As the Affordable Care Act (ACA) third individual-market open enrollment period (OEP) came to a close in January, McKinsey’s Center for U.S. Health System Reform conducted its eighth national online survey to gather insights into how the individual-market and consumer behavior have evolved.
Insights into the 2020 Medicare Advantage marketKim Simoniello
McKinsey’s Center for US Health System Reform recently completed independent research on the options available to consumers selecting Medicare Advantage plans this fall, based on public use data files from the Centers for Medicare & Medicaid Services (CMS).
In July 2021 (July 16–24), McKinsey surveyed strategic and operational leaders from 100 large private sector hospitals in the country to see how COVID-19 had impacted hospital volumes, and to understand what expectations and implications were for the upcoming year(s). A similar survey was also conducted in May 2021, February 2021, and July 2020, with ~30 large health system respondents.
This analysis reflects carrier participation, pricing, and plan type trends for the 2018 individual exchange open enrollment period. Findings are across 50 states and D.C.
Insights into the 2020 individual marketplace—increase consumer choice and de...Kim Simoniello
This analysis reflects carrier participation, pricing, and plan type trends for the 2020 individual exchange open enrollment period. Findings are across 50 states and DC.
Insights into the 2020 Medicare Advantage marketKim Simoniello
McKinsey’s Center for US Health System Reform recently completed independent research on the options available to consumers selecting Medicare Advantage plans this fall, based on public use data files from the Centers for Medicare & Medicaid Services (CMS).
In July 2021 (July 16–24), McKinsey surveyed strategic and operational leaders from 100 large private sector hospitals in the country to see how COVID-19 had impacted hospital volumes, and to understand what expectations and implications were for the upcoming year(s). A similar survey was also conducted in May 2021, February 2021, and July 2020, with ~30 large health system respondents.
This analysis reflects carrier participation, pricing, and plan type trends for the 2018 individual exchange open enrollment period. Findings are across 50 states and D.C.
Insights into the 2020 individual marketplace—increase consumer choice and de...Kim Simoniello
This analysis reflects carrier participation, pricing, and plan type trends for the 2020 individual exchange open enrollment period. Findings are across 50 states and DC.
Consumer optimism in UAE has remained steady since mid-March, but spending patterns have changed.
These exhibits are based on survey data collected in the UAE from June 16–18, 2020. Check back for regular updates on UAE consumer sentiments, behaviors, income, spending, and expectations.
Since May 2020, more Canadians are feeling more pessimistic about the economic recovery and believe COVID-19 will have a lasting impact on the economy .
These exhibits are based on survey data collected in Canada from August 14–19, 2020. Check back for regular updates on Canadian consumer sentiments, behaviors, income, spending, and expectations.
Spanish consumers’ overall economic pessimism has decreased since November, but caution about engaging in out-of-home activities continues.
These exhibits are based on survey data collected in Spain from February 23–27, 2021. Check back for regular updates on Spanish consumer sentiments, behaviors, income, spending, and expectations.
While American optimism on economic recovery continues to recover, over half of US consumers do not expect their routines to return until the latter half of 2021.
These exhibits are based on survey data collected in US from November 9–13, 2020. Check back for regular updates on American consumer sentiments, behaviors, income, spending, and expectations.
In Qatar, the prevailing sentiment is uncertainty about the health of family members and the duration of the COVID-19 crisis. Although consumers are optimistic about the country’s economic recovery after the COVID-19 situation subsides, they are cutting their spending on almost all categories. During the crisis, consumers have both adopted and increased their usage of digital activities such as remote learning, videoconferencing, and contactless delivery and pickup of food and supplies.
These exhibits are based on survey data collected in Qatar from April 24–May 1, 2020. Check back for regular updates on Qatari residents’ consumer sentiments, behaviors, income, spending, and expectations.
A new report from PwC’s Health Research Institute predicts that insurance companies will be spending more to pay for prescription drugs starting next year, from around 3% to almost 6% by 2027. Here’s more forecasts on medical spending from the report:
•Generics: Almost half of the estimated sales from the top 100 brand-name drugs won’t be affected by generic competition for another three years.
•Specialty drugs: Spending on specialty drugs — such as biologics or rare disease treatments — has already been growing over the past five years, but by 2020 these drugs may make up more than half of all U.S. drug spending.
•Chronic disease: 85% of all employer-provided insurance spending is on chronic conditions, and obesity and diabetes will be the two top conditions that will account for spending in 2020.
Mexican consumers continue to be worried about their economy during the COVID-19 crisis, with optimism about a recovery climbing slowly.
