Dale MackelMarket President

Coventry Health Care, an Aetna company

What to Expect from Health Insurance in the Future

ACA Impact on Health Care Industry is Unprecedented

Disruption

Innovation

Transformation

Providers

PractitionersBrokers/Exchanges

Carriers

Today’s Topics

As a carrier, Coventry/Aetna will focus on:• Empowering the consumer• Innovating the Care Delivery System• Changing how insurance is packaged & purchased• Supporting ACA law evolution to preserve the goal of

accessibility, affordability and sustainability

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Empowering the Consumer

Shift from B2B to B2C. For the first time, the consumer will be an informed buyer of health care services• Enablers will be technology and transparency

– Mobile platforms that facilitate symptom-to-service capability (Aetna’s iTriage app)

– Powerful self-service tools that put more control into the hands of consumers

– Price list for services at network providers (may even be variable based on supply & demand)

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Consumers want more health, not more treatment

Care Delivery Innovation

Building new network models to drive quality, affordable care• ACO’s, HPN’s, Narrow Networks, Patient Centered

Medical Homes– Primary care physician will navigate patient through the

health care delivery system– Quality/Efficiency/Outcomes – how the delivery system

will be measured and compensated– Networks customized for certain industries (hospitality)– Must be of value to the consumer

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Goal is not to Pay Less for Care but to Pay for Less Care

How Insurance will be Purchased/PackagedPublic and private exchanges will influence purchasing dynamics

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• Exchanges are here to stay• Public exchanges will become more functional over

time and proper for subsidy eligible consumers• Private exchanges will innovate & flourish

– Offer exceptional on-line consumer buying experience (Amazon, Priceline)

– Keep employers connected to employees from a benefits perspective

– Customize insurance plan offerings based on individual circumstances

Supporting ACA Law Evolution

Restore consumer choice & relevancy for small companies & individuals• Essential Health Benefits are a good start, but benefit

flexibility is required to strike a proper balance among coverage, cost and need (over-insured)• Rating Algorithm Enhancements• Incentives to attract young healthy population into the

insurance pool• Consumer needs should drive changes in the law

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