- CMS acting Administrator Andy Slavitt on Thursday spoke on the ACA marketplace's consumerism during the Marketplace Innovation Conference.
- He disclosed where the agency is aiming its attention to, presented ideas to health insurance companies to work together with hospitals, and emphasized and acknowledged the marketplace is in the middle of a "five year learning and experimentation stage."
- Slavitt encouraged insurers to work with hospitals that have seen significant benefits from the ACA to lower cost for consumers.
The country's uninsured rate hit a record low in 2015, according to a recent report from the CDC's National Center for Health Statistics.
Slavitt noted during his keynote consumers are playing a bigger role in choosing their health plans than ever before. This is leading the marketplace's transition from a business-to-business (B2B) process to a business-to-consumer (B2C) one, where carriers sell products or services directly to consumers.
"The marketplace represents the biggest opportunity for many in health care services to transition from B2B to B2C."— Andy Slavitt (@ASlavitt) June 9, 2016
The ACA marketplace is suceeding by nearly all benchmarks but, as the marketplace is in currrently in an experimentation period, maturity and longterm stability are still yet to come, according to Slavitt. He added the marketplace is a strategic business opportunity for companies to advance into a B2C market.
Slavitt shared three key learnings for the agency "how consumers behave and what they want from the healthcare system." First, even though the markeplace is in a trial and error stage, consumers are engaged. He noted 70% of renrewing consumers on the marketplace returned to proactively chose a plan in lieu of automatic enrollment.
Second, consumers want to shop for their health plans. To wit, consumers chose to search for a hosptial, physician, or prescription (a first in the marketplace last year, processwise) before searching which health plans cater to them 3.6 million times in the 38 state marketplaces.
Finally, consumers "want access to routine services without a deductible, with eight in 10 consumers selecting plans which provide direct services outside of their deductibles like primary care and generic drugs."
Concerning consumer preferences throughout the next two years, Slavitt proposed several questions to prompt exploration and experimentation, including:
- "How do we reach out to and connect with communities that are still left behind?;
- What are innovative and consumer-friendly ways to help consumers manage the costs of care — particularly in rural or other under-served locations?; and
- What marketplace specific contracting approaches will create aligned incentives and reduce the underlying unit costs that are a significant part of a consumer's premium?"
Among the actions CMS has been taking to "strengthen the risk pool, limit upward pressure on rates, and provide a strong foundation for the marketplace for the long term," according to Slavitt, are:
- Eliminated many unnecessary or subject to abuse special enrollment period sign-ups (SEP) and added requirements for validation and enforcement for those who have to enroll during a SEP.
- Proposed enhancements to risk adjustment in order for health plans to invest in serving hard to treat populations via incentives for investments in data and analytics.
- Providing insurers with more timely and improved information for rate filings with the goal of reducing surprise medical bills.
- Improving the data matching process to prevent unnecessary loses of coverage.
"I am highly confident in the focus and expertise of the career staff at CMS, and at the tools at their disposal, to continue to make the marketplace attractive, stable and successful," Slavitt concluded.