New Marketplace

My Favorite Slide: Transitions in Health Insurance Coverage Type Are the Norm

Infographic · July 28, 2016

McKinsey and Company Favorite Slide: Transitions in Coverage Type Are the Norm for Most Consumers Over Time

Transitions in Coverage Type Are the Norm for Most Consumers Over Time. Click To Enlarge.

Transitions in health insurance coverage appear to be the norm for most Americans over time. Our analysis of point-in-time coverage data reveals striking age- and income-related patterns that imply change over time, both in the types of coverage people are most likely to have and in their probability of being uninsured. As the quality and availability of data needed to track individuals across coverage programs improve, a more complete picture of these lifetime dynamics is emerging.

Analysis of the data by age and income using the McKinsey Predictive Agent-based Coverage Tool (MPACT), as well as recent studies on lifetime income dynamics, suggest that short-term fluctuations and long-term coverage transitions over the course of an individual’s lifetime are common. Given Medicaid expansion and the introduction of income-related subsidies in the individual market, an individual may move between Medicaid coverage, a Qualified Health Plan, and uninsured status over the course of a couple years. Similarly, many middle-aged, commercially insured individuals may have been on Medicaid at one time, and most of them will be on Medicare in the future.

Individuals may experience short-term coverage transitions in the context of a longer-term path through different types of coverage. As a result, payers may want to view short-term fluctuations in coverage and long-term transitions of their members as interrelated phenomena, with implications for how they think about their business.

New Call for Submissions ­to NEJM Catalyst


A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From New Marketplace

Predicting the Future — Big Data, Machine Learning, and Clinical Medicine

By now, it’s almost old news: big data will transform medicine. It’s essential to remember, however, that data by themselves are useless.

Caring for Older Adults in a Value-Based Model

Using patient stratification and more primary care visits, Chicago-based Oak Street Health aims to reduce hospitalizations.

Caring for High-Need, High-Cost Patients

Five foundations committed to improving U.S. care for complex patients outline promising program models and keys to success.

How 30 Percent Became the “Tipping Point”

Received wisdom for meaningful change in health care payment and delivery system reform.

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative

Midway through this four-year intervention, participating practices report progress in transforming the delivery of primary care. But savings and improvements in the quality of care or patient experience are lagging.

The Coming Battle over Shared Savings — Primary Care Physicians versus Specialists

The way physicians are organized and reimbursed in the United States is undergoing a once-in-a-generation transformation from a fee-for-service system to alternative payment models. PCPs are well positioned economically and strategically, but specialists must adapt.

How a Pediatric ACO Coordinates Care for Children with Disabilities

Ohio-based Partners for Kids is charting new territory in care coordination for a high-need population.

Mixed Early Performance of Medicare Accountable Care Organizations

The earliest participants in MSSP contracts reduced Medicare spending, but the second cohort did not. Meanwhile, some quality measures improved among MSSP participants, while others were unchanged.

Why UnitedHealthcare’s Withdrawal Is Not the Main Concern for Exchanges

United’s announcement will affect some local markets, but the giant insurer has not been a major player in health insurance exchanges. And exchanges are only one part of the complex payment reforms under way.

Survey Snapshot: Plusses and Minuses of Value-Based Care

Commentary from the NEJM Catalyst Insights Council on the advantages of value-based care — and the problems posed for physicians.


A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »


Value Based Care

133 Articles

Losing Genetic Lottery, but Winning at…

If we don’t get the value-based price for a drug, we let patients go untreated.…


90 Articles

Survey Snapshot: Deep Frustration with the…

Many NEJM Catalyst Insights Council members are frustrated with the pace of value-based payments and…

How to Have a High-Performing Employed…

It’s a generally accepted view that all hospital-employed physician groups are constitutionally incapable of operating…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now