Health Care Consolidation: Trends, Impact and Regulation

In 2014, there were a total of 1,299 mergers and acquisitions in the health care sector – a record number, up from 1,035 the year before. This briefing will discussed the driving forces behind this recent increase in consolidation; the scope and extent of consolidation among doctors, hospitals and insurers; implications for consumers and other stakeholders; and the roles of the Department of Justice and the Federal Trade Commission.

Health Care Consolidation

In 2014, there were a total of 1,299 mergers and acquisitions in the health care sector – a record number, up from 1,035 the year before. This toolkit explores the driving forces behind this trend; the scope and extent of consolidation among doctors, hospitals and insurers; implications for consumers and other stakeholders; and the roles of the Department of Justice and the Federal Trade Commission.

Health Insurance Marketplaces in 2016: What to Expect

With the third open enrollment period for health insurance marketplaces launching November 1st, this briefing took a detailed look at what consumers can expect regarding premiums, health plan availability and affordability.

Empowering the Consumer as the Ultimate Health Care Stakeholder

This briefing, the second in a three-part series on the role of consumers and patients in our health care system, discussed the role of consumers in today’s health care coverage market, exploring questions such as: How is the evolving insurance marketplace affecting the choices consumers have when selecting a health plan, whether through a health insurance exchange, employer, or other mechanism? What information do consumers need to select a plan that is right for them? Are consumers well informed regarding health insurance matters, and do they know how to make use of their coverage once they have it?

The ACA: Experiences in Health Care Coverage and Access

In advance of the third open enrollment period for health coverage under the Affordable Care Act, this briefing examined coverage trends, who has gained coverage and who remains uninsured, and why those uninsured individuals have not obtained coverage.

King v. Burwell Toolkit: To Subsidize or Not to Subsidize

A new Alliance for Health Reform toolkit will help you prepare for and understand the Supreme Court’s King v. Burwell decision, which could come as early as Friday. A major challenge to the Affordable Care Act (ACA) is before the Supreme Court, which is expected to make a decision in the King v. Burwell case by the end of its term in June 2015. The case concerns the legality of health insurance tax credits offered through a federally run health insurance marketplace, as opposed to a marketplace established by an individual state.

The Evolving Coverage Landscape for Small Businesses: Opportunities and Challenges

The Affordable Care Act (ACA) created new health insurance marketplaces for small businesses, known as Small Business Health Options Program (SHOP) marketplaces, and made substantial changes to the regulation of health insurance for small businesses. For purposes of health insurance regulation, small businesses have traditionally been defined by states as businesses with up to 50 employees. The ACA defined the small group market as employers with 1-100 employees, while allowing states to limit small group participation to employers with 50 or fewer workers from 2014 through 2016. Every state chose to do so, but, for plan years beginning in 2016, the definition of small business is set to expand to include those with 100 or fewer employees—with potentially significant consequences for the small group health insurance market and the SHOP marketplaces.

Reporter Briefing: Small Business Health Coverage Changes in 2016- Opportunities and Challenge

Join us for a special breakfast for reporters to address major changes set to take place for small businesses and health coverage in 2016, and proposals to delay or reconsider those changes. The Affordable Care Act (ACA) created new health insurance marketplaces for small businesses, known as Small Business Health Options Program (SHOP) marketplaces, and made substantial changes to the regulation of health insurance for small businesses. For plan years beginning in 2016, the definition of a small business is set to expand from up to 50 employees to up to 100 employees—with potentially significant consequences for the small group health insurance market and the SHOP marketplaces.

Chronic Care Management: Is Medicare Advantage Leading the Way?

Efforts are underway throughout the Medicare program to better manage beneficiaries’ chronic conditions, with the goal of improving quality and lowering the costs of care. With an estimated 31 million Medicare beneficiaries suffering from a chronic condition such as cardiovascular disorders, diabetes and cancer, many still do not receive the coordinated services they need to manage their chronic conditions, and beneficiaries with multiple chronic conditions incur higher-than-average spending. However, traditional fee-for-service Medicare, Medicare Advantage, and newer models such as Accountable Care Organizations (ACOs) differ in the tools and methods available to manage chronic care.

Health Literacy and Health Insurance Literacy- Do Consumers Know What they are Buying?

Despite new private insurance coverage over the past year, many people do not understand the very terms and concepts necessary to make informed choices, according to recent studies. A new Alliance for Health Reform Toolkit, “Health Literacy and Health Insurance Literacy: Do Consumers Know What they are Buying?” addresses the extent and significance of both health literacy and health insurance literacy for Americans buying and using health insurance.

Medicare Advantage in a Changing Health System

Almost three in ten Medicare beneficiaries are enrolled in the Medicare Advantage (MA) program, which offers a choice of competing private health plans – typically managed care plans such as HMOs and PPOs. The Affordable Care Act (ACA) made significant changes to the way Medicare Advantage plans are paid, including tying a portion of payments to a quality star rating system. Despite predictions that MA enrollment would drop in the wake of scheduled payment reductions to the program, the percentage of seniors who are choosing to enroll in MA plans is still growing. However, the impact of upcoming reductions remains the subject of much debate.

Webinar- Regulating Network Adequacy: The New NAIC Model

With the launch of the Affordable Care Act’s second open enrollment period this week, millions of people are again expected to flood marketplace websites to enroll or reenroll in health plans. At the same time, insurance commissioners are announcing draft regulations to help their states respond to an issue that was the subject of major controversy during the first round of enrollment: Some of the new health plans are offering consumers networks that exclude certain doctors, hospitals and other medical providers. Some claim that these networks hamper provider access and choice; others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs, without compromising the quality of care. The November 19 webinar will explain new draft regulations from the National Association of Insurance Commissioners. What are states already doing and must they adopt these regulations? How would this regulatory approach affect consumer costs and access to medical providers? How does it handle tiered networks? What is the effect on consumers, providers and health plans? Will there also be federal standards for health plan networks?

Health Insurance Marketplaces, Round II: Results and Expectations

One day after this briefing, on November 15, the second open enrollment period begins for health plans sold in federal and state marketplaces. More than 7 million people who bought insurance for 2014 can shop around for new plans or stay where they are. Those who received federal subsidies will face a redetermination process to assess their current income and other eligibility factors. Experts estimate there may be millions of new enrollees.

Network Adequacy: Seeking Balance

Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs.

Network Adequacy Briefing for Reporters

Network adequacy experts will meet with reporters Wednesday, August 6 to provide the latest on the subject, including details about model regulations that the National Association of Insurance Commissioners plans to release in November.

Navigating the Health Insurance Landscape: What’s Next For Navigators, In-Person Assisters and Brokers?

Approximately 10.6 million people were aided by more than 4,400 in-person assistance programs in searching and applying for coverage in the first six-month enrollment period. Brokers also played a role in helping consumers sign up for coverage. Some believe that in-person, enrollment assistance programs are key to future enrollment success, while others voice concerns about the training of those offering assistance, and the security of applicants’ personal information. Many questions arise about their effect on coverage moving forward and the funding required to support the programs.

Network Adequacy: Balancing Cost, Access and Quality

Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs.