Markets at Risk— Current and Future Challenges in a Managed Care Marketplace. A. Industry Level Trends


1. Industry profitability and premium trends. Will premium increases continue and will they contribute improved profitability among health plans?

2. Industry consolidation .To what extent is consolidation evident and influential at both the national versus regional levels?

3. Variation in and implications of market level concentration. Is concentration among health plans increasing in local markets and what are its consequences?

4. Product diversification and membership shifts. Will the number of products continue to grow or will they start to shrink, and what will be membership migration trends?

5. Changes in the extent of ASO/self-funded lives. Will the numbers of self-funded members in health plans continue to increase and what are implications of this trend?

6. Trends in cost-sharing/participation across products. How will increased cost-sharing affect product preferences among consumers?

7. Provider consolidation and premium trends. Will increased rates of provider consolidation and concentration be associated with faster increases in premiums?

8. Commitment of MCOs to accreditation and HEDIS reporting. Will plans lose confidence in the value of trying to respond to private sector external oversight?

9. Purchaser interest in alternative models for financing health benefits. Will providers turn to direct contracting models with providers or opt for more dramatic strategic changes like defined contributions?