Wednesday, March 16, 2011

#whchpi Transferable Best Practices for Health Insurance Exchanges - Vince Ashton - HealthPass NY

HealthPass New York is an 11 year old Commercial Insurance Exchange.

- Established 1999. 
- Mission to give greater access to health care for small businesses
- Help stem tide of working uninsured.
- Collaboration between Northeast business group on Health, Mayor of New York, Health Insurance Industry.

Employee choice model.

Community rated environment.
5 boroughs of NY, Long Island and Hudson Valley.

Exchanges will attract varied populations: - Individual:
- Newly insured (pent up demand)
- 40% of uninsured eligible for subsidies and with chronic conditions or poor health

SHOP Exchange:
- Previously uninsured
- Previously insured seeking more affordable options and choices
- Younger, healthier firms and employees.

Best practices - need to apply a model that drives sustainability:
- Diversify the product portfolio
- be careful with churn between Medicaid and Exchanges
- Four types of customers (Individuals with or without subsidy, small biz with or without tax credits)
- Larger employers enter market in 2017
- Consider competitors and new entrants
- Concern for pent-up demand

Exchanges must be sustainable by 1/1/2015.

Product and Strategy will be driven by Exchange Governance, Regional or Statewide exchange structures and Market rules applied by States and Feds.

Lots of discussion about having common infrastructure on back end with different market facing portals for the different state and market exchanges.

Plan Standardization:
- State of MA has 8 benefit plans
- Plan Standardization does not have to mean restriction of choice.
- Value, Brand Recognition and Quality are very important. 
- Stay flexible to compete in the marketplace.

[Ed: Big opportunities for UI innovation to help people choose from a maze of plans - e.g. use health status, Use past history. Use Travel industry models.]

[Ed: can we use this demand to promote use of PHR as the de facto Health Information Exchange? Hey - Google - massive opportunity here]

Brokers and Agents are vital. How will licensing work. 

How to make the SHOP exchange attractive:

- Simple, streamlined purchase experience
- Simple administration and suite of solutions

[Ed: looks like it will be a good thing for exchange to handle premiums and do distribution to carriers on behalf of employers - a major step up in simplifying process for employers]

Position the Exchange as a single point of contact. Single Entry point.

- Employee choice with customized assistance.
- Marketing and outreach must be aggressive. 
- Make it simple for consumers.
- Plan selection and choice counseling is important.

Robust Admin Services:
- Member Services & Advocacy Programs
- COBRA & State Continuation Admin
- Premium Aggregation and Consolidated Billing
- Section 125 for Pre-Tax premium contributions
- Eligibility Determination
- Enrollment and Subsequent Employer and Employee Education

This is big - small businesses do not tend to have this knowledge and expertise. 

How Much Choice:
Try to mirror the full choices available in individual exchange. Otherwise market will erode.

[Ed: This is a big change. We will see more employee choice than has been present in Employer-based market]

Expect a defined Fixed-Dollar employer contribution towards employee plans.

[Ed: Large Group Enrolle organizations like BeneLogic and BenefitFocus are well placed to take on the role of Exchange Administrator. This may be attractive to Health Plans to get a simplified feed rather than dealing directly with enrollment of members. Individual and Small Group member enrollment becomes more standardized.]

1. SHOP Exchanges must support Employer and Employees
2. Do premium aggregation
3. Develop individual and SHOP Exchanges simultaneously.
4. Consider full choice for employees and fixed-dollar contributions in SHOP Exchanges.

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