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10 health insurance stories to watch in 2016

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5. Debate over narrow networks. A trend driven in part by the ACA, the rise of narrow provider networks will continue to be a hot-button topic in 2016. In response to concerns about the practice, state insurance commissioners and the federal government have proposed more network-adequacy controls--the latter receiving industry pushback. Carefully designed tiered networks such Horizon Blue Cross Blue Shield of New Jersey's Omnia Network also have come under fire from hospitals. But with insurers increasingly pressured to keep premiums low and cut overall costs, narrow networks may well be the new normal.

6. Criticism of nonprofit insurers' surpluses. The year 2015 was not an easy one for some large Blue Cross and Blue Shield plans. Blue Shield of California lost its long-held tax-exempt status in March, and has come under fire from advocacy groups and the state ever since. Then in late December, Health Care Service Corp. drew scrutiny over its $9 billion surplus. The heat on such plans isn't likely to dissipate in 2016, and may even increase in the highly charged political environment leading up to the presidential election.

7. Increased focus on value-based care. However the policy winds blow, the healthcare industry's transition from volume to value is certain to continue, with health insurers playing an increasingly active role in cutting costs and improving quality. As four of the country's largest insurers make their case for why their mergers will benefit consumers, the stakes are even higher for them to prove they can play a critical role in helping members access care to improve health. Expect to see Medicaid managed care play a major role in innovation, and accountable care organization agreements will continue to proliferate.

8. Outcry over rising prescription drug costs. Already a major political issue, the drug-cost debate will intensify in 2016. And insurers are likely to seize upon the changing tide of public opinion to pressure the pharmaceutical industry into value-based pricing agreements. Yet at least one expert has already made the case that insurers themselves may share blame for rising drug costs, making it an even trickier issue for the industry to navigate. 

9. Evolution of the payer-provider relationship. Even as they fight to block health insurers from merging, providers seem more willing than ever to join forces with their usual traditional foes in order to adapt to the shifting healthcare landscape. The same goes for insurers, which find that coordinating care with hospitals and doctors can be a sound business strategy. The two sides will continue to compete, however, in the lucrative Medicare Advantage sector, where provider-sponsored plans are proliferating.

10. The disruptive influence of technology. The health insurance sector has seen a slew of tech-driven startups determined to upend the status quo--a trend that will continue as long as the fundraising dollars keep flowing. Even entrenched, traditional payers such as Aetna are constantly revamping their strategies for connecting with consumers through mobile devices. Finally, the federal government's ongoing effort to improve Healthcare.gov will prove to the industry how critical a role technology plays in consumer engagement.

Of course, if there's one major lesson I've learned while covering the health insurance industry, it's that it's wise to expect the unexpected. So there's sure to be plenty in store that will come as a surprise in the coming year. But like all forms of change, better to embrace than fear the unknown. Here's to a productive--and interesting--2016. - Leslie @HealthPayer