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COLORADO HOSPITAL ASSOCIATION
Public and Private Health Insurance Exchanges: Strategic and Financial
Considerations
Denver, Colorado
April 16, 2013
Copyright 2013 Kaufman, Hall & Associates, Inc. All rights reserved.1
COLORADO HOSPITAL ASSOCIATION
Agenda
• Introductions
• Public and Private Exchanges Overview
• Public Exchanges
• Private Exchanges
• Strategic and Financial Implications
• Questions and Discussion
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Public and Private Exchanges Overview
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Healthcare Exchanges Are Coming• “Exchanges” are marketplaces for individuals and businesses to comparison shop
and purchase healthcare coverage
• Seek to increase competition and/or consumer choice while providing benefit standardization, lower costs
• Public and private exchanges will co-exist in many areas
Public: Individual Public: SHOP Private
• Federally mandated for January 2014
• Individual exchanges will target uninsured and self-insured individuals
• SHOP exchanges will target small employers early on
• Community-rated premiums with limited risk-adjustment
• Small business tax credits and individual subsidies will make exchanges attractive
• Won’t exist in all states
• Targeted to large and mid-size employers
• Less regulated than public exchanges
• Will support defined contribution models
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Public Exchanges: Overview
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(as of 4/1/2013)
State Public Exchange Update
Source: Kaiser Family Foundation, statehealthfacts.org. State Decisions For Creating Health Insurance Exchanges as of April 2013.
www.statehealthfacts.kff.org.
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Public Exchanges: Overview
• Available in all 50 states in October 2013 for January 2014 effectiveness
• Operated at state or federal levels (or shared)
• Standard benefit designs will be consistent across five levels
• Some public exchanges may have limited plan options based on amount of payer participation
• Individual and small group subsidies will be possible via tax credits
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Public Exchanges: Insurer Implications
• Insurers will choose state exchange participation selectively
• Plans will be fully insured, filed, and approved prior to being offered
• Minimum (essential) benefit standards consistent across five benefit levels
• Plans will compete based on price not benefit coverage within any given level (price variance on age, geography, smoking)
• Individual premium rates may increase in many states due to increased taxes, benefit mandates, and underwriting reforms
• Small group premium rates may not be as significantly impacted due to less stringent underwriting reforms
• Guaranteed issue
• No lifetime/ annual caps
• No denials for pre-existing conditions
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Public Exchanges: Consumer Implications• Individuals will evaluate and select plans via web, telephone, or paper
applications
• Benefit advisors or navigators will facilitate education and enrollment
• Older consumers cannot be charged more that 3X the rate younger consumers pay (3:1 rate band requirement)
• Premiums will have actuarial values between 60% and 90%
• Out-of-pocket expenses capped at $5,950 for individuals and $11,900 for families
• Subsidies will be available for those individuals and families whose income is between 133% and 400% of the FPL
• Subsidies in the form of refundable and advanceable tax credits will range from 2% to 9.5% of income based on FPL income level
• Non-subsidized individuals also can purchase insurance via exchanges
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Public Exchanges: Enrollment
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Public Exchange Enrollment Will Come From Both the Uninsured and Commercially-Insured Populations
Currently
Uninsured
Commercial
Currently
Uninsured
Commercial
(Group)
Commercial
(Non-Group)
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Low Early Penalties May Slow Public Exchange Enrollment by the Uninsured
1.0%
2.0%
2.5%
2014 2015 2016
$95
$325
$695
2014 2015 2016
Penalty as a Percentage of Income Flat Dollar Penalty per Person1
1) Flat dollar penalty is indexed to inflation after 2016.
2) Some individuals may be exempt from penalties based on religion, citizenship, income, time noninsured, access to affordable coverage, etc.
Source: Kaiser Family Foundation: The Requirement to Buy Coverage Under the Affordable Care Act. www.healthreform.kff.org.
The penalty for not obtaining coverage will be the greater of a flat
dollar amount or a percentage of income unless certain
exemptions are met2
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Public Exchange
Uptake DriverCommentary
Varies by
State?
