The
CMS Blog
June 8, 2016
Marketplace Success Stories
By: Kevin Counihan, Health
Insurance Marketplace CEO
Three years in, the Health
Insurance Marketplace is a competitive, growing and dynamic platform – a
transparent market where issuers compete on price and quality, and people
across the country are finding health plans that meet their needs, and their
budgets.
Increasingly, the Marketplace is
also serving as a laboratory for innovations and strategies that are helping us
build a better health care system. Before the Affordable Care Act,
individual market insurers competed in large part by finding and only covering
the healthiest, cheapest consumers. Today, everyone can buy coverage,
regardless of health status, and issuer competition centers on quality and
cost-effectiveness. As a result, issuers in states across the country are
finding innovative ways new ways to provide quality, cost-effective health
care.
This week, as
we’ve previewed, we’re inviting issuers to HHS to share their stories and
their strategies for success on the Marketplace. We’re calling this conference
“Marketplace Year 3: Issuer Insights & Innovation.”
The presenters at the forum include
issuers from all regions of the country and range from major commercial
insurers to Blues plans to integrated health systems to regional carriers to
new plans to longstanding Medicaid plans. They’ll describe innovations around
paying for high-quality care, working with doctors and clinicians to encourage
coordinated care, and using data analytics to find patients, engage them in
improving their health, and provide the services that meet their needs.
Here are some examples.
Value-Based Payment Design
Aetna set a goal to have 75
percent of its spending go through value-based contracts by 2020. Already
today, they have more than 800 value-based contracts in 36 states like Texas,
California, Virginia, Ohio, and many more. Under their national value-based
care network, providers are transforming their practices and improving the
patients’ experience. For example, they are identifying at-risk patients
earlier, engaging patients in care decisions, coordinating care more
effectively, and providing new hospital case managers to explain discharge
instructions and new medications to patients. Not only are the value-based
contracts improving quality, they’re paying off in reduced costs. Aetna is
seeing medical costs come in 8 percent below what would otherwise be expected
in areas with these contracts.
Blue Cross Blue Shield of
Massachusetts has a payment model called an Alternative Quality Contract.
It pays doctors and clinicians based on the quality, efficiency and
effectiveness of their care. And it works. A study from the New England
Journal of Medicine found that this program saved money; at the same time,
it gave patients better care than similar patients in other states.
Coordinated Care
University of Pittsburg Medical
Center Health Plan in Pennsylvania realized that early collaboration
between providers and care coordination teams leads to measurable success.
These coordination teams are made up of nurses, social workers and community
health workers who can visit while the patient is in the hospital, coordinate
their care as they leave the hospital, and depending on the individual’s needs,
check up on them at home. They’re trusted connections between patients and
providers.
Intermountain Healthcare in Utah
has placed behavioral health specialists within primary care offices. While it
costs more up front, they’re finding that it reduces inpatient behavioral
health admissions enough to lower overall costs in the long run while improving
patients’ lives. They’re calling this effort a “Total Accountable Care
Organization”, or TACO. It’s a health care system that cares for the physical
health and behavioral health of its members, while tailoring its long-term
supports and social service offerings for people with significant health needs.
Using Data Analytics to
Improve Patient Care
Blue Cross Blue Shield in
Florida closely analyzed its prospective Marketplace customers. From its
analysis, they learned that their new market wouldn’t look the same as their
pre-ACA individual market, and that there would be more variety in health
issues across communities. Based on their research, they created plans
for the different needs of unique communities. They used “place of delivery”
care models to bring together nurses, analysts, pharmacists, social workers, and
other experts into inter-disciplinary teams that focused on improving care for
high-risk populations in particular communities.
Horizon Blue Cross Blue Shield
in New Jersey used its consumer analytics to identify the uninsured markets
in their area, and launch a targeted marketing strategy to reach those
uninsured residents. With ad placements outdoors, on public transit, and
through social media, as well as mail, digital and email outreach, it reached
communities that other insurers hadn’t. For example, it saw opportunity in the
large number of Latino residents who were uninsured. With a Spanish
language marketing campaign, it helped grow its Latino membership from 8,000 to
30,000 members. And it stepped up its efforts to retain those new consumers.
***
These are just a few of the new
ideas and innovative strategies that are being used – they’re what makes me so
confident in the future of the Marketplace. And as this market continues to
grow and mature, we’ll see even more stories of success as issuers in every
state find new ways to provide reliable, quality, person-centered coverage for
Americans and their families for years and decades to come.
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