Healthcare leaders dig into reform's business opportunities

Efficient payers will get a bigger share of the bigger pie, says CVS/Caremark CEO Larry Merlo

Healthcare reform presents a big opportunity for insurers to boost membership--as long as they can increase efficiency and embrace trends such as retail healthcare, leaders at this year's JP Morgan Healthcare Conference said.

The San Francisco conference brought companies and investors together to discuss shifts in the healthcare landscape and strategies to address them. Several key themes emerged, according to the Forbes report:

Opportunity: Payers should take advantage of the Affordable Care Act's expanded access, With 30 million new patients entering the system, on top of increased federal subsidies, the spoils will go to the most efficient healthcare organizations, which will "get a bigger share of a bigger pie," CVS/Caremark CEO Larry Merlo said.

Insurers should look to exchanges as an opportunity, as they move healthcare consumers into plans that have greater value-added. Thanks to exchanges, the individual policy market will grow from 6 million lives to 75 million by the end of the decade, Aetna CEO Mark Bertolini said, according to Forbes.

An increased emphasis on community-based healthcare: Conference speakers predicted an increased role for primary care, health sensors, urgent care centers and low-intensity pharmacy care. A report last September indicated pharmacist-provider collaboration is key to improving population health, FierceHealthcare previously reported. The post-reform focus on population health management also has propelled hospitals into the insurance market, as MedStar Health, the largest health system in the Baltimore-Washington, D.C., metropolitan area, has launched its own health plans.

A more retail-focused healthcare system: Aided by governmental and employer subsidies, consumers will be buying more and more healthcare services directly, conference speakers said. This is largely due to the ACA's federal exchanges, Forbes noted. Allowing insurers to directly enroll consumers into plans they're selling on the federal health insurance exchange could send numbers soaring, as FierceHealthPayer previously reported. In fact, approximately 25 percent of Americans are expected to buy individual exchange plans by the end of the decade, according to Forbes.

More insurers have been jumping on the retail bandwagon. Blue Cross Blue Shield of North Carolina, for example, is opening half a dozen retail storefronts to pitch its exchange offerings and educate North Carolinians--uninsured and otherwise--about how the exchange works, FierceHealthPayer previously reported.

To learn more:
- read the Forbes article

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