PenaltiesExemption prevalence (e.g., whether post-subsidy cost of
bronze plan exceeds 8% of income) will vary by market �
SubsidiesSubsidies taper off markedly at higher income levels;
income mix of uninsured varies by region �
Price ShockHigher premium increases will reduce uptake by those
not eligible for subsidies �
Exchange
Promotion
Growing concerns regarding limited marketing budget for
Federal Exchanges �
Political
Support
Key enabler of Massachusetts success; political
opposition could be barrier in many states �
Exchange
Readiness
Not all exchanges will be equally ready for open
enrollment on October 1, 2013 �
Public Exchange Uptake Among the Uninsured Likely to Vary Considerably by State
Note: Other key factors include the size of the illegal immigrant population and whether a state decides to expand Medicaid.
Source: 1. Gold J.: Worries Mount About Enrolling Consumers in Federally Run Insurance Exchanges. Kaiser Health News, April 7, 2013. 2. Citigroup Exchange
Conference Call. April 8, 2013.
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Drivers That Could Impact Commercial Shift and Employer “Dumping” to Public Exchanges
Driver Influence FactorsShift
Impact
Firm SizeSmaller firms are more likely to chose SHOP exchanges or dump
to HIX ↑
Subsidy/Tax CreditsSubsidy and tax credit availability will stimulate exchange uptake
↑
Delivery CostFavorable insurer network contracts will increase plan
participation and pressure on employers to shift ↑
Wages/Part-Time WorkforceLow-wage geographies will have greater subsidy availability, part-
time employees more apt to shift ↑Exchange Implementation and
Promotion
Good communication, promotion, and receptivity will stimulate
enrollment ↔
TimingInitial uptake could be slow but 2015 /16 could see large
secondary uptake wave once market settles out ↔Exchange Plan Options and
Premiums
Fewer plan options and higher premiums will delay uptake↓
Penalties Low penalties to employers and individuals could delay uptake of
HIX or employer-sponsored insurance ↓
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Significant Portion of Individual Market Commercial Lives Expected to Shift to Public Exchanges
16%
43%
42%
Category 1
< 138% FPL
138% FPL to
400% FPL
> 400% FPL
Commercial Individual Market
Income Levels - National
Source: Surveyed 2007 Population as reported in: Kaiser Family Foundation. A Profile of Health Insurance Exchange Enrollees. March 2011.
Portion may shift to exchanges; sensitive
to price shock given absence of subsidies
Lion’s share expected to move to
exchanges to access subsidies
Portion may shift to exchanges in
states not expanding Medicaid
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81%
39%
-14%-20%
0%
20%
40%
60%
80%
100%
CO
32%National Average
OH
NY
Projected Individual Market Claims Cost Increases by 2017
Society of Actuaries, by State
Warnings of “Premium Shock” Are Growing More Prevalent
Note: Figure reflects gross Increases before subsidy offsets.
Source: Society of Actuaries . Cost of the Future Newly Insured under the Affordable Care Act. March 2013. www.soa.org/NewlyInsured.
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Insurer Individual Small Group
As much as
116%+
As much as
25% to 50%
As much as
40% - 50%NA
Average:
55%
Average:
29%
Source: Mathews A and Radnofsky L. Health Insurers Warn on Premiums. The Wall Street Journal, March 22 2013.
Insurers Are Warning Brokers to Brace For Significant Rate Increases in the Individual and Small Group Markets
Insurer Rate Increase Guidance in Recent Broker Meetings
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Uninsured
Rate-Shock
Impact
Public Exchange
Commercial Group
Public Exchange
CommercialIndividual
Public Exchange
Pre-
Reform
Post-
Reform
Lower
Uptake
Higher
Shift
Lower
Shift
Premium Shock Will Reduce Exchange Uptake by Uninsured and Have a Mixed Effect on Rotation to Exchanges from Commercial
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More Exchange Enrollment Is Projected to Originate From Commercial Lives than the Uninsured in 2014
Currently
Uninsured
Commercial
(Group)
Commercial
(Non-Group)Note: Figures do not total 100% due to rounding. 5K enrollees from Medicaid excluded for
simplicity. High risk pool classified as individual. ESI shift includes SHOP (189K) and individual
exchange (72K) lives.
