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The Future of Health Reform: What’s Next?

Explore the evolving landscape of health reform, from private health insurance to employer-based options and disruptive innovations, and the trends shaping the future of healthcare.

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The Future of Health Reform: What’s Next?

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  1. The Future of Health Reform: What’s Next? The future of private health insurance Patrick Cahill Vice President, Massachusetts Market March 27, 2019

  2. Health Reform: Almost A Decade After Passage of the ACA is Constantly Evolving • Uninsured levels are at historic lows; around 14% nationally • Coverage for pre-existing conditions and dependents up to age 26 have become core tenants of the health care lexicon • Risk stabilization, uniform rating rules, and essential health benefits have fundamentally altered and brought consistency to plan offerings • 37 states have expanded Medicaid coverage to ACA limits

  3. After Initial Growth Individual Market Enrollments Shrinking Nationally • Subsidized market driving exchange enrollments • Unsubsidized market shrinking nationally both on and off exchange

  4. Employer Based Insurance Market Health Care Financing Disrupting the Risk Pool Small employers/ Individuals: • Short-term limited duration plans • Association health plans • HRA rule • Self-funding alternatives • Large employers: • Captives • Purchasing coalitions • Private exchanges • Pharmacy carve-outs

  5. Health Plan Focus On Improving Population Health Medical Management Initiatives Pharmacy Management Innovation in Provider & Pharmacy Contracting, concierge Medicine, etc.

  6. Key 2019 trends Employers are playing an activist role Emotional health is moving to the forefront Very high new treatment costs, especially with specialty pharmacy Consumers demanding the latest and greatest New entrants are driving competition and changing the landscape Medical trend continues it’s upward movement • Ranging between 7-9% in New England 2018 Source: National Business Group on Health (NBGH) survey

  7. Tracking disintermediation and new disruptors that could bring significant change Increase in insurers buying physician groups Vertical integrations could significantly change the industry landscape New disruptors are figuring out how to compete in this highly regulated industry • UnitedHealth’s acquisition of DaVita’s physician network • Humana acquiring Kindred Healthcare and Curo Health • Anthem’s acquisition of Aspire Health • CVS – Aetna • Cigna – Express Scripts • Walmart – Humana (rumored) • Magellan – Senior Whole Health

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