Avalere Health
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Insights

Sep 13, 2016

Top Health Policy Stories of Summer 2016

While we technically have a few weeks of summer left, we decided to take a look back at the stories that were catching people’s attention based on our website hits.

As it turns out exchanges 2.0, value frameworks, and bundles were just a few of the hot topics at the top of the list. Get the full details below (stories ranked in order).

Experts Predict Sharp Decline in Competition across the ACA Exchanges (August 19)

The Hook: Avalere data shows that more than one-third of the country will have no exchange plan competition in 2017. 

The Bottom Line: Less competition = less choices for consumers. So what’s causing this? “Lower-than-expected enrollment, a high cost population, and troubled risk mitigation programs have led to decreased plan participation for 2017,” according to Avalere’s President, Dan Mendelson.

What’s Next: That’s up to the administration and Congress. They can choose to stabilize the markets and reestablish competition – but it will need to be through a consensus process that brings together a larger swath of uninsured.  Presidential, Congressional, and state elections will also be a factor.

Early Analysis Finds 2017 Proposed Exchange Premiums for Low Cost Silver Plans Increasing 8 Percent on Average (July 13)

The Hook: In this Insight, Avalere examined premium data for 14 states and found that 2017 premium increases continue to vary significantly by geography. Requested premiums for average silver plans is 11 percent, but consumers have the option to select lower cost silver plans which are expected to increase eight percent. 

The Bottom Line: Right now, it’s looking like premium increases for 2017 appear to be higher than in 2016. Although there is a chance that the rates can decrease between proposed and final filings. “Exchange consumers have been active shoppers who tend to re-shop each year and gravitate toward lower premium plans,” said Caroline Pearson, senior vice president at Avalere.

What’s Next: Premium data will be finalized and released later this Fall.

Health Plans Are Interested in Tying Drug Payments to Patient Outcomes (June 16)

The Hook: According to a survey conducted by Avalere, Hepatitis C and oncology are the top therapeutic area targets for health plans and pharmaceutical manufacturers looking to enter into outcomes-based contracts.   

The Bottom Line: Specialty medicines now make up a large portion of the pipeline and account for the majority prescription drug spending growth, which often makes them a target for these types of contracts. “Despite the difficulties that plans and drug manufacturers may face when entering into a risk-based contracts, there are opportunities for all stakeholders involved to benefit in the end,” said Kathy Hughes, vice president at Avalere.

What’s Next: As the healthcare system continues the shift towards value, more manufacturers and payers will look to this type of contracting vehicle. Several big names have already entered into these agreements for certain products.

New Cardiac Bundles Could Produce Some Big Winners and Losers (August 11)

The Hook: Eighty-five percent of hospitals that may be required to participate in the new Medicare cardiac bundled payment models would not experience gains or losses that exceed $500,000. 

The Bottom Line: While hospitals are distributed relatively evenly between potential winners and losers under this proposed program, some institutions could face major penalties because their spending far exceeds the average spending for their region.

What’s Next: CMMI plans to implement this mandatory bundle in 98 randomly selected markets effective July 1, 2017.

Outpatient Services Are the Largest Driver of 2017 Premium Increases (August 2)

The Hook: Despite the elevated interest and rhetoric surrounding prescription drug pricing, they are not the main contributor to premium increases. 

The Bottom Line: Outpatient spending accounts for 29.9 percent of 2017 rate increases and represents 27.4 percent of spending in these plans, according to 2015 allowed claims data. 

What’s Next: Given the recent challenges with carrier and consumer participation, we anticipate further scrutiny on exchange plans. The upcoming elections will also serve as an opportunity to discuss the successes and failures of the exchanges.

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