These exhibits are based on survey data collected in Mexico from February 20–March 2, 2021. Check back for regular updates on Mexican consumer sentiments, behaviors, income, spending, and expectations.
In Turkey, consumers’ income and household finances have been affected by COVID-19. A majority of Turkish consumers are concerned about personal health, the economy, and the duration of the crisis. Both the observed effects and the uncertainty around the situation are manifesting as decreased spending across most categories. A spike in online spending on household essentials and entertainment is expected to continue, at least in the short term.
These exhibits are based on survey data collected in Turkey from April 7–9, 2020. Check back for regular updates on Turkish consumer sentiments, behaviors, income, spending, and expectations.
As containment measures have been lifted, Australian consumers’ optimism has returned to April levels, though spending intent is still negative.
These exhibits are based on survey data collected in Australia from Sep 4–7, 2020. Check back for regular updates on Australian consumer sentiments, behaviors, income, spending, and expectations.
In Spain, consumer optimism about the economy has doubled since February 2021, reaching 33 percent. Consumers indicated greater intent to spend, and almost half intended to splurge this year. At equal rates of 60 percent, Spanish consumers said they are omnichannel shoppers and have returned to participating in out-of-home activities (way up from 20 percent in February 2021). More than four in ten reported changing brands, mainly for price. Over one-third said more of their holiday shopping would be online in 2021 than in 2020, and about 40 percent said they would start shopping earlier.
This document is meant to help with a narrower goal: provide facts and insights on the current COVID-19 crisis to help marketers and business decision makers. In addition to the humanitarian challenge, there are implications for the wider economy, businesses, and employment. This document includes consumer insights from third-party data providers between February 2019 and August 2021, as well as longitudinal surveys conducted between March 2020 and August 2021, in the United States. Check back for regular updates on US consumer sentiments, behaviors, income, spending, and expectations.
Chinese optimism has improved to the highest level since March. Most Chinese consumers expect their routines and finances to return to normal within three months.
These exhibits are based on survey data collected in China from September 16–24, 2020. Check back for regular updates on Chinese consumer sentiments, behaviors, income, spending, and expectations.
Although Japanese consumer optimism about economic recovery is improving steadily, the majority of consumers are still cautious about reengaging in out-of-home activities.
These exhibits are based on survey data collected in Japan from February 24–27, 2021. Check back for regular updates on Japanese consumer sentiments, behaviors, income, spending, and expectations.
Consumer optimism in UAE has remained steady since mid-March, but spending patterns have changed.
These exhibits are based on survey data collected in the UAE from June 16–18, 2020. Check back for regular updates on UAE consumer sentiments, behaviors, income, spending, and expectations.
Since May 2020, more Canadians are feeling more pessimistic about the economic recovery and believe COVID-19 will have a lasting impact on the economy .
These exhibits are based on survey data collected in Canada from August 14–19, 2020. Check back for regular updates on Canadian consumer sentiments, behaviors, income, spending, and expectations.
Spanish consumers’ overall economic pessimism has decreased since November, but caution about engaging in out-of-home activities continues.
These exhibits are based on survey data collected in Spain from February 23–27, 2021. Check back for regular updates on Spanish consumer sentiments, behaviors, income, spending, and expectations.
While American optimism on economic recovery continues to recover, over half of US consumers do not expect their routines to return until the latter half of 2021.
These exhibits are based on survey data collected in US from November 9–13, 2020. Check back for regular updates on American consumer sentiments, behaviors, income, spending, and expectations.
In Qatar, the prevailing sentiment is uncertainty about the health of family members and the duration of the COVID-19 crisis. Although consumers are optimistic about the country’s economic recovery after the COVID-19 situation subsides, they are cutting their spending on almost all categories. During the crisis, consumers have both adopted and increased their usage of digital activities such as remote learning, videoconferencing, and contactless delivery and pickup of food and supplies.
These exhibits are based on survey data collected in Qatar from April 24–May 1, 2020. Check back for regular updates on Qatari residents’ consumer sentiments, behaviors, income, spending, and expectations.
A new report from PwC’s Health Research Institute predicts that insurance companies will be spending more to pay for prescription drugs starting next year, from around 3% to almost 6% by 2027. Here’s more forecasts on medical spending from the report:
•Generics: Almost half of the estimated sales from the top 100 brand-name drugs won’t be affected by generic competition for another three years.
•Specialty drugs: Spending on specialty drugs — such as biologics or rare disease treatments — has already been growing over the past five years, but by 2020 these drugs may make up more than half of all U.S. drug spending.
