Medicaid’s scale and complexity are unprecedented. State Medicaid leaders will need to innovate if they are to develop the capabilities that will enable them to steer their agencies into the future.
Center for U.S. Health System Reform
The Center for US Health System Reform is McKinsey’s in-house source on health policies related to reform. Launched in 2010 to advance knowledge and insights critical to reform-related strategy, organization, and operations, we have deepened our expertise beyond the ACA to other new policies to help stakeholders continue to thrive in an inherently regulated market. The Center's goal is to help our public, private, and social sector clients address the implications of the ACA-related marketplace activity and other transformative health policies, while also sharing knowledge and research with the broader public. Read more on McKinsey.com
This analysis reflects carrier participation, pricing, and plan type trends for the 2018 individual exchange open enrollment period. Findings are across 50 states and D.C.
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.
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).
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.
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.
A new concept, organizational agility, can help healthcare companies adapt more quickly to changing customer needs, competitor responses, and regulatory guidelines—without requiring a full-scale restructuring.
This paper explores opportunities states could consider to improve their Medicaid programs, both to control spending and improve the program's performance.
In our healthcare system, those in the best position to control risks and costs often have inadequate incentive to do so. Refining healthcare financing and reimbursement requires a deep understanding of the nature of medical risk.
In part I 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.
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.
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.
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.
Two steps—increasing healthcare-sector productivity and improving healthcare-market functioning to better balance the supply of and demand for health services—would likely produce sufficient savings to lower medical cost inflation to the rate of GDP growth.
In October, CMS released the Medicare Advantage Star ratings for 2017. By analyzing CMS’s data, we uncovered trends indicating it will be critical for payors to continue to invest in their capabilities if they want to deliver quality programs that receive a Star bonus.
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.
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.
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.
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.
New McKinsey research shows that changes in health insurance type are a common event for most Americans.
Changes in provider economics are requiring them to rethink their sustainable valuable propositions. Here’s how.
What insights from a large employer survey tell us about the current and future state of employer health benefits.
While the individual market is still in flux, careful analysis of carriers’ performance reveals several factors are associated with better results.
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.
Offering a health plan can give health systems an opportunity for growth, but it is not without financial risk. To benefit from this move, health systems should use a different lens to understand both consumers and risk, know where the best growth opportunities are, rethink their payor-provider interactions, and take advantage of integrated claims and clinical data.
We analyzed every individual exchange hospital network across the U.S., and here’s what we learned.
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.
Facts on the shift toward HMOs on the public exchanges.
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.
Between 2013 and 2014 absolute enrollment and revenue grew by 17 million lives and $86 billion respectively.
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.
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.
As we near the 2016 OEP, outreach and retention efforts are ramping up. Understanding the different consumer segments is critical for driving uptake.
How the competitive landscape on the public exchanges is continuing to unfold
New McKinsey research sheds light on why Hispanic enrollment rates continue to be low – and how these numbers could be improved.
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.
As the Affordable Care Act’s (ACA’s) second individual market open enrollment period (OEP) came to a close in February, McKinsey’s Center for U.S. Health System Reform conducted our seventh national online survey to discern insights into how the individual market has evolved.
State-by-state data and analysis on approved 2015 products offered on federal and state Individual exchanges
Survey findings shed light on how a variety of factors could affect the decisions consumers make about enrolling: eligibility for subsidies, penalties for not enrolling, satisfaction with 2014 plans, and increases in premium rates.
On October 10, 2014, CMS released the Medicare Advantage (MA) Star ratings for 2015.
Eliminate fragmentation in the Medicaid delivery system, and you free up funds for other state spending priorities.
A close look at the public exchange network in 2014.
With the first OEP concluded, this retrospective overview shows how the market landscape has evolved.
Private exchange enrollment is projected to nearly double in 2014 and could comprise 20% of the employer market by 2019.
ACA reimbursement changes are likely to bring shifts in growth and profitability across counties.
From 2012 to 2019, Medicaid enrollment is projected to grow by 9-15M lives (16-26%), and by the end of the period managed Medicaid is expected to cover ~80% of enrollees.
This updated view of the network configurations being offered on public exchanges across the country suggests that consumer choice of health plan design is expanding.
This intelligence brief discusses the results of our April individual-market consumer survey, which confirm observations from the first open enrollment period and indicate possible future behavior.
This intelligence brief discusses the likely impact (on both reimbursement rates and MA margins) of the provisions contained in the the final 2015 Rate Announcement and Call Letter for Medicare Advantage and Part D programs.
The latest round of our national survey of QHP-eligible consumers tells a story of deeper engagement than previous surveys.
This intel brief examines the benefit designs of the new exchange products and their potential impact on consumers, carriers, and providers.
Our third intelligence brief on ACA exchange dynamics sets forth five observations based on analysis of new network configurations across 20 urban rating areas.
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.
This brief comprises an initial set of analyses regarding the structure, competitive dynamics, and pricing on the exchanges, and their implications.
The power of where-to-compete decisions in the health insurance industry is enormous. How can organizations reap greatest benefit from these critical decision points?
This video discusses reform and the unprecedented change underway for payors.
Many payors now have experience developing value networks, but they may not yet have optimized their network configuration or approach. Over the long term, payors must be able to maximize the value these networks deliver.
In the post-reform era, payors will attempt to capture savings by creating limited networks with reduced reimbursement rates. To respond, health systems need a clear understanding—market by market—of their competitive advantages and of when, if, and how to trade price for volume.
For most health systems, the one-time impact of expanded insurance coverage on utilization will be small but significant. Systems that can capture a substantial share of the increase in utilization may gain a competitive advantage.
Although the ACA may make revenue cycle operations more complex, it also presents an opportunity for providers to improve, excel, and differentiate. By adapting their RCM operations and acquiring new capabilities, providers could open up opportunities to win.
This paper outlines five broad changes in the U.S. healthcare system and the likely strategic responses across the value chain.
The United States has a great opportunity to restrain the cost of its healthcare system, improve medical outcomes, and ease the financial and psychological burden on US consumers.
At the time of publication, the United States spent $650 billion more on healthcare than expected, even when adjusting for the economy’s relative wealth. This report examines the underlying trends and key drivers of these higher costs.
Making healthcare more affordable is the key to making the US system sustainable. Bringing the three largest sources of underlying costs and their growth under control is necessary.