Trend 1: Calculating risk is a gamble when it comes to individual plans
The news that Aetna will stop offering individual plans on public exchanges in 11 of the 15 states where it currently operates shouldn’t come as much of a surprise to industry insiders. Aetna’s defection follows the highly publicized decision by UHS, Humana, and Blue Cross/Blue Shield to stop or scale back participation in most public exchanges.
Payers are claiming huge losses due to a higher-than-anticipated pool of high risk patients. To address payer concerns, CMS has modified the way it calculates risk adjustments for CY 2017, but payer concerns about the sustainability of individual health plans offered on public exchanges promises to be an ongoing issue in CY 2018.
Prediction: Look for some payers to experiment with private exchanges and a move away from a defined contribution payment model.
Trend 2: Administrative simplification is making marketing materials a little more complex
CY 2017 marketing material updates included clarifying language on star ratings, LPI requirements, and mobile applications, as well as new submission procedures for the Summary of Benefits, multi-plan documents, alternate formats, and non-English materials. While attempts to standardize submission procedures and add clarifying language may streamline things for CMS, they create potential headaches for health payers who must assume expanded responsibility for complying with new requirements.
Prediction: In CY 2018, payers will seek out automated, repeatable solutions that include reusable master templates and help from skilled solutions architects to incorporate changes for annual enrollment seasons.
Medicare provides profit and opportunity for health payers and CMS
While payers cite huge losses when it comes to individual plans on public exchanges, they do see an upside when it comes to Medicare and Medicaid plans, which continue to be profitable. At the same time, CMS has relaxed marketing restrictions, allowing payers to market plans to potential beneficiaries aging into the Medicare system.
Prediction: Look for payers to absorb risk by expanding Medicare and Medicaid offerings in CY 2018. Meanwhile, CMS will continue outreach efforts to prospective Medicare and Medicaid enrollees.
Accessibility and the Internet of Things is a thing
For CY 2017, CMS added clarifying language regarding delivery of marketing materials via mobile technology and the Internet, a move that indicates healthcare consumers’ growing reliance on the Internet of Things to access correspondence. At the same time, the Department of Justice is considering amendments to Title II of the Americans with Disabilities Act that would make the Internet a public space and add new requirements for web accessibility, while the US Access Board is scheduled to implement new 508 accessibility standards in April 2017. All these changes mean that payers will face increased pressure to provide accessible materials through multiple channels, including downloadable PDFs, mobile applications, and social media.
Prediction: Anticipate an increased focus on accessibility compliance and multi-channel delivery in CY 2018.
References
Luhby, Tami (2016, August 16). Aetna to pull out of most Obamacare exchanges. CNN Money. Retrieved from http://money.cnn.com/2016/08/15/news/economy/aetna-obamacare/index.html
Centers for Medicare and Medicaid Services. (2016, April 4). Strengthening Medicare Advantage and Part D. CMS Press Release. Retrieved from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-04.html
Colman, Kathryn A. (2016, June 10). Contract Year 2017 Medicare Marketing Guidelines. CMS Memo. Retrieved from http://cdn2.hubspot.net/hubfs/608022/2017_MMG_Release_Memo_Summary_of_Changes_061016.pdf?t=1466716964225