Health Care Exchanges

Achieving Success and Sustainability with Health Care Exchanges

Jay Sheehy, Senior Vice President, Product Innovation, EmblemHealth, recently spoke on a panel alongside executives from Kaiser Permanente, Community Health Options and Florida Blue at the 7th Annual World Congress Private and Public Exchange Summit in Washington, DC. Paul Wingle, panel moderator and Aetna’s Executive Director, Individual Business and Public Exchange Operations and Strategy, kicked off the session by reviewing the current health care landscape and changes over the past year, including the Supreme Court decision in King v. Burwell, the closing of health insurance co-ops, and the postponement of the Cadillac Tax.

“There were two major predictions when the Affordable Care Act [ACA] was enacted,” Wingle stated. “First, that the ACA would become a catalyst for big changes in employer health benefits and, second, that the public exchanges would become the place to buy nongroup coverage.”

When asked to assess the accuracy of these predictions, Sheehy commented, “A lot of bold statements were made about the private exchanges, but we’re still moving towards a consumer-based model in health care. Private exchanges will drive a fast-rising share of growth, mainly due to large employers moving towards defined contributions, but the trend has slowed down.”

Responding to the second prediction, Ken Hunter, former Senior Vice President, Health Insurance Exchange Operations, Kaiser Permanente, asserted that, “Consumers believe that, unless they are eligible for a subsidy, off-exchange is a better place to buy.” At the same time, he added, “We shouldn’t underestimate the change the ACA made in the insurance marketplace by creating a place for transition coverage,” citing Kaiser’s model of combining care and coverage.

The panel also discussed strategies for achieving long-term success in the private and public exchanges, as well as opportunities for improvement. “Technology is at the core of giving consumers choices. We need to be asking: ‘How do we simplify this?’” Sheehy argued, using the analogy of online retail. On Amazon, he explained, customers are able to search for a beach chair, apply filters (such as cost, material and shipping) and are presented with a manageable list of options. The site’s algorithm also suggests add-on items: a beach umbrella to go with the chair or, in the case of health insurance, ancillary products such as pet insurance. “Consumers are currently given too many choices. They want to tell their insurer three or four things about themselves, and be presented with a package of options.”

Education and health literacy are also key to success, argued J. Gabriel McGlamery, Senior Health Care Policy Consultant, Florida Blue Center for Health Policy. “The issue with the Bronze Plan is that $0 is a very attractive option. However, the cheapest option isn’t always the best option,” McGlamery said.

The role of the insurer is to support the consumer’s financial health and well-being, Sheehy concluded. “If we ask someone with a Bronze Plan how they’re going to pay for a $5,000 deductible, they don’t know. They pull out a credit card with 26 percent interest rate. They need flexibility, education and support,” he added. Technology and data are essential to helping consumers live healthier on their own terms, as well as achieving long-term success with the public and private exchanges.

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