Doing business with the government is nothing new for many health plans. But even for the most government-oriented insurers, the game has changed. Medicaid is expanding. Medicare’s population is growing. And health insurance exchanges are live. More government money in the system means more government influence as well—and as the government changes its purchase expectations and interactions with plans, plans will likely change not just the amount of business done, but also how it’s done.
Your new biggest customer
Are you equipped for a new era in collaboration and cost control?
Medicare and Medicaid are expanding and exchanges are brand-new. All three models mean your growth opportunities are funded by the public sector—and more of the rules that accompany that funding. Risk selection, plan design and actuarial calculus may not be the focal points of profit anymore. Instead, plans will need to do a better job of improving quality, engaging customers and controlling costs by reinventing relationships with providers and guiding individual members to make better health care choices.
Plans may also diversify to help members with wellness and prevention, help providers with population management, or move into new markets.
What’s your plan to expand and remain profitable as you grow in government-funded programs? Do you have the tools to support the change as you head into new territory?
Government programs: Meet your new biggest customer
There’s more to the government’s new influence than the simple law of supply and demand applied to a huge and growing customer base. Reform brings plenty of explicit new rules about rating, breadth of coverage, actuarial models, and medical loss ratios. More government influence can mean less room to maneuver in plan design, ratings, and risk selection. The challenge for you, as a health plan, is to find other ways to differentiate yourself.
Find out more about meeting the these challenges. Download the report.
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