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Episode I What’s Included in AIS’s Directory of Health Plans?

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Presentation on theme: "Episode I What’s Included in AIS’s Directory of Health Plans?"— Presentation transcript:

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2 Episode I What’s Included in AIS’s Directory of Health Plans?

3 The Directory comes in 2 versions… A printed book version A CD database version, which comes with a free copy of the printed book ALL the information in the book is on the CD. The CD has the data in Excel, Access, CSV and ASCII file formats. The CD also has some additional data not found in the book (more on that later).

4 Two Data Sets The Directory includes databases on two types of organizations — Health Plans All 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. This slide presentation focuses on the Health Plan data sets only. Preferred Provider Networks Organizations 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 has 118 Network records.

5 Overview of Health Plan Data Fields Company Name Company Address — street, city, state, zip Telephone Numbers — corporate business phone, automated number for members and claims info, corporate fax number Company Owner — with Owner ID to link plan to other subsidiaries of the same parent company Company URL Profit Status of Company Private/Public Status of Company Stock Symbol State 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 markets Publication Notes — additional information about the company (e.g., recent mergers, name changes) or about the enrollment data in the record Company Data:

6 Overview of Health Plan Data Fields CEO President Operations Executive Finance Executive Medical Executive Legal Executive Provider Relations Executive Marketing Executive Member Relations Executive Pharmacy Executive Specialty Pharmacy Executive Public Relations Executive Information Systems Executive Purchasing Executive Claims Management Executive Reimbursement Executive Disease Management/Wellness Executive Key Executives Up to 17 names per company — First Name, Last Name — Listed by Job Function

7 Overview of Health Plan Data Fields Key Executives Up to 17 names per company — First Name, Last Name — Listed by Job Function The 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.

8 Overview of Health Plan Data Fields Starting with: Total Medical Enrollment — the total number of members in medical plans (risk and non-risk) nationally, for the whole company Total Medical Enrollment is then broken down into 2 main categories: Fully Funded (Risk-Based) Self-Funded (ASO) Which are further broken down… Enrollment Data (aka Membership or Covered Lives) We count members enrolled in primary medical products only — not specialty benefits like pharmacy, vision, dental, etc.

9 Overview of Health Plan Data Fields Total Self-Insured (Non-Risk/ASO) Enrollment Total Commercial Non-Risk Enrollment Total Public Sector Non-Risk Enrollment Total Fully Funded (Risk) Enrollment Total Commercial Risk Enrollment HMO POS PPO FFS/indemnity Medicare Supplement (Medigap) Total Public Sector Risk Enrollment Medicare Enrollment (Part C) Medicare (coordinated care) Medicare PFFS PACE Program Medicaid HMO Medicaid FFS (state agencies) SCHIP/other local enrollment Also provided: Number of lives in Individual (non-Group) plans, Number of lives in FEHBP plans, and Enrollment specific to each State, plus DC and Puerto Rico This is how enrollment is broken down into subsets: Enrollment Data (aka Membership or Covered Lives) Members enrolled in primary medical products only — not specialty benefits like pharmacy, vision, dental, etc.

10 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:

11 Health Plan Enrollment fields and definitions of health plan models can be confusing Overview of Health Plan Data Fields

12 AIS 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. Health Plan Enrollment fields and definitions of health plan models can be confusing Overview of Health Plan Data Fields

13 Highlights and Analysis of the Health Plan Industry Which health insurer is the largest by membership? Highlights — Chapter 1 offers many tables, charts and calculations that have been performed for you by AIS editorial staff, to answer such questions as: Who has the largest Medicare membership? Which are the top 10 companies by HMO enrollment? Where does my insurer rank by 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

14 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 purposes A PDF version of the book allows for fast keyword searching You get a free copy of the paper book, so you’re not giving up anything Free Copy!

15 Special Features of the CD Version Files are in regular Windows formats — no special software to learn

16 Special Features of the CD Version Spreadsheets Developed for the CD Only Subsidiary Addendum Excel workbook with: Worksheets featuring enrollment details for 18 large national companies with multi-state service areas Lines for distinct subsidiaries/units by state, with enrollment breakdowns by type of product

17 Special Features of the CD Version Spreadsheets Developed for the CD Only Parent Organizations spreadsheet with: Total enrollment, by product type, for all subsidiaries Corporate address, phone and CEO for 31 large national organizations Subsidiary Addendum Excel workbook with: Worksheets featuring enrollment details for 18 large national companies with multi-state service areas Lines for distinct subsidiaries/units by state, with enrollment breakdowns by type of product

18 Special Features of the CD Version Spreadsheets Developed for the CD Only (continued) Convenient mailing lists Total enrollment by company by state Enrollment breakdowns, rolled up by parent organization Checkbox indicating whether a company is a Blue Cross and Blue Shield affiliate Total number of physicians (PCPs) and hospitals (acute-care) in health plan networks Additional Data Fields Included on the CD Only Spreadsheets for specific market sectors: Breakdowns by company, by state, of commercial enrollment only Breakdowns by company, by state, of Medicare Advantage enrollment only Breakdowns by company, by state, of Medicaid HMO enrollment only Breakdowns by company, by state, of FFS Medicaid enrollment only All of the above enrollment types, broken down by company, by state

19 All 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. AIS’s Directory of Health Plans is the foremost authority on health plan enrollment statistics 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. Methodology

20 Ready to Order AIS’s Directory of Health Plans? Order Via Our Website at Or 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.


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