Overview

Over 100 issuers and healthcare systems and policy officials gathered on June 9th to share the learning from the first 3 years of the federal healthcare marketplace. The event was kicked off by Sylvia Mathews Burwell, Secretary of Health and Human Services (HHS), with an optimistic review of the progress made with the Affordable Care Act (ACA) from lowering the rate of the uninsured (“9 in every 10 Americans have…healthcare”), to the slowing of insurance prices (“Prices have risen at its slowest rate in years”), and better, higher quality care.

Major themes

Key themes emerged during the course of the day-long forum which included health plans Aetna, UPMC, SelectHealth, Horizon BlueCross BlueShield, BCBS Massachusetts, CareSource of Ohio, BCBS of Florida, CareFirst, Molina Healthcare as well as the Society of Actuaries. Those key themes included the need to use data and analytics to understand the population, grassroots efforts which need to go beyond just traditional healthcare delivery, and the willingness to engage in the journey that will result in healthcare value. Each of the issuers selected to speak at the forum are leaders in the journey towards a shared risk system of healthcare. Also in attendance were key policy makers from CMS and HHS who have been pivotal in interpreting and implementing the provisions of the Affordable Care Act (ACA).

With HHS’s stated mission of funneling more healthcare towards value-based care, the presenters discussed what they learned during the first years of working with the new members they received through the Health Insurance Marketplace. What is clear from their insights is that the health conditions of the population being served need to be analyzed with a data-driven approach. The results of the health and social economic conditions for the unique population requires a tailored approach. Insurers especially need to be sensitive to cultural differences in their populations while building awareness and trust of the ways to use the healthcare system.

Takeaways

According to the presenters at the forum, the outlook is bright for the future of healthcare as we move from fee for service to value-based care. The represented organizations at the forum have seen improvements in the health status of their member populations, and many discussed the need for long-term, sustainable growth. The key message is the need to be flexible and to learn from the data and consumers of healthcare services. Unfortunately, the speakers did not discuss the future direction of key programs like the RADV audits and expectations for how these would impact issuers. Policy implementation direction was noticeably absent at this event.