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CMS aims to improve the marketplace through innovation

The Health Insurance Marketplace has become a reliable source of health insurance coverage for millions of Americans, many of whom used to be locked out of coverage because it was either unaffordable or because of a preexisting condition. Thanks to the combination of the Health Insurance Marketplace, expanded Medicaid, and other provisions of the Affordable Care Act, the share of Americans without health insurance has fallen to the lowest it’s ever been. 

The Marketplace continues to deliver on its promise to offer consumers a place to find affordable coverage that meets their needs. Now in its third year of operation, the Health Insurance Marketplace is a dynamic platform that allows consumers to compare plans not only on premium price, but also on other plan features like the size of the deductible and whether a consumer’s doctors, hospitals, and prescription medications are covered. 

However, the Marketplace is still very young. Just four years ago, the individual market still relied on a business model of denying coverage to those most likely to need it, imposing limits and carve-outs on covered services, and capping insurance coverage well short of what a serious illness can cost. Thanks to the market reforms and financial assistance in the Affordable Care Act, the individual market now looks very different. Today, any consumer can buy any plan, and insurers compete based on the quality and cost-effectiveness of their products, instead of on how well they select their customers. 

Everyone expected that it would take time for companies to adjust their pricing and practices to what is effectively a new market. And it’s also no surprise that the pace of adaptation has varied across issuers. Some companies have struggled so far in this new market, while others are already succeeding in providing affordable care through a sustainable business model. 

The success stories come from all across the country and from diverse types of insurers and approach to providing care than was required for success in the old individual market. 

CMS is inviting health plans and issuers that have found particular success in serving the new population to present their insights and innovations at a forum on June 9th. At the forum, presenters will describe strategies around consumer engagement, provider contracting, and care coordination models tailored by population data. And everyone (including issuers Aetna, BCBS of Florida, BCBS of Massachusetts, CareSource, Horizon BCBS, SelectHealth, UPMC, and the Society of Actuaries) will have the opportunity to discuss novel techniques that may help companies offer better health care coverage at lower cost.

 If you’d like to join the conversation on June 9, you can watch a live stream at