HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, announced its list of the ten most important managed health trends to watch in the coming year.

  1. The year 2006 will mark the biggest change -- and biggest free-for-all      -- to hit the Medicare program since its inception -- Between 11 and 20      organizations are offering Medicare Prescription Drug Plans (PDPs) in      each Medicare-defined region. Nine organizations are offering PDP      coverage nationwide. In addition to PDPs, seniors face a huge range of      coverage choices, from Medicare Advantage PPOs and HMOs to private fee-      for-service plans. The Centers for Medicare & Medicaid is heavily      promoting regional PPOs as a way to extend access to rural areas, but      local health plans are still drawing the most interest.   2. Health plan mergers and acquisitions will continue -- In 2005, the      largest plans, UnitedHealth Group and WellPoint Inc., increased market      share through purchases of other health plans. Expect to see further      activity in 2006: CIGNA and Aetna have spare cash, and Coventry Corp.      seems ready for another acquisition.   3. Consumer-directed plans generate more media coverage than healthcare      coverage -- A lot of health plans and financial institutions like the      new Health Savings Accounts (HSAs) and their associated high-deductible      health plans. However, traditional first-dollar-coverage health plans      have loosened their restrictions in recent years and remain the first      choice among consumers. Despite a lot of discussion, this is unlikely      to change in 2006.   4. The uninsured remain uninsured -- Employers and government tried a      variety of innovative ways of getting healthcare coverage to the      uninsured in 2005. Attempts included "three-share" style plans in which      government, employers, and employees each kicked in a third of premium,      and Maine's launch of its Dirigo Health, but both saw poor uptake.      Small-scale attempts to deal with a large-scale problem are no more      likely to succeed in 2006.   5. Medicaid moves back toward managed care -- Texas, Ohio, and Georgia all      extended their managed care Medicaid programs in 2005, moving large      numbers of beneficiaries out of fee-for-service. This won't sweep the      country in 2006, but expect to see several companies, including Aetna,      extending their management of Medicaid.   6. Health plans continue their progress on encouraging electronic medical      records (EMRs), and 2006 could be a break-out year -- Health plans love      EMRs, which make tracking and quality checking of healthcare easier and      cheaper, and want providers to love them too. So the upgrading of      systems will continue, with dramatic initiatives by Kaiser, Blue Cross      and Blue Shield of Massachusetts, and others.   7. HMOs decline -- HMOs have been losing market share. A few bastion      states, like Michigan and Massachusetts, will have high HMO      participation, but, as employers move more and more to self-insurance,      HMO market share nationally will continue its decline.   8. Disease management expands -- Health plans will rely on disease-      management programs to attempt to control costs, and are beginning to      see results. The newest programs are in managing complex chronic      conditions such as hemophilia, scleroderma, and multiple sclerosis.      Such conditions are relatively rare, but greater oversight of each      expensive case can show good financial return.   9. Individual insurance plans with basic benefits increase market share --      As the cost of health insurance rises for employers of all sizes,      insurance is becoming more of an individual game. Health plans are      tapping into this market with basic-benefits plans for recent college      graduates, early retirees, and people between jobs.   10. Pay-for-performance shows its hand -- Health plans have been pushing       pay-for-performance measures on physicians for several years. 2006       will be a critical year for measuring return on investment now that       some P4P programs have several years' worth of data to evaluate. Does       P4P improve physician performance or pay already high-performing       physicians more for work they would do anyway? Results in 2006 will       help answer these questions.  

The full Top Ten Health Trends for 2006 report is available on request from

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  For more information, contact:    Alex Jablokow    Decision Resources    781-296-2562 

SOURCE: HealthLeaders-InterStudy

CONTACT: Alex Jablokow of Decision Resources, +1-781-296-2562,

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