Source: Society of Actuaries . Cost of the Future Newly Insured under the Affordable Care Act. March
2013. www.soa.org/NewlyInsured.
2014 Exchange Lives:
616K
228K
(37%)
262K
(42%)
127K
(20%)
Projected 2014 Colorado Public Exchange Enrollment by Source
Society of Actuaries
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Public Exchanges: Provider Contracting Terms
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Hospital in
South Carolina
System in
Ohio
System in
Texas
Hospital in
Kentucky
System in
Florida
Medicare Medicare (+) Commercial (-) CommercialMedicaid
• Reimbursement rates will be driven by a variety of factors including provider competition, payer competition, and current contract rates
• Payers are carefully evaluating and selecting a limited number of markets for exchange participation (i.e., UnitedHealthcare selecting between 10-25, BC/BS: 15-25)
• Initial contracts will mirror current commercial contracts but may shift to value-based reimbursement over time
A Broad Range of Public Exchange Contract Rates Is Emerging
Note: Rate examples listed are not meant to be representative of a given state’s exchange contract rates across all providers/ markets.
Source: Mathews A and Kamp J, Another Big Step in Reshaping Healthcare, The Wall Street Journal, 28 Feb. 2013 and UnitedHealth Weighs In on New
Exchange Option, The Wall Street Journal, 17 Jan, 2013
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• A variety of network configurations will be seen across markets
• Tiered and narrow networks are beginning to form in many markets
• FFS reimbursement likely for early network configurations
• Value-based reimbursement likely to follow based on reduced pricing/ cost pressure
• Providers will need to demonstrate the ability to provide high-quality, cost-effective care under a variety of contract designs
Public Exchange Network Design
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"We believe the exchange
is going to be driven by
price, and therefore we're
looking for a lower-price
option.” - Chief Executive
Patrick J. Geraghty
"The need for a smaller network with lower
pricing was critical,“ indicating they hope to offer
a PPO plan built around a provider network
around 40%-45% of its traditional PPO scope
- Juan Davila, EVP
Source: Mathews A.W. and Kamp J. Another Big Step In Reshaping Health Care. The Wall Street Journal, Feb 28, 2013.
Public Commentary from Key Players Suggests… Has recently signed three
BC/BS narrow or "tiered"
network exchange contracts at
less than 10% discount from
existing commercial rates
“Premiums are the most
important factor in consumers'
choices, with more than half
typically opting for a narrow-
network product if it cost them
at least 10% less than an
equivalent with broader choice”
Aiming to pay providers
somewhere between
Medicaid and Medicare
rates, and sees talks
trending toward rates
close to Medicare
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Private Exchanges
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Private Exchanges – What Are They?As the commercial insurance market continues to move from defined benefit to
defined contribution, employers will seek new benefit models to maximize or cap the value of their healthcare benefit subsidies
Private Exchange Sponsors
Defined ContributionDefined Benefit
Private exchanges will support this market shift by offering a broader choice of plan and coverage options sponsored by a variety of organizations
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Private Exchanges – Why Are They Attractive?• Targeted to large employers for active employees and retirees
• Large employers have used retiree private exchanges for 5+ years
• Allow for better benefits cost management and administrative expense reduction
• Employers can continue employee subsidies via defined contribution
• Used to improve coverage choice and potentially offer lower-cost options
• Can be based on “single-carrier” or “multi-carrier” models
• May not be available in all states and areas
• Offer greater flexibility and broader scope of services than public exchanges
• 100+ private exchanges already operating across the country
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1) Percentage of employers who are “extremely” or “very” confident.Source: 1. Employers Held Health Benefit Cost Growth to 4.1% in 2012, the Smallest Increase in 15 Years. Mercer, Nov 14, 2012. www.mercer.com/press-releases/1491670. 2. Nixon A. Western Pa. Employers Explore Private Insurance Marketplaces to Lower Costs. TribLive, March 15, 2013. www.tribline.com. 3. Morrison I. The Impact of Private and Public Health Insurance Exchanges. Hospitals and Health Networks, Jan 8, 2013. www.hhnmag.com.