•Chronic disease: 85% of all employer-provided insurance spending is on chronic conditions, and obesity and diabetes will be the two top conditions that will account for spending in 2020.
Mexican consumers continue to be worried about their economy during the COVID-19 crisis, with optimism about a recovery climbing slowly.
These exhibits are based on survey data collected in Mexico from February 20–March 2, 2021. Check back for regular updates on Mexican consumer sentiments, behaviors, income, spending, and expectations.
In Turkey, consumers’ income and household finances have been affected by COVID-19. A majority of Turkish consumers are concerned about personal health, the economy, and the duration of the crisis. Both the observed effects and the uncertainty around the situation are manifesting as decreased spending across most categories. A spike in online spending on household essentials and entertainment is expected to continue, at least in the short term.
These exhibits are based on survey data collected in Turkey from April 7–9, 2020. Check back for regular updates on Turkish consumer sentiments, behaviors, income, spending, and expectations.
As containment measures have been lifted, Australian consumers’ optimism has returned to April levels, though spending intent is still negative.
These exhibits are based on survey data collected in Australia from Sep 4–7, 2020. Check back for regular updates on Australian consumer sentiments, behaviors, income, spending, and expectations.
In Spain, consumer optimism about the economy has doubled since February 2021, reaching 33 percent. Consumers indicated greater intent to spend, and almost half intended to splurge this year. At equal rates of 60 percent, Spanish consumers said they are omnichannel shoppers and have returned to participating in out-of-home activities (way up from 20 percent in February 2021). More than four in ten reported changing brands, mainly for price. Over one-third said more of their holiday shopping would be online in 2021 than in 2020, and about 40 percent said they would start shopping earlier.
This document is meant to help with a narrower goal: provide facts and insights on the current COVID-19 crisis to help marketers and business decision makers. In addition to the humanitarian challenge, there are implications for the wider economy, businesses, and employment. This document includes consumer insights from third-party data providers between February 2019 and August 2021, as well as longitudinal surveys conducted between March 2020 and August 2021, in the United States. Check back for regular updates on US consumer sentiments, behaviors, income, spending, and expectations.
Chinese optimism has improved to the highest level since March. Most Chinese consumers expect their routines and finances to return to normal within three months.
These exhibits are based on survey data collected in China from September 16–24, 2020. Check back for regular updates on Chinese consumer sentiments, behaviors, income, spending, and expectations.
Although Japanese consumer optimism about economic recovery is improving steadily, the majority of consumers are still cautious about reengaging in out-of-home activities.
These exhibits are based on survey data collected in Japan from February 24–27, 2021. Check back for regular updates on Japanese consumer sentiments, behaviors, income, spending, and expectations.
Why Pioneer ACOs Are Disappearing and 3 Trends to Expect from the ExodusHealth Catalyst
Over of half the Pioneer ACOs have dropped from the program in the last four years, despite achieving $304 million in savings, and fifty percent of the participating ACOs receiving shared savings reimbursements. Why the exodus? Overutilization and inconsistent performance benchmarking and attribution hindered the ability of many participants to achieve success. The overall impact of the program, however, has been a positive one for value-based care. In the next 3-5 years, providers and health systems will bear more of the financial risk of the populations they serve. The proliferation of data, and the tools to analyze and exchange it, will be critical to the long-term success of value-based care.
Five years in, and the Affordable Care Act continues to command conversation in the benefits landscape. Industry players are still scrambling to implement new provisions, keep healthcare costs down, create infrastructure to support new reporting requirements, and develop new payer, provider and care delivery models.
This has, in turn pushed the respective hands of health plans, who have had to change their strategies to fit both the consumerization of insurance and the standards set forth under the ACA.
With end-users in the forefront, health plans must take the strategy implemented 15 years ago with the rise of the internet, and push the marketing and communication initiatives into overdrive to gain and retain customers.
Health plans are shifting their mentality and communication, ant the best of the best are putting time, money, and energy into literacy and new business initiatives.
To simplify, a health plan needs to put the consumer at the center of every decision it makes.
However, in order to plan, communicate, and effectively market to consumers, your health plan must know the consumer, the technology, and the future.
If you’re looking to grow your health plan, we have just released a new guide to help your health plan leverage trends in the post-reform consumer marketplace.
In our latest whitepaper, we share the keys to success for health plans, including the following:
Consumer Trends: Top 5 Healthcare Executive Consumer Strategy Points, Today’s Healthcare Consumers: Six Types of Consumers You Need to Know, Millennial Consumers Special Report
Technology Trends: Big Data, Administration Technology, Payment Technology, mHealth and more.
