Insights

How Do Governments Stay Dynamic in an Evolving Healthcare Landscape?

July 30, 2017

LMI Staff

We’re the Catalysts For Smoothly Run Health Insurance Markets

Every project has its scientists and its engineers. LMI represents the latter—we are the interface that governments entrust with taking a brilliant idea or policy and making it work in the most practical terms.

Health insurance marketplaces are helping individuals and workers in smaller companies obtain a better range of affordable health insurance products. States and the federal government launched these marketplaces in October 2013, when open enrollment began.

LMI’s role dates back to 2012, when we helped lay the groundwork for the health insurance marketplaces, focusing on the processes and practices that will ensure proposed health insurance plans meet the standards outlined in the Affordable Care Act (ACA) and comply with federal guidelines so they can be offered as qualified health plans.

The Affordable Care Act requires each qualified plan to cover essential health benefits, or EHBs, across 10 benefit categories that are comparable to typical employer health plans. We identified and mapped EHB data to each benefit category. We then collected and reviewed EHB benchmarks to ensure all categories were covered and were not discriminatory.

LMI also adapted a U.S. Pharmacopeial Convention mapping of drugs to therapeutic categories and classes so that qualified health plans can offer formularies that include a minimum number of drugs in each category and class.

Monitoring Compliance and Identifying Best Healthcare Practices

Accountable care organizations will help move the nation away from the currently fragmented healthcare delivery system engendered by the fee-for-service system. The ACA established two new models of care—shared savings and pioneer ACOs—that test the extent to which organized systems of care and the assumption of greater financial risk will improve the quality and efficiency of the healthcare provided.

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