United States

Are You Making the Right Decisions? Exchange business under pressure: Risk payments and growth potential

Jul 11, 2016
From the Healthcare & Life Sciences Institute

This is a critical juncture for health plans involved in the exchange business as concerns rise about the security of risk payments under the 3Rs (reinsurance, risk corridors, and risk adjustment). Already, risk corridor payments are forecasted to only be a fraction of what was expected, and some health plans may find themselves returning payments if and when the CMS conducts audits of monthly enrollment data. However, this is not just about future solvency; it is also about future strategy. Indeed, those able to improve the efficiency of their exchange business today should be well placed to make the right decisions to grow tomorrow.