Monday Jun 16, 2014

Healthcare Payers Need Agility and Flexibility to Implement Medicare Changes for 2015

Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has increased by nearly 33 percent.  Today, enrollment in Medicare Advantage is approximately 15 million beneficiaries. Over half of these beneficiaries are enrolled in a four star or greater plan, which improves their access to care as well as the quality of care they receive.

Kathy McCarthy, Director of Sales Consulting for Oracle Health Insurance, discusses the topic in today’s post:

Many Changes Are in the Cards for Medicare Advantage Plans in 2015

The change in Stars ratings is significant. Plans receiving fewer than 4 stars will no longer be eligible for bonus payments.  Bonus payments for 4 and 5 star plans will be reduced. This can result in the loss of revenue for affected plans. Insurers need to look for new ways to reduce costs to account for the revenue shortfall. This can include anything from lowering administrative costs to improving quality of care.
Some other changes include:

  • Changes in payment models, capitation rates and reconciliation calculations
  • Changes to  out-of-pocket drug spending amounts
  • Improved notification for beneficiaries regarding changes in Medicare Advantage plan networks
  • Greater protection for beneficiaries:
    • Improved access to preferred cost-sharing
    • Improved coordination of care

Payers must act quickly and decisively to implement changes required to improve performance, whether boosting quality, outcomes, operational efficiency, or profitability. As such, healthcare payers should seek greater agility – including in their IT systems, which support modern enterprises. Specifically, they require the ability to quickly introduce new plans as well as support efforts to reduce operating costs and take advantage of emerging opportunities.
As a means to control TCO, healthcare payers are also looking to leverage engineered systems – solutions that combine hardware and software optimized to work together. In addition, many seek more open as well as scalable solutions that can cost effectively expand to meet changing requirements.

Don’t forget to keep up with us year-round:

Monday Mar 10, 2014

Join Us in Boston this Month for Oracle Industry Connect

The global insurance industry is undergoing unprecedented change driven by an uncertain economic outlook, increased regulation, and changing consumer needs. In the midst of this volatility, Oracle’s customers and partners are achieving transformational growth and we want to share their insights with you.

Join us for Oracle Industry Connect, a premier conference designed to promote innovation and transformation through open and provocative discussion within the Life, Property & Casualty and Health Insurance communities. The event will take place March 25-26, 2014 in Boston and features sessions where you can talk to the leaders from the carriers who are embracing innovation. Hear from the carriers themselves about how the Oracle Insurance is helping them streamline their business and technology operations.

You’ll also have a unique opportunity to join your industry peers for in-depth discussions on trends, challenges and opportunities facing insurers today. Reasons to attend include:

  • A Different Kind of Event: Highlighting current industry challenges and opportunities as well as the role of technology in fostering business transformation. The content is discussed and presented through real life customer successes. Our goal is to create a close community of industry visionaries.
  • Content Relevant to the Current Business Environment: This year’s theme is “Time to Transform.” We will explore investments in different functional areas and present multiple approaches to IT investments covering both Business Transformation and IT Transformation.
  • Keynotes by Insurance Industry Leaders and Executives: Hear Celent CEO Craig Weber deliver the insurance program keynote and attend best practices sessions by executives from ING, HPHC, NCB, TIAA CREF, VGZ, Wellpoint and many others.
  • Over 25 Sessions: Focused on Insurers and Healthcare Payers: Insurance and healthcare leaders will discuss the impact of transformation and modernization efforts and how insurers can position themselves to achieve operational efficiency and cost reductions for competitive advantage. Review the full agenda.
  • Breakouts on Special Topics for Deeper Insight: Given the disruptive potential of the Affordable Care Act, we provide insight into technologies that can help leverage this regulation for growth.
  • Customer Appreciation Night: Join us for an electric evening of world-class entertainment, food, and drink at the legendary House of Blues. We are thrilled to present American pop-punk band the Gin Blossoms and the soulful Jermaine Paul.

Don’t forget to keep up with Oracle Insurance year-round:

Friday Oct 25, 2013

Insurers Pushed to Transform Their Business

Everyone in the P&C industry has heard it “We can’t do it.” “Nobody wants to do it.” “We can’t afford to do it.”  Unfortunately, what they’re referencing are the reasons many insurers are still trying to maintain their business processing on legacy policy administration systems, attempting to bide time until there is no other recourse but to give in, bite the bullet, and take on the monumental task of replacing an entire policy administration system (PAS). Just the thought of that project sends IT, Business Users and Management reeling.

However, is that fear real?  It is a bit daunting when one realizes that a complete policy administration system replacement will touch most every function an insurer manages, from quoting and rating, to underwriting, distribution, and even customer service. With that, everyone has heard at least one horror story around a transformation initiative that has far exceeded budget and the promised implementation / go-live timeline.   

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Thursday Oct 10, 2013

Solvency II: The Latest Developments from a Data Management Perspective

The European Commission put forward a draft Directive postponing the application date of the Solvency II Directive to 1 January 2016. The Solvency II Directive, already adopted, creates a modern and risk-based prudential regime for insurance and reinsurance undertakings. National regulatory regimes for insurance, which vary greatly, are no longer able to guarantee an efficient internal market and prevent possible future crises. Join Glenn Lottering, Senior Director of the Insurance Global Business Unit at Oracle, as he discusses the latest Solvency II developments from a data management perspective.

[Read More]

Monday Jul 22, 2013

Health Insurance Exchanges Go Live for Enrollments October 1, 2013. Are You Ready?

The clock is ticking towards October 1, 2013 when public insurance exchanges are set to open their doors and begin offering health plan benefits to an estimated 30 million previously uninsured Americans – as mandated by the Patient Privacy and Affordable Care Act (PPACA). Americans without insurance coverage will be able to choose the insurance coverage that works best for them in a new, open, competitive insurance market. The Insurance Exchange will pool buying power and give Americans affordable choices of private insurance plans that will compete for their business based on cost and quality.

[Read More]

Oracle's flexible solutions can help insurers navigate the change necessary to meet today’s challenges and have the business agility to be prepared for the future.

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