Action may come from the states
With encouragement from the Trump administration, states increasingly are going their own way to develop healthcare solutions. Idaho, Maine, Nebraska, New Hampshire, Utah and Virginia are engaged in efforts to expand Medicaid enrollment. Iowa and Idaho have sought to allow the sale of insurance plans that don’t conform to federal requirements, though Idaho’s attempt was limited by CMS. All-payer models, like ones in Maryland, Pennsylvania and Vermont, could help set the stage for later universal healthcare systems. It pays to understand what states are considering because they are as empowered as ever to tailor their own regulatory landscapes.
Focus on efficiency
Consumers, employers and federal programs are committed to seeing value for the high
Diversify product offerings
Most proposals would expand coverage using existing public and private frameworks. Most new growth has come in this area, as can be seen through the ongoing expansion of Medicare Advantage. This continuing shift creates opportunities for payers. Under new models, payers would likely maintain their presence in network and claims management, though they could expect to see administrative savings, increased regulatory burdens and greater compliance requirements. Remaining flexible, reducing redundant processes and capitalizing on opportunities for savings under new regulations are key. Payers that focus on developing supplemental products, investing in retail capabilities and expanding core competencies like fraud prevention will find themselves positioned to continue adding value even in the face of systemic change.