Emerging health insurance products in an era of health reform

November 11, 2013

Many pieces of health equipment around a clipboard with a paper reading "Health Insurance".At least in part in response to the health coverage changes of the Affordable Care Act (ACA), many health plans are making significant changes to products that they plan to offer in the employer and individual market. While insurers were already moving away from paying for volume and toward paying for value prior to health reform, the ACA has been a catalyst for greater development of an array of health plan products.

Many health insurers are anticipating a shift from employer-sponsored to individually-purchased health insurance. Individuals and small businesses may now purchase coverage on the individual insurance exchange and on the Small Business Health Options Program (SHOP) exchange, respectively. Furthermore, the majority of plans offered in Michigan on both the individual and SHOP exchanges are limited or narrow network plans. At the same time, consumers seem willing to consider products that include fewer providers in exchange for lower premiums.

This brief focuses on three growing categories of health plan products and provider arrangements in the commercial market:

  • Accountable care arrangements
  • Narrow and tiered network products
  • Reference pricing strategies

It also describes the characteristics of these new products, explains how they may affect consumers, and provides examples of health plan offerings.


Suggested Citation: Shigekawa, Erin and Udow-Phillips, Marianne. Emerging Health Insurance Products in an Era of Health Reform. November 2013. Center for Healthcare Research & Transformation. Ann Arbor, MI.

Special thanks to: Jim Boyman, Elizabeth Curran and Sherry Sanderford, Aetna; Janet Fava, Blue Cross Blue Shield of Michigan; Kathryn Klippel, Ben Umansky and Olivia Wheeler, The Advisory Board Company.