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Health Insurance Exchanges: Delivering Value for Health Care Consumers and Challenges Ahead Dan Durham Executive Vice President America’s Health Insurance.

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Presentation on theme: "Health Insurance Exchanges: Delivering Value for Health Care Consumers and Challenges Ahead Dan Durham Executive Vice President America’s Health Insurance."— Presentation transcript:

1 Health Insurance Exchanges: Delivering Value for Health Care Consumers and Challenges Ahead Dan Durham Executive Vice President America’s Health Insurance Plans February 24 th, 2015

2 Outline Consumer Priorities Delivering Value in the Exchanges Challenges Ahead Deeper Dive: Provider Consolidation & High Cost Drugs What Are Next Steps

3 Consumer Priorities 3 AffordabilityChoiceQuality

4 Delivering Value in the Exchanges 4 AffordabilityChoiceQuality “…no meaningful performance difference between broad and narrowed exchange networks based on key CMS hospital metrics.”* 92% of individuals have access to narrow networks; 90% have access to broad networks* Premiums for narrower network plans are 5-20% lower compared to broader network plans** *McKinsey Report on Networks on the Exchanges (June) **Milliman, High-Value Healthcare Provider Networks ***Commonwealth Fund, Tracking Trends in Health system performance, July 2014

5 Challenges Ahead 5 Threats to affordable, high quality choices Rising Health Care Costs High Cost Drugs Provider Consolidation Need for Quality/Cost Transparency Health Insurance Tax Barriers to Plan Innovation Limited Information on What Works

6 Deeper Dive: Provider Consolidation 6 Consolidation Has Been Ramping Up Rhetoric Does Not Match the Reality Need to Ensure Competitive Provider Markets Nearly 50% Increase in M&A Activity Since 2009 Mergers Are Leading To Higher Prices and Not Necessarily Higher Quality Creating Efficiencies Cannot Be An Excuse for Anti-Competitive Behavior

7 Deeper Dive: High Cost Drugs 7 Not a Truly Competitive Market Limited Negotiating Power on Consumers’ Behalf Need to Ensure More Competition and Transparency How Do We Get More Competition? How Do We Prevent Anti-Competitive Practices? How Can We Ensure that Prices Are Truly Representative of Value?

8 Next Steps 8 Collaboration Performance Measure Alignment Transparency Removing Barriers to Delivering Quality Care Improving the Evidence-Base to Drive Value

9 Stay


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