Surveys Suggest Growing Interest Among Employers in Private Exchanges
18%
56%
2011 2012
Percentage of Employers Who Would
Consider Private Exchange for Active or
Retired Employees
Mercer
23%28%
Public
Exchange
Private
Exchange
Percentage of Employers Who Are
Confident1 Exchanges Would Provide a
Viable Alternative in the Next Few Years
Harris Interactive, 2012
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Drivers That Could Impact Commercial Shift to Private Exchanges
Driver Influence FactorsShift
Impact
“Me Too” Effect Initial wave of employers moving to private exchanges
will result in larger secondary wave in subsequent years ↑Rising Administrative Costs Employers continue to look for ways to lower admin.
expenses of employee benefits ↑Delivery Cost Favorable insurer network contracts will increase plan
participation and pressure on employers to shift ↑Exchange Plan Options and
Premiums
Plan designs and premiums must be as good or better
than current group coverage ↔Paternalism Large employers can be paternalistic and are resistant
to significant changes in employee benefit design ↓Union and Public Sector Collectively bargained cohorts and public sector
employers typically are slower to change ↓
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Source: 1. Based on interview with Liazon Corporation (a defined contribution benefit company) documented in Singhal S, Stueland J, and
Ungerman D, How US Health Care Reform Will Affect Employee Benefits. McKinsey & Company, June 2011.
Chose Less
Expensive Plan
Primary Options for Private Exchange
Employees Seeking to “Trade Down”
�
High
Deductible
Narrow/ Tiered
Network
Impact on Plan Choice of Shift From
Defined Benefit to Defined Contribution
Liazon Corporation1
Attacking Moral Hazard: Private Exchanges Are Likely to Lead Some Employees to Trade Down to Less Expensive Options
70%
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Source: 1. Enrollment Results Show Aon Hewitt’s Corporate Exchange Empowers Employees to Become More Astute Health Care Consumers. Aon Hewitt,
March 18, 2013. www.aon.com. 2. Mathews A.W. Big Firms Overhaul Health Coverage. The Wall Street Journal, Sept 26, 2012. online.wsj.com.
Sears and Darden Private Exchange
• Sears and Darden chose a defined benefit/ private exchange healthcare benefit model
for 2013
• More than 100,000 Sears and Darden employees were given a company credit to
purchase benefits via an exchange sponsored by Aon Hewitt
• Aon Hewitt decision support tools and benefits advisors facilitated employee plan
decisions
Sears and Darden Among the First Major Employers to Pioneer the Private Exchange Concept for Active Employees
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Sears and Darden found that choice of plans changed when employees were presented with expanded plan options and control over employer subsidy
Source: Mathews A.W. To Save, Workers Take on Health-Cost Risk. The Wall Street Journal, Mar 17 2013. online.wsj.com.
70%
47%
18%
14%
12%
39%
2012 2013
Consumer-Directed
Health Plan
HMO
PPO
Distribution of Sears and Darden Employee Health Benefits
by Type of Plan
Many Participants Shifted to Consumer-Directed Plans in the First Year of the Sears and Darden Private Exchange
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Private Exchanges Likely to Be a Catalyst for the Shift to Narrow Networks Over the Longer TermProviders and health systems may have limited or no access to existing and new managed care populations under private exchange plans
�����
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Current State
Open Access
Provider Network
Employee Populations
Enrolled in Traditional
Group Plan
Seek Care Across Broad
Network
Employer groups have traditionally chosen open
access PPO plans with large provider networks
where patients are free to choose any network
provider
Future State
Private exchanges will offer a variety of new plans
which may have narrow or limited networks and
require PCP referrals
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Exchange Product
Provider Networks
Employee
Populations
Enrolled in Private
Exchange Plans
Seek Care Across
Limited or Narrow
Networks
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Private Exchanges Will Break Apart Employee Populations, Leading to New Contracting and Strategic Considerations
Employee populations
will break apart
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Lives will be broken up across multiple carriers and networks, resulting in
increased fragmentation of the market, risk of share and revenue loss
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Public and Private Exchange Summary Outlook
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13%
7%
16%
36%
65%
27%
20%
3%
5%
30%
25%
5%
8%
25%
10%
65%
62%
53%
29%
17%
Projected Shift of Commercial Lives to Public and Private Exchanges 2018 Illustrative National Midpoint Scenario
Estimated Commercial Lives
Distribution by Segment
ESI - Public
ESI - Private
>100
ESI - Private
50-99
ESI - Private
<50
Individual
17%
53%
8%
9%
2018 % Shift to Public and
Private Exchanges - by Segment
2018 % Shift to Public and
Private Exchanges - Total
13%
Note: See appendix for sources and methodology/limitations.
