United States

A financially viable health insurance marketplace: 3 building blocks

Jul 27, 2015
From the Government Institute

The U.S. Supreme Court's King v Burwell ruling, upholding the availability of subsidies for purchasing health insurance, will certainly generate widespread analysis regarding the future of health insurance marketplaces. Much of the analysis will center on State-based Marketplaces (SBMs).

Whether a state is attempting to stabilize its SMB or considering a transition to another marketplace model, it will need to address the appropriate expense level to operating a marketplace while simultaneously boosting both enrollments and the level of transparency.

The past few years of actual experience offer valuable lessons and insight. This issue brief highlights three priority issues that marketplace leaders should consider as they balance the requirements for lean and efficient operations, against the demands of a highly variable and complex health insurance market.

  1. Consider utilizing a "Per Member Per Month" (PMPM) budgeting and contracting approach
  2. Continually monitor and re-evaluate the IT platform
  3. Do not re-invent the wheel: Share solutions that work


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Patrick Holland
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