Future Trends: Accountable Care Organizations, The Future of Telehealth, Continues Rise of Private Exchanges
All of this, and insights on how to make it work for your health plan.
Download this detailed guide, Health Plans: Your Guide to Leveraging Trends in the Post-Reform Consumer Marketplace, free from the Healthcare Trends Institute.
http://www.evolution1.com/health-plans-your-guide-to-leveraging-trends-in-the-post-reform-consumer-marketplace.html
How Physicians Can Prepare for the Financial Impact of MACRAHealth Catalyst
If all goes according to plan, the first performance period for the new Medicare Access and Chip Reauthorization Act (MACRA) is just around the calendar corner. It’s a complicated reimbursement structure with multiple tracks that are guaranteed to reward with bonuses or inflict pain through penalties in CMS’s new zero sum game. To the physicians and practices that adopt this new program early and position themselves for the best fiscal outcomes, go the spoils. But for many smaller practices and those that consistently underperform, the outlook may be glum regardless. Here are some highlights of the new program and the financial impact it will have on clinicians and practices.
The Top Three Healthcare Financial Trends in 2017: Payment Transitions, Disru...Health Catalyst
Influential healthcare financial trends in 2017 emerged in three areas:
Transitions in payment.
Disruption from familiar players and newcomers.
Emerging data skillsets.
Uncertainty has been a common theme for 2017. Organizations continue waiting for clarity on the future of the Affordable Care Act (ACA), while working to implement value-based care. Changes from established healthcare organizations as well as the arrival of prominent newcomers (e.g., Amazon) add to the unsettled outlook, as do emerging data skillsets. Amid the uncertainty, however, healthcare is clearly continuing on the path to patient-centered care. Organizations best positioned for 2018 will understand their performance in 2017’s top three healthcare financial trends as they evaluate their preparedness for the coming year.
Combat the confusion surrounding the changes associated with Heath Care Reform and make sure your marketing plans are suited to thrive in this new environment. Plus, take advantage of our 2015 Essential Marketing Checklist to help you stay ahead of your competitors with your acquisition efforts, while simultaneously maintaining member retention.
Increasing Retention and Reducing Churn Through Innovative Renewal StrategiesEnroll America
While the enrollment community has already made significant progress in connecting the uninsured to coverage over the last two open enrollment periods, action must be taken to address a crucial element in helping consumers maintain coverage —annual renewal. Come learn directly from Michigan Primary Care Association staff that have been actively involved in developing and implementing innovative strategies, materials, and partnerships to increase health coverage retention rates.
Succeeding in Population Health Management: Why the Right Tools MatterHealth Catalyst
The U.S. healthcare market projects that by 2022 90 million Americans will be in an ACO. The upward trend in population health management (PHM) makes the move towards risk-based contracts increasingly urgent for health systems. The industry has been largely unprepared for the shift, as it hasn’t established a clear definition of population health or solid guidelines on transitioning from volume to value. Organizations can, however, prepare for the demands of PHM by adopting a solution that manages comprehensive population health data, provides advanced analytics from new and complex challenges, and connects them with the deep expertise to thrive in a value-based landscape.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
The public health insurance exchanges have been in operation for nearly three years now and may be opening the door for a new generation of engaged health care consumers. Deloitte’s 2016 Survey of US Health Care Consumers sought to understand their satisfaction with coverage, confidence in handling future health care costs, use of online services, knowledge of costs, and how they shop for coverage. http://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/health-care-consumers-health-insurance-exchanges.html
Findings reveal:
o Exchange consumers say they are satisfied with their coverage at the same rate as people with employer coverage
o More exchange consumers feel prepared to handle future costs and able to access affordable care than last year
o More than twice as many exchange consumers report using online information sources to shop for a policy than the average consumer, including those with employer coverage
o More exchange consumers say they understand their costs than consumers with employer coverage, and when they used their coverage, few had surprise out-of-pocket costs
o Exchange consumers shop around for coverage and evaluate the total costs before making decisions, and they continue to be willing to accept network tradeoffs for lower payments
American consumers are navigating a “new normal” of living with COVID-19, embracing at-home testing and the added convenience of virtual care, and seeking new options for how and where they conduct work, according to the latest consumer healthcare insights survey.
Some hospitals have reported returning to pre-COVID-19 volumes for certain services, but the pandemic continues to affect outpatient and surgical volumes, largely due to workforce capacity constraints.
Consumers’ top reasons for delaying healthcare visits in the UAE include concerns around exposure to other people coupled with a lack of trust in facility safety.
