The Affordable Care Act, which officially turned five years old this week, has impacted the healthcare landscape by not only prompting the public healthcare exchanges, but impacting employer-sponsored plans and sparking the growth of Medicare and Medicaid. Here are some of the payer strategies specifically growing in 2015 as a result.
Industry sales, acquisitions and mergers
The time appears ripe for major deals, such as Humana's newly announced sale of Concentra.
Experts suggest the market is still strong for employer-sponsored health plans, and that five years into the ACA, industry leaders have a better sense of where they fit in to the new healthcare landscape and where they want to focus for future growth.
"I definitely think people are getting a lot more confidence and the market is opening up for bolder moves," says Cathy Kenworthy, CEO of Interactive Health, the nation's largest independent workplace wellness provider. One of the trends she's seeing in this regard is hyper-specializing, or micro-specializing, on very specific program elements to become a leader in that space.
Bill Toman, a law partner at Quarles & Brady whose focus areas include healthcare plans, suggests that while many insurers are offering products on the health insurance exchanges and pursuing the individual policy market, there should still be a strong angle for those focusing on employer-sponsored plans—at least for now.
"…The main impact on such plans is yet-to-come when, in 2016, the employer shared responsibility mandate (ESRM) kicks in and requires certain employers to offer coverage to employees," he told Healthcare Dive. "Thus, there should still be growth in the market for employer-sponsored plans and I don't think that model is in jeopardy in the short term."
A recent paper from the Wharton School examines this very question: Is There a Future for Employer-Sponsored Health Insurance? It concludes that the effects of the ACA on employer-sponsored plans will remain modest initially, but grow to impact about 15% of the workforce.
Interest in Medicare and Medicaid
Experts are eyeing the growth of Medicare and Medicaid as a specific market disruptor. Bloomberg Business recently suggested that large insurers might be expected to seek expansion beyond employer-based plans by acquiring companies that provide Medicare coverage, such as Humana and WellCare.
"I have seen a lot of interest in Medicare Advantage, but I think that's as a result of applying the benefits of managed care to Medicare," Toman says. "Rates paid by the government for Medicare Advantage are obviously key, but I'm not sure if the ACA affected those or not."
Derek Bang, CIO of accounting and consulting firm Crowe Horwath, suggests that while it's a reasonable expectation that large payers may go after the growing government-based markets, the particular market trend he sees is in deals with large health systems.
"We have seen many large health systems either acquire or enter into affiliations with payers for closer integration," Bang tells Healthcare Dive. He notes these arrangements are allowing companies to take additional contracting risk with other payers and to contract directly with employers.
"The trend that I believe will continue is payer/provider integration, as concepts like accountable care organizations become more prevalent," he says.
The evolution of wellness programs
A key concern for providers of employer-sponsored health plans is measurement of impact, says Kenworthy.
She tells Healthcare Dive that the market for a sophisticated, measurable, high-impact, preventive care program in the employer workplace is still relatively young and fast-growing.
"From our company's perspective, I think the factors that are driving these workplace programs is the ability to achieve business impact that's measurable, clear and definable," she says. "With regard to the altruism of preventive care, players want to see that translated into clear results and impacts."
As these programs are maturing, she notes, demonstrable impacts are what she sees fueling this trend, more than regulation.
What she sees currently is the "continued pruning" of wellness programs, such as determining what strategies create and generate sustained impact, and moving from program elements that have been discretionary to those that emphasize real impact—such as the identification of individuals in a population that have chronic issues that need intervention.
The trend corresponds to the ACA's move to increase the premium reduction that employers can offer to employees who participate in wellness programs from 20% to 30%, creating a popular incentive.