Helping Payers and Providers Grow Amid Volatility: Leveraging Data to Improve the Care Experience

July 6

By Erin Trompeter

Preliminary data indicates that 2023 may prove to be the most volatile year for health plan enrollment in a decade. The convergence of major market disruptions—namely the Inflation Reduction Act (IRA) and the end of the Public Health Emergency—is sparking tremendous shifts in the individual and public exchange market.

For health IT vendors, understanding these shifts is essential for identifying potential growth areas for their clients. Both payers and providers will need to improve the quality and variety of their services to attract and retain patients, who are increasingly focused on accessibility and value. Health IT vendors can also leverage real-time coverage, restriction, and reimbursement data to help payers and providers offer a more seamless care experience.

Each year in April, MMIT conducts a comprehensive survey of all payers offering commercial risk and ASO products to confirm and audit their state-filed enrollment data. The results of this research are published in MMIT’s Directory of Health Plans tool and used by AHIP as its definitive source of health insurance enrollment data. Here’s a peek at our early findings and what they signal for the year ahead.

Understanding the driving forces behind enrollment shifts

While the process is still underway at the time of publication, our preliminary results indicate major enrollment upheavals. Some larger ACA insurers, like Bright Health, have chosen to leave the exchanges, resulting in millions of members searching for a replacement plan. In the first half of 2023, our research reveals that many regional insurers have seen enrollment increases in the tens of thousands, while national insurers have gained hundreds of thousands of members in the individual market.

Read the full article on Modern Healthcare. For more information, see how MMIT’s solutions for Healthcare IT vendors can help you analyze enrollment data, evaluate access and create new applications.