PHIX Archives - Recon Strategy

The “weaponization” of ACO narrow networks: Strategic destabilizers which compel their own replication?

Tory Wolff October 1, 2014

In theory, narrow networks built around a single provider or a network of aligned providers (“provider-orchestrated narrow networks” or “ACO networks”) can pose a much higher stakes threat to non-participating providers than ones assembled solely by payers (i.e., where the payer picks who is in based on cost and rates): They are more likely to achieve broad utilization reduction because participating providers can align on principles, build shared capabilities and coordinate management of specific patients consistently. As a result, discounts can play a smaller role in creating a compelling value

Aetna not conceding the private exchange space to the benefits consultants

Tory Wolff May 16, 2014

Summary Aetna is stitching its inventory of ACO deals into a national ACO network and will offer them on its proprietary private exchange (PHIX) Linking ACOs and PHIXs is smart because PHIX’s defined contribution feature creates a strong consumer reward for picking a tighter network product Promising a national network of ACOs is bold: ACO deals depend on willing providers and opportunity in local care patterns; in many geographies, the delivery system isn’t ready or interested. If Aetna can create a national network, it should be attractive to major employers

Risk-taking providers in private exchanges: Medica’s “My Plan” private exchange

Tory Wolff December 4, 2012

At a TEDMED conference a couple years ago, I had to write some sample “ask me” questions on the bottom of my ID badge as conversation starters. One of them was “Ask me why PHIX+ACO=:-)” Given the presentations on 3D tissue printers and technologies to help blind people just about see again, I was not surprised to have few takers. However, recent news from Minnesota suggests that others see the potential in combining risk-taking providers with exchanges. Medica – one of the early leaders in private exchanges with Bloom Health

The Blues system and PHIXs: not standardizing on a single utility

Tory Wolff May 29, 2012

BCBSMN has licensed the platform for its private health insurance exchange (PHIX) and defined contribution product from eHealth (original announcement April 30). For eHealth, which has seen its government systems revenue fall off by $2M year-over-year in the most recent quarter (per Q1 2012 analyst call), the deal will be a welcome addition to its non-commission revenue stream. It also represents a significant in-road into the Blues system (the previous deal with Blues I could uncover was in mid-2010 for licensing the technology behind Premera’s online Medsupp sales). It appears

Towers Watson’s bold move in private insurance exchanges: leapfrog Aon and leave Mercer’s alliance compromised

Tory Wolff May 23, 2012

With its acquisition of Extend Health, Towers Watson has ensured that (1) PHIXs will be a key competitive arena among the major benefits consultants and (2) that it has taken the lead. Extend Health serves 170K members and has annual revenues of ~$50M+, EBITDA margins of ~30% and a growth rate in the most recent reported quarter of 40% vs. a year ago (all taken from the S-1 filing and acquisition press release). Two leading competitors have been publicly discussing their capability building: Aon Hewitt began their exchange in April

Big box retail as health insurance channel: thoughts on the Aetna-Costco deal

Tory Wolff April 27, 2012

Summary Aetna has struck a deal to sell individual health insurance with Costco, the #6 retailer. The deal targets 9 populous states first with more to follow in 2012 While the deal lacks some of the levers of the very successful Walmart-Humana Part D deal, there is real potential for this channel to attract consumers if employers opt-out on a large scale Given that Aetna has some arrangements with Best Buy (the #9 retailer) and an established alliance with CVS (the #7 retailer), it looks like Aetna is building out

The ASO escape hatch for small group: California says “not so fast”

Tory Wolff March 31, 2012

Next week, the California insurance commissioner will propose legislation to deter small employers from exiting the traditional health insurance market and going self-insured. The legislation will put a floor on the amount of losses an employer must incur with any one employee before the stop-loss coverage is triggered (“attachment point”). This won’t affect larger employers which benefit from the balancing impact of their large numbers and so only need to protect themselves from the most catastrophic risks. The bottom lines of self-insured smaller employers are much more vulnerable to even

Private health insurance exchanges and defined contribution: thoughts on Wellpoint’s acquisition of Bloom Health

Tory Wolff September 23, 2011

Why would a health plan want to buy an exchange? Isn’t the only synergy if the owning plan tilts the exchange in their products favor? And won’t that damage the value proposition of the exchange for buyers and see them flock elsewhere? To understand the Bloom Health acquisition, it is important to recognize that the private health insurance exchange (PHIX) space is quite fluid, consisting of three or four distinct market opportunities. (The fourth — capabilities resell — might not really qualify as a PHIX specific opportunity, it is more

Tag: PHIX

Recon takes an analytical look behind select developments in healthcare

The “weaponization” of ACO narrow networks: Strategic destabilizers which compel their own replication?

Aetna not conceding the private exchange space to the benefits consultants

Risk-taking providers in private exchanges: Medica’s “My Plan” private exchange

The Blues system and PHIXs: not standardizing on a single utility

Towers Watson’s bold move in private insurance exchanges: leapfrog Aon and leave Mercer’s alliance compromised

Big box retail as health insurance channel: thoughts on the Aetna-Costco deal

The ASO escape hatch for small group: California says “not so fast”

Private health insurance exchanges and defined contribution: thoughts on Wellpoint’s acquisition of Bloom Health

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