Monday, 20 June 2016 04:59

Online Forum Touts Successes Experienced with Health Insurance Marketplace

Written by Mark Spivey

m spiveyThe launch of the federal Health Insurance Marketplace three years ago came with its share of issues and controversy – but today, the ship seems to have been righted, according to some providers and the head of the Marketplace itself.

Health Insurance Marketplace CEO Kevin Counihan lauded a host of success stories leading up to the June 9 “Marketplace Year 3: Issuer Insights & Innovation,” a live-streamed forum organized so providers nationwide could share anecdotes and best practices.

“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,” Counihan wrote in a recent post on the Centers for Medicare & Medicaid Services (CMS) Blog.

Presenters for the forum included issuers from across the country, ranging from major commercial insurers to integrated health systems to regional carriers and others. They were invited to describe innovations regarding 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.

“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 (Patient Protection and) Affordable Care Act (PPACA), individual market insurers competed in large part by finding and only covering the healthiest, cheapest consumers,” Counihan wrote. “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.”

Counihan outlined three areas in particular where progress has been made:

Value-Based Payment Design

Aetna set a goal to have 75 percent of its spending go through value-based contracts by 2020, Counihan noted in his blog post. Today, the company has more than 800 value-based contracts in 36 states.

“Under Aetna’s 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,” he added. “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.”

Additionally, Counihan noted, 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. A study performed by the New England Journal of Medicine recently found that the program saved money while also resulting in patients receiving better care than similar patients in other states.

Coordinated Care

The University of Pittsburgh Medical Center (UPMC) Health Plan in Pennsylvania has leveraged early collaboration between providers and care coordination teams, leading to measurable success, Counihan said. 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.

“(Additionally), 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,” Counihan wrote. “They’re calling this effort a ‘Total Accountable Care Organization,’ or ‘TACO.’ It’s a healthcare 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 recently closely analyzed its prospective Marketplace customers, and from this the company learned that their new market wouldn’t look the same as their pre-PPACA individual market – and that there would be more variety in health issues across communities. Based on the research, the company created plans for the different needs of unique communities, using “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,” Counihan added. “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, the company helped grow its Hispanic membership from 8,000 to 30,000 members.

“These are just a few of the new ideas and innovative strategies that are being used – they’re what make me so confident in the future of the Marketplace,” Counihan wrote. “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.”

For more insurance about the Health Insurance Marketplace, go online to


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Mark Spivey is a national correspondent for

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Last modified on Tuesday, 21 June 2016 06:48