Topic Individual insurance

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The Sanitas journey: A digital business model at its core

In this interview, Otto Bitterli (Chairman of Sanitas Health Insurance) discusses the company’s digital transformation and its commitment to being an innovative long-term partner to its customers.

How technology and payment trends are impeding revenue excellence
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How technology and payment trends are impeding revenue excellence

Recent trends are affecting providers’ revenue cycles and altering how providers should manage those cycles. Basic RCM is no longer enough.

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Individual market enrollment dropped 10-12% year-over-year as of the end of first quarter 2017

Enrollment in the individual market decreased by about 2 million members between Q1 2016 and Q1 2017. However, membership changes differed considerably between the on-exchange and off-exchange markets, and between carrier types.

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2016 individual market losses are in the high single digits—a slight improvement from 2015

A new McKinsey analysis suggests that overall carrier losses in the individual market were probably smaller in 2016 than in 2015 (7% to 9% of premiums, versus 10.1% of premiums).

Reports

Against the odds: How payors can succeed under persistent uncertainty

The US health insurance industry continues to be defined by uncertainty. The 25 articles in this compendium can help health insurers navigate the changes ahead.

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Hospital networks: Perspective from four years of the individual market exchanges

An analysis of the individual market health plans being offered across the U.S.reveals that the trends toward narrowed hospital networks and managed care continue.

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What can states do to change key parameters of the individual market?

In part II of this February 2017 conversation, Erica Coe and Stephanie Carlton of the McKinsey Center for US Health System Reform discuss this question with Thomas Barker, former General Counsel at the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, and Ken Choe, a former Deputy General Counsel and Counselor to the Office of Health Reform at HHS. Mr. Barker is now a partner and co-chair of the Healthcare Practice at Foley Hoag. Mr. Choe is now a partner at Hogan Lovells.

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Winning in private health insurance through technical excellence

In private health insurance, a focus on technical excellence in product development, pricing, underwriting, and claims handling can improve insurers’ bottom line—while easing their dependence on investment returns.

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Potential impact of individual market reforms

A wide range of changes to stabilize the individual market have been proposed. This special report examines the impact some of the initiatives could have on claims costs and enrollment by the uninsured.

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Navigating the uncertainty of potential ACA ‘repeal and replace’: A preliminary analysis

The findings in this Intelligence Brief provide an introductory perspective on how the next US administration and Congressional Republicans may approach altering the ACA and related legislation. The information is based on publicly reported information released through December 8, 2016. Our Reform Center team is continuing to refresh this perspective on a real-time basis and is closely analyzing potential implications and economic impacts for each policy element under a full range of scenarios.

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2017 exchange market: Pricing trends

Analysis of exchange premiums indicates that overall prices will continue to increase in 2017. Despite this, some consumers will see their premiums decline given the effect of government subsidies.

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2017 exchange market: Plan type trends

Analysis of exchange plans indicates that a majority of carriers are continuing to shift toward managed offerings, and consumers will see less unmanaged plan designs available to them than in previous years.

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2017 exchange market: Carrier participation trends

Analysis of exchange carrier participation nationwide indicates that the overall number of carriers has dropped below 2014 levels. However, a majority of markets will continue to have more than one carrier participating.

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Understanding consumer preferences can help capture value in the individual market

As consumers gain experience purchasing health insurance in the individual market, their attitudes are evolving—and so is the market. McKinsey’s 2016 Individual Market Open Enrollment Period Consumer Survey reveals the changes.

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Transitions in coverage type are the norm for most consumers over time

New McKinsey research shows that changes in health insurance type are a common event for most Americans.

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Exchange performance: Three years in

Three years in, the public exchange market is still in flux. Here’s a look at financial performance to-date.

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Exchanges three years in: Market variations and factors affecting performance

While the individual market is still in flux, careful analysis of carriers’ performance reveals several factors are associated with better results.

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2016 OEP: Consumer survey findings

As the Affordable Care Act (ACA) third individual-market open enrollment period (OEP) came to a close in January, McKinsey’s Center for U.S. Health System Reform conducted its eighth national online survey to gather insights into how the individual-market and consumer behavior have evolved.

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2016 Individual Exchange Rates

Based on nationwide 2016 individual exchange rates, here are overall and state-by-state insights on carrier participation, price leadership shifts, gross premium changes, and the impact of subsidies on 2016 rates.

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2016 exchange market remains in flux: Plan type trends

Facts on the shift toward HMOs on the public exchanges.

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Debunking common myths about healthcare consumerism

As consumers take an increasingly active role in healthcare decision making, payors and providers need an accurate understanding of how healthcare consumerism is playing out. Using data from surveys of thousands of people across the U.S., we debunk eight of the most common myths circulating in the industry.

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Health insurance enrollment and revenue shifts 2013-2014: An emerging story

Between 2013 and 2014 absolute enrollment and revenue grew by 17 million lives and $86 billion respectively.

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2016 exchange market remains in flux: Pricing trends

Despite higher increases in lowest-price plan gross premiums this year, a greater share of consumers are seeing less expensive lowest-price silver net premiums.

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2016 exchange market remains in flux: Evolution of carriers and offerings

The mix of carriers and plans is continuing to change, with nearly half of consumers seeing a new entrant, and plan types becoming more managed.

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Exchange-eligible consumers heading into OEP

As we near the 2016 OEP, outreach and retention efforts are ramping up. Understanding the different consumer segments is critical for driving uptake.

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The emerging story on new entrants to the individual health insurance exchanges

How the competitive landscape on the public exchanges is continuing to unfold

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Insights into Hispanics’ enrollment on the health insurance exchanges

New McKinsey research sheds light on why Hispanic enrollment rates continue to be low – and how these numbers could be improved.

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Hospital networks: Evolution of the configurations on the 2015 exchanges

Updated 2015 network data, including a comparison of networks offered on the 2014 and 2015 exchanges, insights into how networks’ pricing structures are evolving, and insurer and provider participation.

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2015 Individual Exchange product information

State-by-state data and analysis on approved 2015 products offered on federal and state Individual exchanges

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2015 OEP: Emerging trends in the individual exchanges

An analysis of the 2015 exchange landscape, with a view to gaining a preliminary understanding of how the 2015 OEP will differ.

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Individual market enrollment: Updated view

The latest round of our national survey of QHP-eligible consumers tells a story of deeper engagement than previous surveys.

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Exchange product benefit design: Consumer responsibility and value consciousness

This intel brief examines the benefit designs of the new exchange products and their potential impact on consumers, carriers, and providers.

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Individual market enrollment: Early assessments

Our fourth intelligence brief on exchange dynamics shares observations of the individual market through the mid-point of open enrollment.

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Hospital networks: Configurations on the exchanges and their impact on premiums

Our third intelligence brief on ACA exchange dynamics sets forth five observations based on analysis of new network configurations across 20 urban rating areas.

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Exchanges go live: Early trends in exchange dynamics

Our second brief on exchange dynamics is based on a comprehensive analysis of all exchange offerings across the entire US—more than 21,000 unique qualified health plans filed on the public exchanges in all rating areas.

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Emerging exchange dynamics: Temporary turbulence or sustainable market disruption?

This brief comprises an initial set of analyses regarding the structure, competitive dynamics, and pricing on the exchanges, and their implications.