Let’s face it: Insurers are the one segment of the health care sector that everyone has loved to hate. Employers blame insurers for rising premiums; physicians and hospitals blame them for their declining reimbursement rates; consumers blame them for lack of sufficient coverage; and policymakers think they make too much money.

As if being at the center of scorn isn’t enough, the health care insurance business model itself stands in the crosswinds of market and nonmarket forces. Between the standardization of benefits and other regulations imposed by the ACA and employers’ laser focus on price, commercial payers have found themselves in a commoditized business. Competition is coming from unexpected places—even providers—as employers contract directly with “centers of excellence” and integrated delivery networks. Consumers, feeling the increasing burden of out-of-pocket costs and high deductibles, are more focused than ever on getting their money’s worth.

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