HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, finds that Humana Inc.'s regional PPO and competitively priced stand-alone drug plan will challenge local Pennsylvania Medicare plans. According to the latest issue of Pennsylvania Health Plan Analysis from HealthLeaders-InterStudy, the state's two largest Medicare plans, Highmark Blue Cross Blue Shield and Independence Blue Cross are ready to compete.
"Humana is trying to transform itself into a leading national Medicare plan, and is going after new markets like Pennsylvania," said Micaela Brown, HealthLeaders-InterStudy analyst. "Humana might seem to have a competitive advantage through underpricing and reach, but the Pennsylvania Blues are a well-recognized brand among seniors. Each plan will play to its strengths to retain and increase market share."
Humana is the only health plan offering a regional Medicare PPO in Region 6, which comprises Pennsylvania and West Virginia. It's still unclear whether offering a regional PPO in those areas will be profitable, because the Centers for Medicare & Medicaid Services rules say that a regional PPO has to offer the same benefits at the same premium in every single county in the region. Local plans, without the obligation to match services and price in every county, can more narrowly focus what they offer.
Other health plan news in Pennsylvania: * Membership in HMO and point-of-service plans plummeted by some 1 million members as of January 2005, signaling the end of Pennsylvania's HMO heyday. * Next year, state employees are going to test a consumer-driven health plan, continuing the trend of having state employee insurance more closely resemble private insurance, as public workers have more responsibility and costs shifted to them. * The University of Pittsburgh Cancer Center and Highmark Inc. are jointly developing innovative cancer-treatment protocols they will market to health plans and hospitals. About Health Plan Analysis
Health Plan Analysis identifies key health plan trends, allowing healthcare businesses to create comprehensive strategic plans and sales strategies at state and local levels.
HealthLeaders-InterStudy, a company of Decision Resources, Inc. (http://www.decisionresources.com/), is the authoritative source for managed care data and analysis. For more information, please visit http://www.healthleaders-interstudy.com/.
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