These insights draw upon findings from McKinsey’s Consumer Surveys from March 15–22, February 8–12, January 4–11, 2021, and in 2020, November 20, December 6, October 22–26, September 5–7, July 11–14, June 4–8, May 15–18, April 25–27, April 11–13, March 27–29, and March 16–17, 2020 on COVID 19.
Why consumers are crucial for building a sustainable healthcare systemMcKinsey on Healthcare
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2017 hospital networks: perspectives from four years of the individual exchangesMcKinsey on Healthcare
An analysis of the indivdual market health plans being offered across the U.S.reveals that the trends toward narrowed hospital networks and managed care continue.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
The global radiation oncology market size reached US$ 8.1 Billion in 2023. Looking forward, IMARC Group expects the market to reach US$ 14.5 Billion by 2032, exhibiting a growth rate (CAGR) of 6.5% during 2024-2032.
More Info:- https://www.imarcgroup.com/radiation-oncology-market
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
The Importance of Community Nursing Care.pdfAD Healthcare
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Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
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Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
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Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
Tips for Pet Care in winters How to take care of pets.
OEP Survey Consumer Profiles
1. healthcare.mckinsey.com | Center for U.S. Health System Reform
2016 OEP:
Reflection on enrollment
Center for U.S. Health System Reform
May 2016
2. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System Reform
Overview
As the Affordable Care Act (ACA) third individual-market open enrollment period (OEP) came to a close in
January, McKinsey’s Center for U.S. Health System Reform conducted its eighth national online survey to gather
insights into how the individual-market and consumer behavior have evolved.
We surveyed a nationally representative sample of 2,763 qualified health plan (QHP)-eligible uninsured and
individually insured consumers (excluding employer-sponsored, Medicaid- and Medicare-eligible; see appendix
for details) to find out what actions they reported taking during the 2016 OEP (e.g., how they shopped for, and
evaluated, various plans; whether they decided to enroll or go uninsured). We also learned about their awareness
of potential subsidies and penalties and other factors influencing their actions.
All findings reflect the rapidly evolving individual market through February 18. These self-reported findings cannot
be directly compared with publicly reported exchange enrollment; we have examined enrollment trends across
non-ACA and ACA plans (on and off marketplace), while public reports are focused specifically on the ACA on-
marketplace enrollees. We have based our findings on how respondents described their behavior, attitudes, and
demographics, and the descriptions may naturally include some subjectivity.
For additional methodological details, or with any further questions, please contact us at
reformcenter@mckinsey.com.
3. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System Reform 3
Over half of QHP-eligible uninsured individuals have been uninsured for
over three years; many understand trade-offs of remaining uninsured.
While awareness of penalties and subsidies continues to rise, fewer
consumers understand their personal eligibility or are shopping.
Most consumers are renewing; carrier renewing is more likely among those
previous plan renewers, younger, and higher income
Switching is largely driven by plan discontinuation, carrier dissatisfaction,
influence of brokers, and large premium increases.
Nearly a quarter of consumers stopped payment on their premiums in 2015,
yet most repurchased an exchange plan in 2016 and many repurchased the
same plan.
Key observations from our 2016 Open Enrollment Survey
SOURCE: McKinsey Individual Market OEP Survey, February 2016
1
2
3
4
5
4. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System Reform 4
There are seven key segments of the QHP-eligible market
NOTE: The 2016 ACA market is made up of the profiles: New to Insurance, New to ACA plan, Switchers, Renewers, and Payment Stoppers. The Uninsured profile represents the 2016 uninsured market, and Non-ACA profile represents the 2016 non-
ACA market
1 Includes those who report not having insurance for most of 2015. See appendix on page 11 for methodology around how this differs from other publicly reported figures. 2 Other includes Medicaid, TriCare/VA, and other types of health insurance. 3
Percentage represents the number of payment stoppers who re-purchased an ACA plan in 2016. Those who remained uninsured in 2016 are in the Uninsured profile (7% of payment stoppers) and those who purchased a non-ACA plan in 2016 are
in the Non-ACA profile (6% of payment stoppers).
