OBJECTIVES : A better understanding of current health plan management and tools.

METHODS : Online interactive survey of US health plan officers.

RESULTS : The survey was completed by 77 respondents. Most payors were not eliminating their ACA plans, however 18.6% are being phased-out in 2018, 7% in 2019. The average 2018 ACA family-deductible was >$10,000 (12.1% of plans) and <$1000 (18.2%). Respondents expect the Trump presidency will most likely decrease access to healthcare (66.7%), Rx drugs (37.3%), and quality (50%), while increasing costs (52.9%).Most plans cover physical therapy (95.9%), psychotherapy (85.7%), chiropractic care (83.7%) about one-third cover alternative medicine/gym memberships and 2% covered medical marijuana. Most plans support some digital-health programs with 22% expecting them to raise costs,18% to save money, and 60% to be budget neutral. Common uses: messaging=80%, telemedicine=78.2%, web-based programs=70.9%, personal health records=50.9%, consumer applications (43.6%), disease-management applications (30.9%). Commonly-used applications for Lifestyle+Stress=70.6%, Exercise+Fitness=64.7%, Medication Reminders+Info=58.8%, Diet+Nutrition=54.9%, Healthcare Providers/Insurance=49.0%, Disease-specific purposes=49.0%, Women's Health+Pregnancy=29.4%. Value based contracting (VBC) is being used for services in <45% of plans, for pharmaceuticals only 36.2%. Areas for prescription-drug VBC included Oncology,Hepatitis-C,MS,Specialty products,and diabetes. Prescription VBC is expected to increase to 45% this year. 85% of respondents believe managed care commonly uses EBM today in coverage decision-making, 63% expect to regularly utilize CER in formulary decision-making by 2018, 50% believe we are obtaining usable CER today. CER information is expected to affect the value of care,clinical guidelines,and medical or pharmaceutical benefit management.

CONCLUSIONS : With the rapidly shifting health care marketplace, politics and regulation are effecting payers' willingness to participate in the ACA. Health plan coverage continues to cover most therapies. Digital-health tools offer more information and insights into care and are expected to be budget neutral. VBC is growing slower than expected, CER for EBM continues as a promising tool but the quality of information still needs improvement.