SummaryHospitals aligned with top payers in the exchanges in their service areas will be well-positioned to benefit from increased volumes and revenues once exchanges start in January 2014.
To maximize opportunities in the exchanges, hospitals must identify health plans likely to gain significant lives in the exchange and work with these payers and community partners to boost enrollment. Hospitals should also work to influence key exchange implementation decisions at the state and federal levels, including the design and implementation of exchange quality and patient satisfaction metrics. Last, hospitals should leverage the value-based payment efforts they are engaged in across payers to exchange-covered lives as well.
While contracting for plan year 2014 is largely over, hospitals should prepare for 2015 to ensure continued alignment with top exchange payers – as the first few years of the new marketplaces will be the most volatile.