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Although it appears unlikely there will be widespread, dramatic design changes in 2011 as plan sponsors attempt to understand the full implications of healthcare reform, there will be some adjustments, primarily among small-group plans. All signs point to cost shifting from employer to employees with the biggest changes focused on deductibles, out-of-pocket maximums and coinsurance. For the managed Medicaid segment, changes in the rules governing rebates from pharmaceutical companies could lead to to a carve-in of pharmacy benefits for the state's Medicaid program. On the Medicare front, Texas providers are moving quickly to establish accountable care organizations.

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