SOURCE: McKinsey Individual Market OEP Survey, February 2016
UNINSURED
QHP eligible
uninsured in
2016
NEW TO ACA
PLAN
Enrolled in
group, non-ACA,
or other2
coverage in
2015, and
purchased an
ACA plan in
2016
PAYMENT
STOPPERS
Enrolled in an
ACA plan in 2015
and stopped
paying premiums
during the year
and became
uninsured or
gained other
coverage
RENEWERS
Enrolled in ACA
plan in 2015
and renewed
with the same
carrier in 2016
(either on or off
marketplace)
2015
NON-ACA
INSURED
Enrolled in a
non-ACA plan,
i.e., plan
renewed from
before 2014, or
new limited
coverage
Details follow Details follow Details follow
% of the 2016 QHP-eligible market
NEW TO
INSURANCE
Uninsured in
2015 and
enrolled in an
ACA plan in
2016 (either on
or off
marketplace)
39% 2%1 10% 6%3 18%20%
SWITCHERS
Enrolled in
ACA plan in
2015 and
switched to
new ACA plan
in 2016 with a
different carrier
(either on or off
marketplace)
Details follow
5%
ACA market
5. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System Reform 5
QHP eligible
uninsured in 2016
UNINSURED
Over half of QHP-eligible uninsured individuals have been uninsured for over three
years; many understand financial trade-offs of remaining uninsured
1 Other includes those who were uninsured as of February 2016, but have churned in and out of having insurance in the past 3 years.
Of the uninsured report concern
about the financial impact of
a major medical event
ATTITUDE
TOWARD
HEALTH
COSTS
Of the ACA-insured report concern
about the financial impact of
a major medical event
CONCERN
Of the uninsured currently
report medical debt
19%
Of the ACA-insured
currently report medical
debt
DEBT
Of the 2016 uninsured have
estimated that it is less expensive
to remain uninsured
43%
TRADE-OFFS
MOST HAVE BEEN UNINSURED SINCE 2013
27
10
Uninsured
only 2016Other1
59
5
Uninsured
for 1-2 yearsUninsured for
3+ years (since
2013 or earlier)
% of 2016 uninsured
SOURCE: McKinsey Individual Market OEP Survey, February 2016
68% Of the 2016 uninsured have tried
to negotiate down a medical bill,
of which 76% were successful
28%
46% female
27% under 30
66% <250% FPL
68% healthy
24% married
“If my health gets any worse or
if it was mandatory that I needed to get
health insurance, then I
could be convinced.”
“Couple of friends of mine did get
penalized…”
“I’m getting full-time hours at my job to
make sure I can afford it first.”
25%54%
6. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System Reform 6
AWARENESS OF SUBSIDIES AND PENALTIES HAS INCREASED
AMONG QHP-ELIGIBLE UNINSURED
SHOPPING HAS DECREASED; PERSISTENTLY UNINSURED LEAST LIKELY TO SHOP
Report they know whether
they are eligible for the
premium and/or CSR1
subsidy
Report they are aware of
how much of the premium
subsidy they qualify for
36%
30%
OPPORTUNITY EXISTS FOR
INCREASED AWARENESS OF
SUBSIDY ELIGIBILITY
41%
60%
62%
70%
% of uninsured who say they are aware of
the existence of premium subsidies, but not
whether they are eligible for it
SUBSIDYPENALTY
% of uninsured who say they are
aware of the penalty amount
2016
2015
45%
40%
% of uninsured
who report shopping
SHOPPED
SOURCE: McKinsey Individual Market OEP Survey and follow-up phone calls, February 2016
While awareness of penalties and subsidies continues to rise, few consumers
understand their personal eligibility or are shopping
1 CSR refers to the cost-sharing reduction subsidy offered to eligible participants by the Affordable Care Act, which helps to reduce consumers’ out of pocket expenditure for deductibles, coinsurance, copayments, and maximum out-of-pocket
costs. Premium subsides are also offered to eligible participants to help reduce the cost of the monthly premium payment 2 Includes those who report not having insurance for most of the previous year. See appendix on page 11 for
methodology around how this differs from other publicly reported figures
TIME SPENT UNINSURED
3+ years 33
1-2 years
Only 2016 68
44
% of 2016 uninsured who shopped
2016
2015
2016
2015
26%
12%
5%
2014 2015 2016
FEWER NEWLY INSURED THAN
PRIOR YEARS
% gaining ACA coverage
in respective year that
were previously
uninsured2
UNINSURED
% of 2016 uninsured
7. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System Reform 7
23%
57%
Enrolled in ACA plan
in 2015 and
renewed with the
same carrier in 2016
RENEWERS
1 Of those who were ACA-insured in 2015 and 2016.
Most consumers are renewing; carrier renewing is more likely among those previous
plan renewers, younger, and higher income
58% female
18% under 30
74% <250% FPL
45% healthy
40% married
GROUPS THAT ARE LESS LIKELY TO SWITCH CARRIERS1…
Individuals who renewed their plan
in 2015 were ~50% less likely to
switch carriers in 2016 than those
who bought a new plan in 2015
Younger individuals (under 50)
were 50-60% less likely than older
persons (50 - 64) to switch carriers.
