The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.


ACA Disrupts Business Model for Health Insurance Companies

By Truven Staff
Bill Bithoney imageAfter years of selling insurance plans in large measure to private employers, the ACA now requires private insurers to begin . The ACA has mandated public Health Insurance Exchanges within which qualifying employees will pick and choose from among multiple insurance plans within their market.  This represents a radical, disruptive change in the health insurance market.

Of special interest to many employers (and employees for that matter) is the simultaneous development of private insurance exchanges wherein employers contribute a fixed amount toward a health policy but then have the employee choose the level of plan and the insurer they prefer. 

It is hard to imagine a more disruptive model to the health insurance industry’s historical approach to selling insurance. It is also difficult to imagine a more exciting time in the health care industry.  Let’s all stay tuned!

William Bithoney, MD

Impact of Federally-Run Health Insurance Exchanges

By Truven Staff
Anita Nair-Hartman imageA recent American Medical News highlighted the heavy role federally facilitated exchanges will have now that states have made their decisions on creating exchanges.   Health plans must soon decide whether to participate in public exchanges. To date, 25 states have opted for HHS to run their exchange, and you would think this would streamline operational challenges for health plans. But this is not necessarily true. It’s not clear how much of a role states will have in these federally facilitated exchanges.

From decisions on approving “qualified” health plans to adhering to state insurance regulations, HHS may allow states to have more input into the federal facilitated exchanges.  But for everything we do know about federally facilitated exchanges, there are many unanswered questions. And that, in itself, is adding another layer of complexity as health plans navigate their state exchange strategy and make decisions about their participation. 

Anita Nair-Hartman
Vice President, Market Planning and Strategy

Opting in to Federally-Run Health Insurance Exchanges

By Truven Staff
Mike Taylor imageNew reports show that , leaving the door open for the federal government to fill this void. Some states are ceding exchange responsibilities completely to the federal government, but many states are actively planning to run their own exchanges as a way to decrease the rolls of the un-insured and provide a credible, state-run solution to address health care disparities. While it is true that federal exchanges have their own set of hurdles, I submit a federal exchange system offer some advantages.

Several years ago, before the decision to allow states the ability to run exchanges was announced, some observers noted the allure of a single federal platform for exchanges.  The drawback to state-run exchanges is the complexity that results from up to 50 different sets of exchanges. A federally run exchanges can offer consistency across the country.  Further, non-discrimination rules and “minimum essential coverage” rules and standards can be more easily monitored in a federal exchange as compared to many models in state exchanges.

Employers with operations and employees in many states, and health plans as well, would appreciate a standard set of rules; for these organizations, navigating a single system may be the better option.

These decisions by states are not final – states annually have the option of starting an exchange, and a standard for exchanges could prove to be the “template” for newer models. We will all see how this develops, but I wouldn’t be surprised to see consolidation in these exchanges of the future, rather than re-inventing the wheel 50 times.

Michael Taylor, MD
Chief Medical Officer