of physicians (PCPs) and hospitals (acute-care) in health plan networks
18 MethodologyAll known health insurers and PPO networks operating as of Jan. 1 believed to fit the criteria of the database are included. Inclusion is not optional. Companies are surveyed by AIS staff between Oct. 1 and Dec. 31 of the year preceding the date of the Directory. AIS researchers are specially trained to understand enrollment terminology and how membership is counted by plans.Each organization is contacted and offered options to fill out an online or paper form, or to provide data via , fax, mail or via telephone interview. Information provided directly by companies is deemed the most accurate and up-to-date information. For companies that do not return a survey, or where blanks are left on responses, researchers endeavor to complete the record through other means. Survey data is audited against public records as available.Fully insured commercial HMO enrollment is audited against state insurance department filings. Medicare enrollment is audited against Centers for Medicare and Medicaid Services (CMS) records. Medicaid enrollment is verified with state Medicaid agencies. Records are supplemented by data from company websites, SEC filings, press releases and news reports.Q: How Can AIS Get Such Comprehensive Participation from Health Plans?A: As the publishers of Health Plan Week, and many other long-running, highly respected industry publications, AIS has established relationships with all the major health insurers.Additionally, AIS’s Directory of Health Plans is the official directory resource of America’s Health Insurance Plans (AHIP), the trade association representing health insurance companies.AIS’s Directory of Health Plans is the foremost authority on health plan enrollment statistics
19 Ready to Order AIS’s Directory of Health Plans? Order Via Our Website atOr call Customer Service at (800) Still Have Questions?Our Customer Service Representatives will gladly put you in touch with our technical editors to make sure you have a full understanding of the database and how to apply it to your specific projects. Call us!View Episode 2 for more information about how to use the Directory to research details about insurance companies.View Episode 3 if you don’t know whether to purchase the book OR the CD.View Episode 4 for more information about using the contact data and mailing lists.