In 2019, the Washington legislature enacted a bill requiring insurers on the state’s health insurance exchange to offer plans with standardized benefit designs, beginning in 2021. Colorado and Maryland are considering similar requirements. As these and other states consider the option of standardized health plans, they can benefit from the experiences of California, the District of Columbia (D.C.), Connecticut, Massachusetts, New York, Oregon, and Vermont, all of which require insurers to offer standardized benefit designs. This Expert Perspective outlines benefits and risks of plan standardization, and raises critical questions that states will need to consider, and offers a decision roadmap for states implementing a standardized benefit design requirement.
Safeguarding Financial Stability of Provider Risk-Bearing Organizations
Erin Taylor and Michael Bailit, Bailit Health
JoAnn Volk, Georgetown University Center on Health Insurance Reforms
An increasingly common feature of health care payment models is the transfer of financial risk from payers to providers for health care services delivered to a defined population of patients. In these “value-based payment” models, providers accept financial responsibility (i.e., liability for financial losses) should spending for most, or all, services for an attributed patient population exceed targeted levels. This financial liability is often shared with payers, and maximum risk exposure is typically capped. This issue brief explores options for states as they consider oversight of risk-bearing organizations , with a focus on states that have elected to act to protect against provider insolvency.
The State Health Policy Highlight, Risk-Bearing Organizations Oversight: State Considerations, reviews specific state considerations when overseeing risk-bearing organizations. An accompaniment to the issue brief, Case Studies: State Examples of Safeguarding Financial Stability of Provider Risk-Bearing Organizations, provides a deeper dive into approaches in four states: California, Massachusetts, New York and Texas.
State Health and Value Strategies hosted a companion webinar, Safeguarding Financial Stability of Provider Risk-Bearing Organizations, based on the issue brief that provided an overview of options for states as they consider oversight of risk-bearing organizations (RBOs) as well as a deeper dive on the Massachusetts approach.