Improving the Marketplace through Innovation

CMS Blog

https://blog.cms.gov/2016/05/09/improving-the-marketplace-through-innovation/

 

May 9, 2016

By: Kevin Counihan, CEO of the Health Insurance Marketplace

 

Improving the Marketplace through Innovation 

The Health Insurance Marketplace has become a reliable source of health insurance coverage for millions of Americans, many of whom used to be locked out of coverage because it was either unaffordable or because of a preexisting condition. Thanks to the combination of the Health Insurance Marketplace, expanded Medicaid, and other provisions of the Affordable Care Act, the share of Americans without health insurance has fallen to the lowest it’s ever been. 

The Marketplace continues to deliver on its promise to offer consumers a place to find affordable coverage that meets their needs. Now in its third year of operation, the Health Insurance Marketplace is a dynamic platform that allows consumers to compare plans not only on premium price, but also on other plan features like the size of the deductible and whether a consumer’s doctors, hospitals, and prescription medications are covered. 

However, the Marketplace is still very young. Just four years ago, the individual market still relied on a business model of denying coverage to those most likely to need it, imposing limits and carve-outs on covered services, and capping insurance coverage well short of what a serious illness can cost. Thanks to the market reforms and financial assistance in the Affordable Care Act, the individual market now looks very different. Today, any consumer can buy any plan, and insurers compete based on the quality and cost-effectiveness of their products, instead of on how well they select their customers. 

Everyone expected that it would take time for companies to adjust their pricing and practices to what is effectively a new market. And it’s also no surprise that the pace of adaptation has varied across issuers. Some companies have struggled so far in this new market, while others are already succeeding in providing affordable care through a sustainable business model. 

The success stories come from all across the country and from diverse types of insurers and markets. But one theme that’s consistent is that success in the Marketplace requires a different approach to providing care than was required for success in the old individual market. 

We are inviting health plans and issuers that have found particular success in serving the new population to present their insights and innovations at a forum on June 9^th. At the forum, presenters will describe strategies around consumer engagement, provider contracting, and care coordination models tailored by population data. And everyone (including issuers Aetna, BCBS of Florida, BCBS of Massachusetts, CareSource, Horizon BCBS, SelectHealth, UPMC, and the Society of Actuaries) will have the opportunity to discuss novel techniques that may help companies offer better health care coverage at lower cost.

 We’re excited to bring together national leaders within the Marketplace to discuss innovative strategies for providing private health insurance coverage. The issuers who will join our conference have diverse characteristics. They are each successful in the Marketplace, but represent plans that are big and small, are commercial and non-profit, and hail from around the country. 

This discussion will also help us work together towards a vibrant Marketplace that drives high-value, high-quality health care. Whether you are a patient, a provider, a business, a health plan, or a taxpayer, the long-term stability of the Marketplace is in everyone’s interest – both families who need access to quality, affordable coverage they can count on, and companies that have a chance to expand into a new market with millions of consumers. 

 

I look forward to our conversations about how to continue to support a competitive Marketplace that rewards better, smarter care.  If you’d like to join our conversation on June 9, please watch a live stream at www.HHS.gov/live .