Higher-income individuals (400%+
FPL) were ~40% less likely to
switch carriers than lower-income
individuals (<399% FPL)
PAST PLAN RENEWERS
MIDDLE AGED AND
YOUNGER
HIGHER INCOME
“I’ve got to keep my PCP – I’ve had her for 12 years. I see lots of specialists and wanted to maintain those relationships.”
“I went back on the Exchange to shop, but it’s overwhelming… I chose my [same] plan again.”
“I've had this insurance company for a long time. I think they do a good job.”
SOURCE: McKinsey Individual Market OEP Survey and follow-up phone calls, February 2016
2015
2016
RENEWALS
ARE HIGH
% of 2016 ACA-insured who were ACA-insured in 2015
Renewed…
Carrier and plan
Carrier, not plan
Neither 20%
8. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System Reform 8
1 Of those who reported paying a premium for their plan as of February 2016
2 Of those whose plan was not discontinued in 2015, since this is mutually exclusive with a premium price change. Includes only
those who reported a change in their premium price.
What switching remains is largely driven by plan discontinuation, carrier
dissatisfaction, influence of brokers, and large premium increases
61% female
8% under 30
76% <250% FPL
55% healthy
45% married
PREMIUM PRICE
INCREASE
PLAN
DISCONTINUATION
2016 PURCHASE CHANNEL
% of 2015 and 2016 ACA-insured
respondents who switched companies1
23
32
Carrier
8
BrokerExchanges
13
20
Increased >10%Increased <10%Decreased
7% of 2015 and 2016 ACA-
insured respondents who
switched companies2
2015 reported plan
premium price change
WHAT DRIVES CARRIER SWITCHING?
SOURCE: McKinsey Individual Market OEP Survey, February 2016
of those who reported
their 2015 plan was NOT
discontinued switched
carriers in 2016
14%
CARRIER DISSATISFACTION
% of 2015 and 2016 ACA-insured
respondents who switched companies
Dissatisfied
37
Satisfied Neither
15
25
Enrolled in ACA plan
in 2015 and
switched to new ACA
plan in 2016 with a
different carrier
SWITCHERS 49% of those who reported
their 2015 plan was
discounted switched
carriers in 2016
9. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System Reform 9
Of payment stoppers were individually
insured in 2014, of which…
67% said they had also stopped
payments on their 2014 plan
REPEAT BEHAVIOR
Reported that they gained
other coverage
Reported that they could no
longer afford insurance
RATIONALE VARIES
MAJORITY REPORTED RE-PURCHASING A PLAN IN 2016, HALF OF WHOM BOUGHT THE SAME PLAN
% of 2015 ACA respondents1
2016 ACTIONS OF THOSE WHO STOPPED PAYMENTS
1 This sample includes only those who were in our survey (uninsured or individually insured in 2016) and therefore may not be
completely representative of the total 2015 ACA market.
Nearly a quarter of consumers stopped payment on their premiums in 2015, yet most
repurchased an exchange plan in 2016 and many repurchased the same plan
49% Of these said they purchased the same plan that they
stopped payment for in 2015
87%
Repurchased
ACA plan
7%
Stayed
uninsured
6%
Bought
non-ACA plan79%
Didn’t stop
payment
21%
Stopped
payment
36%
26%
>50% STOP BEFORE Q4
PAYMENT STOPPERS IN 2015
SOURCE: McKinsey Individual Market OEP Survey, February 2016
% of 2015 payment stoppers by
quarter stopped
Don’t
know
Q2 Q4Q1
20 22
13 17
29
Q3
36% female
31% under 30
71% <250% FPL
43% healthy
48% married
Enrolled in an ACA plan
in 2015 and stopped
paying premiums during
the year and became
uninsured or gained
other coverage
PAYMENT
STOPPERS
DEMOGRAPHICS
67%
10. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System ReformSOURCE: McKinsey Individual Market OEP Survey, February 2016
NOTE: ‘New to insurance’ profile not included here due to insufficient sample size.
1 FPL refers to income as a percent of Federal Poverty Level (FPL)
2 Defined as ‘low’ health risk based on number of chronic conditions and expected healthcare utilization.’ Medium’- and ‘high’-risk percentages not shown here.
