By Monica E. Oss, Chief Executive Officer, OPEN MINDS
The policies and practices of health plans are a driver of health and human service delivery systems in most markets. Managed care models for the financing and delivery of services have been widely adopted by almost every payer. Over 80% of Medicaid beneficiaries now have their benefits managed by health plans. In Medicare, half of Medicare beneficiaries have opted into Medicare Advantage plans. Commercial health plans now manage benefits for over 90% of that market.
And managed care companies are now managing long-term services and supports, including services for the I/DD population. And managed models have been introduced into the child welfare system and for other types of social services.
At the same time payers and health plans have increased the proportion of service reimbursement involving downside financial risk—now at 19% of total payments. And many health insuring organizations are becoming providers of care. CVS/Aetna, United/Optum, and Humana have completed a number of provider system acquisitions in the past year—CVS Health To Acquire Oak Street Health For $10.6 Billion, Massachusetts AG Approves Optum’s $236 Million Acquisition Of Non-Profit Atrius Health, and Humana Subsidiary, CenterWell Home Health, To Acquire Trilogy Home Health In Florida.
Most executives of organizations in the health and human service market see the direct effects of changes in health plan strategy—and tracking these changes is critical to their own strategy to navigate a changing market.