McKesson Corporation · NYSE:MCK
McKesson — Health Insurance Exchange and Network Management Solutions Webinar (June 2013)
19 slides from McKesson's conference presentation, Jun 19, 2013
Slide 1: Health Insurance Exchange & Network Management Solutions
Health Insurance Exchange & Network Management Solutions Mike Flanagan AVP, Product Management June 19, 2013
Slide 2: Today's Presenter
Today’s Presenter Mike Flanagan Associate Vice President of Product Management McKesson Health Solutions 2
Slide 3: Agenda
Agenda Health Insurance Exchange Projections Required Health Plan Capabilities Network Flexibility is Key Other Challenges Solved with Network Flexibility Q&A
Slide 4: Insurance Enrollment Projections
Insurance Enrollment Projections By 2016, many HIX products will require narrow networks Projected Insurance Enrollment 2012 2017 Uninsured drops 50% due to ACA FFS Gov Market up 13% • Most of growth due to FFS Medicare with more boomers drawing Medicare benefits Government Commercial Market u
Slide 5: The Models – States Choose Approach
The Models – States Choose Approach U.S. Department of Health & Human Services 5 Copyright © 2013 McKesson Corporation and/or one of its subsidiaries.
Slide 6: States using varied approaches for HIX
States using varied approaches for HIX 6 Copyright © 2013 McKesson Corporation and/or one of its subsidiaries.
Slide 7: Top 3-5 Health Plans in a State expected to participate in HIX
TOP 3-5 Health Plans in a State are expected to participate in HIX 7 Copyright © 2013 McKesson Corporation and/or one of its subsidiaries.
Slide 8: HIX Minimum Plan Requirements & Plan Cost Sharing
HIX Minimum Plan Requirements & Plan Cost Sharing Minimum Plan Requirements1 Cost Sharing Models • Ambulatory patient services, such as doctor’s visits • 60 % of costs covered and outpatient services BRONZE • Emergency services by the health plan • Hospitalization • Maternity and newborn care • 70 %
Slide 9: Health Insurance Exchange Challenges
Health Insurance Exchange Challenges Market Payer Challenges Complexities No clear standard Price Contraction Compressed Timelines Network Adequacy Managing beneficiaries and Impacts of Newly Insured churn Manage changes to operations, Employers’ Strategies? technology and capital 9 Copyright © 2013
Slide 10: Health Insurance Exchange Challenges: Network Adequacy Regulatory Standards
Health Insurance Exchange Challenges Network Adequacy Regulatory Standards Qualified Health Plans must meet network adequacy network standards… • include essential community providers to ensure reasonable and timely access to a broad range of such providers for low-income, medically underserved indi
Slide 11: Health Insurance Exchange (HIX) Challenges: Network Management Opportunity
Health Insurance Exchange (HIX) Challenges Network Management Opportunity Direct to Consumer Model Compete on Price and Network Quality and Access Nimbly create Closely manage narrow but medical & Targeted accessible network administrative costs Networks, to fit enrolled Low Price Flexible to mainta
Slide 12: HIX Impacts on Network Management
HIX Impacts on Network Management Our customers have shared with us… Network Cost Impact Network Design Operations and Contracting • Studies in MA • Repurposing closed • Uncertain if existing demonstrate that HMO network as networks will be while HIX narrow network for sufficient to handle successfu
Slide 13: Need to Efficiently Design & Manage Networks
Need to Efficiently Design & Manage Networks Manage quality, access, cost/price, contracts Design Networks • Rapidly design and deploy attractive and efficient networks for HIX • Model complex contract terms & value based arrangements Manage Networks • Single source of truth for provider data • Alig
Slide 14: Clearly, today's approach is no longer sustainable
Clearly, today’s approach is no longer sustainable… Increased administrative costs Database 1 due to inefficient provider and Database 3 Network network management processes Development Manual Configuration & Maintenance Manual Load Provider Data • New Credentialing Management applications Manual •
Slide 15: Network management automation & integration
Network management automation & integration Automated Network Design Automated Network Eligibility & Maintenance Network Provider Data Credentialing Development Management Identify HIX On going providers based maintenance of HIX upon specific criteria network affiliations Single source of network in
Slide 16: Network flexibility can solve other challenges as well
Network flexibility can solve other challenges as well… New Populations Care Delivery • Health Insurance • Accountable Care Exchanges (HIX) Organizations (ACOs) • Managed Medicaid / • Patient Centered Medicare Medical Home (PCMH) Payment Reform Employer & Member • Bundled / episodic Demands payments
Slide 17: McKesson Provider Manager Brings the Required Capabilities
McKesson Provider Manager Brings the Required Capabilities Required Capabilities Business Value • Automate network design and • Reduce medical costs via narrow maintenance for enhanced flexibility networks • Establish single source of truth • Reduce administrative costs through to management and pro
Slide 18: McKesson Network Management Solution Suite
McKesson Network Management Solution Suite Provider Manager Contract Manager Reimbursement Manager Helps health plans increase auto- Helps health plans cost effectively Helps health plans centralize and adjudication rates for new drive strategic care delivery & standardize contracts while driving re
Slide 19: Questions?
Questions? 19 Copyright © 2013 McKesson Corporation and/or one of its subsidiaries.
McKesson — Health Insurance Exchange and Network Management Solutions Webinar (June 2013) on 6ix