5. Opportunities to support insourced programs. “An industry challenged at times by payer decisions to build rather than buy care management programs could face additional competitive pressure in 2012,” read the report. An industry leader added that the market will continue challenging the value of each program and, with the consolidation in the [managed care] industry, will continue looking at insourcing versus outsourcing. “ACOs may be a greater opportunity, but … these groups will often favor their own solutions rather than those from the outside,” he added. To that point, the report said, many components of population health management will likely prove especially valuable to health plans in 2012, regardless of the build or buy decisions. 

6. Improving care coordination for dual eligibles. Dual eligibles, or those eligible for both Medicare and Medicaid benefits, “attracted significant attention from policymakers in 2011 as economic pressures created an imperative for savings in both programs,” the report read. The need to reduce costs associated with this population is high, and as one respondent put it, “focus on improved care coordination for complex, multi-morbid patients is a must.” The report added Congress and the administration recognized the savings possible through better care coordination for dual eligible by formalizing federal oversight of the population in the ACA. “This heightened federal recognition … places a premium on care coordination services, such as those population health management provides.” 

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7. Federal support for prevention and wellness. Although the ongoing deficit reduction debate in Congress has jeopardized federal support for wellness and prevention, said the report, industry leaders are optimistic about federal program opportunities. “The $15 billion Prevention and Public Health Fund … is an important part of the deferral effort, but only one element of a broader prevention and wellness strategy encompassed by the ACA,” according to the report. Since the law’s passage, Medicare has added annual wellness visits and expanded coverage of obesity and cardiovascular disease prevention services, “and the federal government has made significant grant funding available to states and communities for prevention and care coordination initiatives.”

8. Development of ACA health insurance exchanges. According to the report, development of the reform law’s health insurance exchanges – scheduled to open their doors in 2014 – will draw significant attention in 2012. “Especially with respect to how CMS structures the essential benefits package all participating plans must offer,” it said. Industry leaders said the challenge is ensuring the package is comprehensive and plans don’t dilute population health services to maintain competitive pricing in the exchange market. Although the law includes “preventative and wellness services and chronic disease management,” putting the exchanges squarely in the opportunity column, concerns remain the plans could mirror inadequacies in preventative services sometimes found in smaller employer plans. 

Follow Michelle McNickle on Twitter, @Michelle_writes