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Worcester Business Journal www.wbjournal.com 2014 Economic Forecast 25 h e a lt h c a r e S P O N S O R E d B Y T he most notable new reality for 2014, of course, is the ACA's individual mandate requiring everyone to buy insurance. It's important to keep in mind that sev- eral other key provisions will have a significant impact on small groups and those buying individ- ual plans. They include the expansion of coverage and a change in how plans are rated. Driving the coverage expansion is the 2014 requirement that all small group and individual plans incorporate Essential Health Benefits, com- prised of 10 different categories of services. While the new benefits provide greater peace of mind, they don't come without a price. For many, the changes mean higher premiums, and the situation could become even more difficult if fewer younger and healthier consumers buy the new plans. How plans are rated is changing as well. Beginning in January, insurers must move from subscriber-level rating in the individual and small group markets to a per-member rating approach. The new rating methodology change can result in very different premium pricing for families who appear to be otherwise similar. As ACA changes come into play in 2014, the ongoing battle to improve quality, affordability and well-being will take place on several fronts: High-deductible and network-based plans To help enhance consumer engagement, more and more employers will continue to move from traditional first-dollar plans to lower-premium, high-deductible plans in 2014. Network-based plans will also grow in popular- ity, as they provide premium savings while still ensuring strong coverage and quality care. The adoption of tiered network plans will also grow. These include plans that save members money when they visit select lower-cost providers for lab tests and outpatient surgery, as well as plans featur- ing tiered copayments based on provider cost and quality measures. New care delivery models The push to improve quality of care while con- trolling costs will continue to gain momentum in 2014 and beyond. New care delivery and payment models – such as those now at Harvard Pilgrim – will help shift provider payment from a fee-for- service method to alternative reimbursement approaches. The new approaches are designed to improve efficiencies and coordination of care, while rewarding providers based on health outcomes. Cost and quality transparency tools Armed with the right information at the right time, employees can become more savvy health care consumers. A growing number of state-spon- sored and insurer cost and quality tools support this behavior, including our Now iKnow SM online tool, which provides members with plan-specific cost and quality comparison information. Healthy investments in wellness More and more employers will adopt wellness programs, wisely viewing them as an investment in a healthier, more productive workforce. Health questionnaires, biometric screenings, nutrition/ weight management, stress reduction, smoking cessation and other programs are helping them create a culture of well-being, and they're using employer-sponsored incentives to help boost par- ticipation. It's hard to predict what kind of impact the ACA will ultimately make over the course of 2014. But by working together, we can make a real difference in helping to enhance quality, control costs and improve our state of health. n Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care and its affiliates, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. Reform's new realities, plus the ongoing battle to improve quality, affordability and well-being