New State Exchange Enrollment Projections Illuminate 2014 Healthcare Marketplace

State-Specific “Exchange Profiles” from Decision Resources Group Highlight Potential Winners and Expose a Few Surprises

December 17, 2013—Burlington, Mass.  Decision Resources Group’s projections of 2014 enrollment reveal national trends that are hard to ignore—while simultaneously illustrating the unique nature of each state’s exchange. State Exchanges, which opened for enrollment October 1, 2013, are both state- and federally-run. Within many states, there are significant regional advantages for carriers with strong ties to health systems and providers.
 
Key Facts:
  • Blue plans will likely be among the leaders in the states where they are dominant and able to leverage that clout into narrow-network plans with a price advantage over competitors.
  • Humana is projected to be within the five largest carriers in enrollment for each exchange it is competing in.
  • Centene is poised to capitalize on its position as a leading managed Medicaid carrier and could become a major exchange player nationally through its Ambetter plans.
  • Aetna, through its acquisition of Coventry, is in a prime position to be a top exchange player in several states and is particularly strong in the Southeast.
  • A just-released pdf download, “Exchange Profiles: A National Look,” elaborates on these findings.
  • Decision Resources Group’s projection model uses proprietary enrollment data, brand recognition metrics and pricing.
 
Quotes:
  • Dave Raiford, Market Analyst for Decision Resources Group, said: “Given the turmoil of the first few months of health insurance exchanges, forecasting how enrollment will shake out by the end of 2014 is tricky.  A look at the carriers participating in the exchanges, their past experiences and the relative pricing of their health plans can be instructive, but accurate state-specific market data is probably the most important variable.”
  • Carolyn McMeekin, Vice President of Insight Products for Decision Resources Group, adds: “Exchange participation among health plans is not for the faint of heart. The broken website has dominated conversation, but the breadth of exchange involvement from dominant players is an indication that regional and national health plans recognize the inherent opportunity—both for their images as well as their bottom lines. Yet as time goes on, it is likely exchange participation among health plans will dwindle, as merger and acquisition activity and the continued introduction of narrow network products on the exchanges play out.”
 
Additional Resources:
  • Decision Resources Group has created a “State Exchange Report Card”, which evaluates each state’s exchange on a variety of criteria, including readiness, competition and potential to impact their markets. Download the latest “Report Card” at www.hl-isy.com/State-Exchange-Report-Card
 
About Health Plan Data & Analysis

NEW: The “Exchange Profile” report series, which includes state-specific enrollment projections, is now part of Health Plan Data & Analysis.

Health Plan Data & Analysis is the tool for understanding the competitive managed care organization landscape, providing state health plan information that drives meeting preparation, strategic planning, and sales strategy development. It provides event-driven insights into the latest state health plan trends that drive local-level sales and planning strategy development and includes updates on:
  • Commercial Carriers
  • Managed Medicare Markets
  • Managed Medicaid Markets
  • Pharmacy Benefits
  • Patient Care Management
  • Legislation
  • Healthcare Reform
  • Key Market Events

About Decision Resources Group
Decision Resources Group offers best-in-class, high-value information and insights on critical issues within the healthcare industry. DRG insights and analysis on the U.S. managed care market are powered by HealthLeaders-InterStudy. Clients rely on this analysis and data to make informed decisions. Find out more at www.hl-isy.com and www.DecisionResourcesGroup.com.



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