Appendix: Demographics of QHP-eligible market segments
UNINSURED
46%
27%
66%
68%
24%
NEW TO ACA
PLAN
53%
19%
47%
39%
49%
2015
NON-ACA
INSURED
51%
27%
44%
51%
46%
SWITCHERS
61%
8%
76%
55%
45%
RENEWERS
58%
18%
74%
45%
40%
PAYMENT
STOPPERS
36%
31%
71%
43%
48%
Female
Under 30
<250% FPL1
Healthy2
Married
11. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System Reform
Survey overview
Through the McKinsey Center for U.S. Health System Reform, we regularly survey a national sample of QHP-eligible uninsured and individually
insured consumers (excludes those eligible for Medicaid and Medicare). This research is independently funded by McKinsey & Company without
contribution from any third party. The objective is to understand the intended actions, shopping, and purchasing behavior of consumers who are
eligible to purchase individual coverage on the ACA exchanges or elsewhere. These surveys therefore provide snapshots of enrollment over time.
These surveys have included phone interviews of a subset of respondents, from which quotes have been used in this publication.
To date, we have completed eight rounds of surveys:
Nov. 25 to Dec. 6, 2013: sample size of 1,846
Dec. 16 to Dec. 20, 2013: sample size of 1,677
Jan. 6 to Jan. 10, 2014: sample size of 1,040
Feb. 4 to Feb. 13, 2014: sample size of 2,096
Apr. 7 to Apr. 16, 2014: sample size of 2,874
Nov. 6 to Nov. 10, 2014: sample size of 2,000
Feb. 21 to Feb. 24, 2015: sample size of 3,007
Feb. 2 to Feb 18, 2016: sample size of 2,763
Caveats: Three important points help clarify how these survey findings should be interpreted.
Some of the reported 2016 ACA-insured respondents purchased coverage through channels other than online exchanges. As a result, our
survey numbers cannot be directly compared with publicly reported exchange enrollment.
Our survey was conducted only in English. Thus, it does not reflect the behavior or attitudes of those who would have preferred a survey in
Spanish or another language.
Some survey findings cannot be compared to publicly-reported figures because of methodology differences. For example, our survey's “New to
Insurance” estimates (2% of 2016 QHP-eligible and 5% of 2016 ACA-insured) are limited to respondents who self-reported to be uninsured for
most of 2015. Some publicly-reported estimates of "newly insured" include a broader group of all consumers who were uninsured at the time
they signed up for a 2016 marketplace plan.
Appendix: Survey Overview
12. McKinsey & Company |healthcare.mckinsey.com | Center for U.S. Health System Reform
Appendix: Further Methodology
Methodology: The survey was designed and analyzed by McKinsey teams. The surveys were administered online in English by a third-party
vendor. We used the following characteristics to focus on the consumer segments eligible to purchase individual coverage on the ACA exchanges
or elsewhere:
Ages 18 to 64
Income above 100% FPL in Medicaid non-expansion states and above 138% FPL in Medicaid expansion states
Primary 2016 coverage (by self-report) is no insurance or individual insurance
Primary decision-maker, equally involved, or contribute to health insurance decisions for their household
Weighting: Each response was weighted separately for the 2016 QHP-eligible uninsured, ACA-insured, and non-ACA-insured segments similar to
previous annual post-OEP surveys, using the following factors: age, gender, geography, household size, income. In addition, responses were
weighted across reported primary 2015, 2014, and 2013 coverage to reflect the national distribution of uninsured vs. individually insured QHP-
eligible consumers over these three years. To inform the weighting, we used the McKinsey Predictive Agent-based Coverage Tool (MPACT),
which provides specific county-level demographic details about the 2013, 2014, and 2015 QHP-eligible populations. These details are attained by
merging county- and state-level data from the U.S. Census Bureau, Small Area Health Insurance Estimates (SAHIE), American Community
Survey (ACS), Centers for Medicare and Medicaid Services (CMS), and Health and Human Services (HHS). These estimates have been
reconciled with publicly reported enrollment information for 2015 (i.e., exchange enrollment, Medicaid enrollment).
Insurance coverage status: Respondents were asked their coverage in 2013, 2014, 2015, and 2016, as follows:
“Which of the following best describes your primary insurance coverage in 2013? For most of the year I was…”
“Which of the following best describes your primary insurance coverage in 2014? For most of the year I was…”
“Which of the following best describes your primary insurance coverage in 2015? For most of the year I was…”
“Which of the following best describes your current (2016) insurance coverage? I am covered by…”
Health status: We categorized respondents into three types of health risk—low, medium, high—based on self-reported chronic medical conditions
and self-reported details on their use of the health care system.