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The healthcare payment landscape continues to face uncertainty as support grows for additional “site neutrality” in reimbursement, with the policy goal of reducing or eliminating payment differentials between hospital-based outpatient departments (HOPDs) and freestanding physician offices or ambulatory care sites for the same services.

Multi-year health plan products have the potential to change a lot about how healthcare business models work today.

Assessing the future of healthcare price transparency requires taking a couple of steps back to review its recent history.

The hospital and health system leaders we work with are extremely concerned about the financial impact their organizations may experience from potentially significant Medicaid policy changes, following the recent passage of a budget resolution by the U.S. House of Representatives.

The future will favor payers that adapt to changing market circumstances with agency and velocity. Payers will need to make tough choices.

As the Medicare Advantage (MA) Annual Enrollment Period (AEP) is fast approaching, let us imagine a future where Artificial Intelligence (AI) plays a much bigger role in the health plan sales process.

For Medicaid plans that enjoyed a surge in business during the pandemic, this rapid decline in the market may be disheartening, and the large rapid shifts in the Medicaid risk pools will be challenging to manage to target profit margins in the near-term.

U.S. employers have played a dual role in the health insurance of their employees – both paying for their health insurance coverage and choosing their health insurance options. These two roles have been tied at the hip, but now, ICHRA (individual coverage Health Reimbursement Arrangement) products offer an opportunity to bifurcate that role.

The Health Insurance Exchange (HIX) or Marketplace segment can be considered the largest growth market in the payer sector after Medicare Advantage (MA). From a relative low of 11.4 million members in 2020, the HIX market grew to 16.4 million members in 2023.

Today, the commercial group health insurance market is hollowing out, primarily driven by affordability pressures that have been building for decades.

Medicare Advantage has been a tremendous growth story in recent years. Today, however, new risks are emerging from both providers and regulators that could stall and perhaps even reverse the growth strides health plans have made in the MA market.