2%
1%
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29%
11%
26%
66%
7%
3%
7%
17%
13%
7%
16%
36%
2018 % Shift to Public
and Private Exchanges
Low Scenario
2018 % Shift to Public
and Private Exchanges
Midpoint Scenario
2018 % Shift to Public
and Private Exchanges
High Scenario
Note: See appendix for sources and methodology/limitations.
Projected Shift of Commercial Lives to Public and Private Exchanges 2018 Illustrative National Scenario Summary
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Strategic and Financial Implications
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Already Second-Guessing? Timing of Public Exchange Participation Can Cause Uncertainty
• Large Texas health system with exclusivity, strong market position, and favorable contract rates (180% of Medicare)
• Offered rates between Medicaid and Medicare for public exchange product participation
• Opted not to participate for 2014
• Other providers in the market accepted contract and rates
Texas Health System Case Study
“Initially we thought this was a no-brainer, but now we’re wondering if
we made the right choice not to participate and what impact it may have
on our existing revenue and growth”
Texas Health System CFO
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Exchanges Will Accelerate Transition to Emerging Payment Models and Create New Strategic/Financial Challenges
Today’s Model Emerging Models
Open Access PPO High Deductible Narrow/ Tiered
Public ExchangesDeployed in some
markets
Catastrophic plans
for enrollees <30
Common payer strategy absent
regulatory/market restrictions
Private ExchangesExpected to decline
over time
Likely near-term
model of choice
Expected to increase over time as
narrow/tiered networks mature
Implications
Risk of Share Loss Limited threatRisk of OP share loss to lower cost/
freestanding competition
Risk of IP/OP loss
if not in-network
Price Pressure Limited threatSignificant for OP services with
cheaper freestanding competition
Threat of steerage increases payer
leverage for IP/OP prices
Bad Debt Limited threat ChallengeLow actuarial value exchange
plans may create challenges
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Transparency Tools Are a Key Catalyst for High Deductible Impact
• Growth in high deductible health plans has prompted payers and employers to develop price transparency tools revealing cost and quality data to members
• Informed patients are likely to choose the “low-cost/high-quality” providers when faced with increased cost sharing
• Providers in competitive markets are at risk of revenue and market share erosion as payers and patients become aware of reimbursement variance
• Improving cost structure and competing on value is the only viable long-term option
Select Companies Offering Transparency Tools
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Exchange Participation Timing Implications
• Current market position should drive participation timing
• First and second mover options present unique costs and benefits
2014 2015 2016 2017
Enter
Exchange
Market
Enter
Exchange
Market
Health System A
Non dominant
market position and
low rates
“Second Mover” Advantage
• Rate/ revenue preservation
• Market settling
• Access more favorable contracts
Enter
Exchange
Market
Enter
Exchange
Market
“First Mover” Advantage
• Increase market share via initial wave
• Narrow network priority access
• Revenue growth
Health System B
Strong market
position and high
rates
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COLORADO HOSPITAL ASSOCIATION
• Current market position should drive participation timing
• First and second mover options present unique costs and benefits
2014 2015 2016 2017
Enter
Exchange
Market
Enter
Exchange
Market
Health System A
Non dominant
market position and
low rates
“Second Mover” Dis-Advantage
• Carved out of narrow networks
• Revenue and share loss
• Less favorable contract options
Enter
Exchange
Market
Enter
Exchange
Market
“First Mover” Dis-Advantage
• May lock-in unsustainable low rates
• Increased bad-debt exposure
• Slow exchange uptake could delay benefits
Health System B
Strong market
position and high
rates
Exchange Participation Timing Implications (continued)
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What is the optimal way to balance these threats and opportunities?
