Managed Care

 

Insurers Struggle To Adapt To Health Care Reform

MANAGED CARE October 2012. © MediMedia USA
Editor's Memo

Insurers Struggle To Adapt To Health Care Reform

John Marcille

John Marcille

The Affordable Care Act really is turbocharging change in the managed care industry. Let’s leave aside the election because I believe that there is only a slight possibility that the law will be repealed.

In our cover story about new bundled payment programs, Michael Bailit, the founder of Bailit Health Purchasing, rightly says that the ACA greatly encourages insurer experimentation with new payment methods. He concludes that “bundled payment is an incremental step toward more payment reform.”

Insurers will find that taking incremental steps will be a luxury they’ll covet when it comes to health insurance exchanges. Time is short, and many of the rules aren’t known. The consulting firm PricewaterhouseCoopers released a study this month pointing out that by this time next year, about 12 million people will begin buying their insurance through states exchanges.

In the study — “Health Insurance Exchanges: Long on Options, Short on Time” —Kim Jacobs of UPMC Health Plan points out that “This is the largest open enrollment in our careers.”

What to expect? “Consumers care about price, and with all else being equal price will win — and that’s where health plans will start competing on the exchanges,” says the study.

“Insurance companies must determine how to price at the different levels of plans laid out in the ACA — bronze, silver, gold, and platinum — each having cost-sharing percentages. Some plans will price low to attract new customers, while some may price higher to join the game without initially attracting only the sickest, costliest patients.”

How successful the business side is in designing these plans for the individual market will have a big effect on what is expected of clinical executives.

Ready or not, here it comes.

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014