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Survey: Medicaid-Level Rates Could Cripple Health Insurance Exchanges

National Survey of Hospital Executives Reveals Payor Talks Off to a Bad Start


NASHVILLE, TN – With the results of the presidential election and the fate of state health insurance exchanges decided, a new national survey of hospital executives on the subject finds that talks between providers and payors are already off to a rocky start.
Of the 112 hospital executives surveyed, 62 percent said they have begun conversations with payors about participation in the exchanges, 54 percent said those conversations included a discussion of reimbursement rates, and 48 percent of those conversations are “fair to poor.”
The survey, commissioned by ReviveHealth and conducted by Catalyst Healthcare Research, also revealed that respondents – hospital executives responsible for negotiating contracts with health insurance carriers – are very concerned about the rates being offered to care for people who buy their health benefits through an exchange. Download the full survey results at Additional survey findings include:

  • Hospitals say that exchanges capable of providing access to high-value, quality health care will require care coordination, population health management and fair payment rates from payors that don’t undermine the financial viability of hospitals, health systems and the physicians providing the care.
  • Providers say they worry whether the exchange networks will truly serve the uninsured and broaden the risk pool.  Instead, they could result in a huge shift of people currently covered by employer-sponsored coverage into the exchange products marked by narrower networks, less choice, and rates that fail to cover the provision of high-value health care. 
  • 62 percent said existing commercial rates are the right starting point for exchange network payment rates and 26 percent said “somewhere between commercial and Medicare rates.”
  • 56 percent said they would have to make substantial cuts to operating costs or “do something drastic” if Medicaid-level rates prevail for the exchange networks while 11 percent said they would likely decline to participate or simply “go out of business.”

About ReviveHealth
ReviveHealth is a strategic communication firm specializing in Health Services, Health Technology, and Healthy Living. Ranked the 11th largest health care PR firm in the country, ReviveHealth is recognized by PRWeek, Holmes Report, and O’Dwyer’s for its strong agency culture, strategic excellence, and client results. The firm’s clients include major hospitals and health systems, academic medical centers, physician organizations, health care industry associations, health technology companies, wellness and population health companies. ReviveHealth has offices in Nashville, Tennessee, and Santa Barbara, California, and can be found on the web at


 Health Insurance Exchange
 Insurance Exchange Rates
 Hospital Executives
 Fiscal Cliff

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