Balancing New Revenue Opportunities and Cannibalizing the Existing Commercial Business
Uninsured
�
Exchange
Commercial
�
Exchange
New Rev. Lost Rev.
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COLORADO HOSPITAL ASSOCIATION
Multiple Interdependencies Warrant Careful Consideration
New Exchange Revenue from
Uninsured
Commercial Rotation to Exchange
Uptake Rates
Market Share
Contract Rates
Degree of Shift
Market Share
Contract Rates
Financial
Impact
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Strategic Dynamics Will Vary by Market
Driver Commentary
Commercial Price
Levels
Higher prices relative to Medicare create more “room” for
undercutting and amplify the potential for material financial impacts
Capacity Utilization
Narrow/tiered networks less impactful if capacity constraints
preclude meaningful steerage; some spare capacity needed for
tiered/narrow networks to be effective
Market Willingness to Give
Up Choice
The price discount required to give up choice will vary by market,
leading to different tradeoffs between price and volume
Urban vs. Rural
Competition is required for narrow/tiered contracts to be
practical/effective; rural markets with sole community providers will
be less dynamic
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Impact Area Commentary Imperative
Rates
Accepting lower rates for exchange
products could negatively impact existing
commercial rates (“spillover effect”) via
employer and payer pressure
Careful evaluation of current
commercial book to determine
financial risks/opportunities of
accepting new rates
Contract Terms
Terms and conditions of exchange
contracts could impact existing commercial
products
Use caution developing contract
strategies and conducting
negotiations. Ensure reasonable
termination periods
Reimbursement
Methodologies
Initial methodologies will most likely not
differ from current commercial contracts
but future models will be value-based
Must possess or develop key skills
and competencies for increased risk
and value-based contract success
Price
Transparency
Transparency will drive consumer selection
towards low-cost/high-quality providers
Cost reduction and management
are critical for long-term
sustainability
Market ShareShort-term growth may result in long-term
loss based on changing market conditions
Population segmentation analysis
necessary to understand full market
opportunity
Implications of Exchange Participation on Current Contracts and Contracted Rates
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• No risk
FFSIncentive
-Based FFS
P4PCase Rates
Partial Risk
Full Risk
Health Plan
• VBP• Bonuses• Withholds
• Episodic• Bundled
payments
• Limited scope
• Gain-share• MSSP
• PMPM• Percent of
premium
• Full integration• Health plan and
delivery system
• Quality and cost payments
• PQRS
• Continued reductions in FFS rates are not sustainable
• Health systems will need to compete on value to maintain and grow market share
• Markets will likely offer a variety of choices based on payers, providers, costs, and sophistication
Upon determination of the appropriate value-based model, specific skills and capabilities must be in place to produce optimal results
Notes: FFS = fee for service; P4P = pay for performance; PMPM = per member, per month; PQRS = Physician Quality and Reporting System.
The Long View: Value-Based Reimbursement Must Be Considered
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How Do You Prepare for Healthcare Exchanges?Kaufman Hall believes that operational and financial success with healthcare exchanges requires an integrated planning framework
• Strategic Planning: A Healthcare Exchange Strategy will be necessary to compete in the changing market environment. New reimbursement and contract models, in addition to FFS, will be used for exchange-based products, most likely requiring providers to assess and acquire new strategies and tactics
• Financial Planning: Many health systems and providers are in the early stages or have not yet begun to plan for how healthcare exchanges will impact their current and future patient populations and revenue base. A thorough analysis and plan to quantify the implications and potential financial impact should be completed
• Tactical Planning: New skills and capabilities will certainly be required for financial and operational success when working with healthcare exchanges. Developing the right tactical plan, resources, and investments while taking into consideration specific opportunities, priorities, risks, and benefits will be necessary
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Questions and Discussion
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COLORADO HOSPITAL ASSOCIATION
Appendix
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COLORADO HOSPITAL ASSOCIATION
• Distribution of lives by segment were estimated using national data on employees by segment (Census, BLS), insurance uptake by segment (Kaiser/HRET survey), and individual market size estimates (Urban Institute)
• Key limitations to distribution estimates
• Linear interpolation applied to the 20-99 segment to estimate <50 and 50-99 segments
• Public firms assumed to have the same coverage rates as large national private firms
• High scenario definition reflects adapted 2011 McKinsey survey results1
• ESI shift to public exchange of 37% (<50 EE), 31% (50-499 EE), and 22% (500+ EE)
• ESI shift to SHOP of 45% (<50 EE) and 44% (50-99 EE)
Projected Shift of Commercial Lives to Public and Private Exchanges 2018 Illustrative National Scenarios – Methodology Notes
1) McKinsey survey results represent portion of employers who would “definitely or probably” shift assuming exchanges become an “easy and affordable” way to obtain coverage.
