Health Plan Analysis
Strengthen account engagement, strategic planning and sales strategy development
US managed care from every angle
National and regional healthcare is in constant flux due to shifting health plan dynamics. You need to understand payer realities and reactions to build effective relationships.
Insight by markets
Strategic targeting
Refine messaging
Insight by state, health plan, MCO and exchange
Insights into benefit utilization dynamics
Our data and analysis help customers understand control and influence over benefit utilization within each market segment. You can also see how payers are responding to challenges and how that affects benefit cost and utilization. Additionally, we bring clarity to key relationships between payers, providers and PBMs.
Dedicated analysts
Our team of analysts are dedicated to researching trends affecting enrollment and benefit utilization in each market and our insights keep you up to date on those trends, saving you time and resources.
Anticipate changes and challenges
Our insights provide forward-looking analysis so you can anticipate future changes and challenges.
Marketplace insights
For account managers, our insights provide a deep understanding of the broader marketplace and the policies/regulations that may influence access to drugs and requirements placed on payers/providers and pharma.
Strengthen account engagement, strategic planning and sales strategy development
- Use our statewide predictive analysis of health plan enrollment and benefit design
- Assess payer and provider influence over benefit utilization through our data and insights
- Identify the emerging payer cost control trends and strategies and investigate the dynamics driving payer decisions
- Understand the policy decisions and rules affecting access to medical and pharmacy benefits
- Gain a state level understanding of the relationships between payers, providers, and pharmacy benefit managers and how the market is changing
- Leverage our event-driven analysis to stay abreast of changes in your markets and eliminate blind spots in your account engagement strategy
- View CMS Star Ratings by plan and by state
- Plan with Clarivate’s Medicare Advantage enrollment forecast
We leverage our unparalleled market access data and analysis to deliver personalized, actionable insights, from pre-launch through product maturity and down to the local level to answer the most important questions your Market Access team faces.
The Health Plan Analysis Dashboard
Insights include:
- County level heat maps of enrollment, allowing quick analysis of where the largest payers are most prevalent
- Snapshot of pharmacy copay and rejection rates by therapy area for each state based on DRG real world pharmacy claims data
- Full Medicare Advantage rate information by plan and by state
- Medicare Advantage enrollment forecast
- Full CMS Star Ratings by plan and by state
- PBM enrollment and market share analysis
Powerful and comprehensive analysis:
- Major M&As and their impact on the state’s healthcare environment
- Updates on recent healthcare reforms
- Recent legislations passed/ proposed by the state that will affect participating insurers, providers, PBMs and pharma manufacturers
- Key developments and their implications summarized in an easy to assimilate, tabular format
- Provides an in-depth overview of economic indicators such as unemployment rate and un-insurance rate at MSA level
- Explains regional differences within the state
- Explores the relationships between providers, payers and patients with respect to drug reimbursement
- Detailed description of state’s exchange market
- Exchange enrollment data and trends
- Key exchange developments and their impact on patient care and drug utilization
- Commercial sector enrollment trends, market share of key insurers
- Foundational things to know about commercial enrollment and providers in each state
- Key commercial market developments and their implications for patient care and pharma strategy
- Medicaid enrollment trends, market share of key insurers
- Administration
- Key decisions taken by the state regarding expansion of Medicaid eligibility, implementation and adopting mandatory managed care policies, and more
- Medicaid spending, including recent budget adjustments and their impacts
- Medicare enrollment trends, market share of key insurers
- Detailed data on description of Medicare Health Plan Quality and Performance Ratings (commonly known as star ratings)
- Foundational things to know about Medicare Advantage in each state
- Key managed Medicare developments and their impact on patient care and drug utilization
- PBM coverage and relationships
- Key PBM developments impacting patient care and pharma strategy
- Foundational things to know about PBMs in each state
- Summary of recent legislation impacting the payer and pharmaceutical sectors
