King v. Burwell: How should payers move forward after the ruling?

david_toumala_headshotWith the U.S. Supreme Court handing down its decision today in the Affordable Care Act case King v. Burwell, health insurers can turn their full attention to preparing for their continued participation in the health insurance exchanges. Ruling to retain policies in accordance with the current PPACA law as written allows the tax subsidies to stay in place, enables consumers to continue purchasing insurance coverage through the exchanges, and avoids any potential market disruption.

But while it may be “business as usual,” payers should take this opportunity to reflect on their processes and offerings to ensure they are ready for the next year.

  • Achieving sustainable growth. What is your product mix? What customer segments will you target? A sound market and branding strategy, and responsiveness to risk-sharing programs are critical to sustaining growth via exchanges.
  • Operational effectiveness. Addressing gaps in your business processes is critical as open enrollment is fast approaching.
  • Consumer engagement. Providing an optimal customer experience will be more important than ever as consumers continue to become more involved in making decisions regarding their health. The capability to respond to evolving consumer needs, and effectively engage them at every step of the health care journey, should continue to be a priority.
  • Managing risk and improving quality. Data management and reporting, clinical analytics and provider network adequacy must be reviewed to meet quality criteria requirements and better achieve population management goals.

To read more, please download this article: Positioning for continued growth in public exchanges

About the Author

David Tuomala, FSA, MAAA, FCA
Vice President, Risk Optimization and Growth Consulting, Optum

David leads pricing new and existing individual and group benefit plans, analysis of new state and federal laws and regulations, and Medicare Advantage plan pricing and analysis for Optum. He has more than 20 years of experience with plan design and pricing, individual and group pricing and experience analysis, rate filings, and state and federal health care regulation and legislative initiatives.

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