Expected costs related to COVID-19 may increase or decrease health insurance premiums in the Patient Protection and Affordable Care Act (ACA) commercial markets. When setting premiums for 2021, health insurers will consider a variety of factors related to virus, including the acute treatment and vaccination for COVID-19, changes in access and demand for healthcare, lasting effects on population health, economic effects on enrollment and utilization of care, and other operational effects.
The National Association of Insurance Commissioners (NAIC) has released a template to assist state regulators in their reviews of 2021 premium impact assumptions for COVID-19. The template outlines a number of pricing considerations.
As of June 15, 2020, six states and the District of Columbia have publicly released preliminary ACA premium rates for 2021. This paper by Milliman’s Dane Hansen, Andrew Bochner, and Emily DeAngelis examines the reported impact of COVID-19 on these rates.
As the prevalence of partnerships between payers and
providers increases, it is critical for payers to monitor and track emerging
experience and communicate these results to partner providers.
Data-driven insights through claims-based monitoring and
analytics can help identify areas of action and allow payers and providers to
efficiently allocate resources, increasing the likelihood of successful,
Many partnerships have found that engaging a neutral third
party to assist in negotiating and monitoring contractual provisions is helpful
in building trust and identifying activities for potential improvement.
Data-driven insights through claims-based analytics can help identify provider
inefficiencies in utilization and cost and improve overall provider
To read more about how claims analytics can help boost provider performance, read the article “How to optimize partner providers’ performance using claims analytics” by Milliman’s Dane Hansen and Noah Champagne.