- The healthcare industry is undergoing a major transformation, and organizations that learn the new rules of the game will be the ones that succeed, CMS acting Administrator Andy Slavitt told industry leaders at the Marketplace Year 3: Issuer Insights and Innovations forum in Washington, D.C.
- The ACA set the transformation in motion, bringing millions of newly insured into the healthcare system and shifting the focus to value-based care.
- As a result of the ACA, a new $40 billion market has opened up that will continue to grow, Slavitt said.
Slavitt said there are five questions that every organization should be asking if they want to succeed in today’s evolving healthcare space:
- What is your vision and cultural reference point for serving this population?
- How well do you know your customers?
- Can you build a relationship with consumers around things they need and value?
- Have you created a product that meets the needs of your customers both for service and affordability — not a commercial product, but a marketplace product?
- When you find what works, how do you replicate it into a growth strategy?
He noted, for example, that some newly insured continue to use the emergency room at high rates because they don’t understand how to use the healthcare system. Services such as telemedicine, free primary care and engaging physician networks to manage and reduce bed days can cut down on ER use.
“Almost everyone, including those who are contracting this year, have told us they want to find a way to grow into this market and are still committing significant capital to getting their models right,” Slavitt said. He mentioned that one commercial plan that is growing via a Medicare Advantage physician collaborative and another that sees the ACA marketplace as a way to grow a national plan.