Source: 1. Historical Data Tabulations by Enterprise Size 2009. U.S. Census. www.census.gov/econ/susb. 2. Employment, Hours, and Earnings. Bureau of Labor Statistics. www.bls.gov/data. 3.
Employer Health Benefits Survey. Kaiser Family Foundation and Health Research & Educational Trust, 2012. 4. Blavin F., Buettgens M, and Roth J. State Progress Toward Health Reform
Implementation: Slower Moving States Have Much to Gain. The Urban Institute, Jan 2012. 5. Singhal S, Stueland J, and Ungerman D, How US Health Care Reform Will Affect Employee Benefits.
McKinsey & Company, June 2011.
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COMPREHENSIVE
SOFTWARE SUITE
Over 1,400 software licenses are in place
nationwide. The ENUFF Software Suite uses
corporate finance principles to directly support the
financial management cycle
COMPREHENSIVE
SOFTWARE SUITE
Over 1,400 software licenses are in place
nationwide. The ENUFF Software Suite uses
corporate finance principles to directly support the
financial management cycle
CAPITAL ALLOCATION
Kaufman Hall helps organizations design and
implement capital allocation processes which provide consistent and rigorous
methodologies to guide the capital decision-making
process
CAPITAL ALLOCATION
Kaufman Hall helps organizations design and
implement capital allocation processes which provide consistent and rigorous
methodologies to guide the capital decision-making
process
MERGERS, ACQUISITIONS,
AND DIVESTITURES
Kaufman Hall has advised on hundreds of M&A-related
engagements including analyzing, structuring,
negotiating and executing mergers, acquisitions,
divestitures, joint ventures, strategic partnerships and
affiliations
MERGERS, ACQUISITIONS,
AND DIVESTITURES
Kaufman Hall has advised on hundreds of M&A-related
engagements including analyzing, structuring,
negotiating and executing mergers, acquisitions,
divestitures, joint ventures, strategic partnerships and
affiliations
FINANCIAL AND CAPITAL
PLANNING
Introduced concept of strategic financial planning to
healthcare field in 1983. Kaufman Hall has prepared
financial and capital plans for over 800 hospitals and
healthcare systems
FINANCIAL AND CAPITAL
PLANNING
Introduced concept of strategic financial planning to
healthcare field in 1983. Kaufman Hall has prepared
financial and capital plans for over 800 hospitals and
healthcare systems
STRATEGIC SERVICES
Kaufman Hall provides a broad range of strategy-
related services to support organizational management
and decision making. Kaufman Hall pioneered the
development of the integrated strategic financial
plan
STRATEGIC SERVICES
Kaufman Hall provides a broad range of strategy-
related services to support organizational management
and decision making. Kaufman Hall pioneered the
development of the integrated strategic financial
plan
CAPITAL MARKETS
Since 1985, Kaufman Hall has acted as financial
advisor to more than 1050 healthcare debt transactions. Total debt and swaps issued
on behalf of our clients exceeds $105 billion and $50
billion, respectively
CAPITAL MARKETS
Since 1985, Kaufman Hall has acted as financial
advisor to more than 1050 healthcare debt transactions. Total debt and swaps issued
on behalf of our clients exceeds $105 billion and $50
billion, respectively
Kaufman Hall Services at a Glance
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