4 exchange opportunities for payers

During a recent panel discussion hosted by the Nashville Health Care Council (NHCC), industry leaders from provider and payer organizations plus consultants and state regulators all discussed trends and issues occurring throughout the country as the health insurance exchanges get implemented.

"Obviously this is a time of great change in the healthcare industry, which means both challenges and opportunities," Heather Howard, lecturer at Princeton University and director of the Robert Wood Johnson Foundation State Health Reform Assistance said during an interview the NHCC posted on YouTube.

Although several challenges certainly exist, including a majority of counties still lack competition among insurers, the panelists focused on opportunities emerging as a result of the exchanges. Here are four opportunities they addressed:

1. Bringing value and improving health outcomes

Millions more people obtaining health insurance coverage means there will be more people accessing the healthcare system. So the industry will "need to innovate and think about how to meet the needs of those new customers and do so in a way that's financially sustainable," Howard said. Insurers and providers alike will need to determine how to best bring value to the healthcare system and improve health outcomes for consumers.

"Much of the success in expanding the number of Americans with health insurance depends on the ability to efficiently implement the coverage priorities of the ACA," Howard said, according to an NHCC statement. "I am hopeful that this need will lead to innovation within the system."

2. Engaging with more consumers

One of the "fascinating" aspects to the start of the exchange open enrollment season, said Paul Lambdin, the director of Deloitte's health plan sector health insurance exchange solution area, is the variability and competition throughout the markets. "Some markets have intense competition, new entrants, Medicaid plans going on to exchanges, integrated health systems that have become insurers and gone on the exchanges," Lambdin said. "And then you have 55 percent of the counties in the United States of America that only have one or two competitors in the exchange market."

And despite all the technical glitches still facing the exchanges, Lambdin maintained the exchanges' functionality will improve and offer "significant opportunities" for state and federal governments to engage exchange customers. The same likely holds true for insurers as they soon will have millions more members signing up from the exchanges, which is why Humana foresees long-term exchange opportunities for its company.

3. Getting help from hospitals to enroll consumers

"Hospitals will play a critical role in exchange enrollment and the implementation of the new health reform," said Chip Kahn, CEO of American Federation of Hospitals. "Hospitals, to the extent they can, are going to help those who don't have insurance obtain insurance through the new means that are available on the exchanges." In fact, many hospitals also are providing community resources and education to help consumers enroll in the online exchanges, which Kahn said, "is critical for the marketplace to be successful."

4. Lowering cost of care by signing up more young, healthy people

"It is critical to have every individual sign up for healthcare to ensure a balance in the risk pool," AHIP Executive Vice President Daniel Durham said during his interview. "Having the younger, healthier [consumers] sign up--they have lower cost of care--balances the risk pool and helps bring down premiums, so the cost of coverage is more affordable for everyone."

That's why he said it's critical for insurers to reach out to young adults to communicate the importance of becoming insured and the value in signing up for a health plan through the online marketplaces. "Our members are educating consumers about the changes to health insurance and helping them to enroll in coverage that best meets their needs."

Otherwise, problems with the HealthCare.gov website could cause fewer young adults to sign up for coverage, as older, sicker people who really need coverage are likely to put up with technical difficulties to get it, while younger, healthier adults may quit trying to apply for it, FierceHealthPayer previously reported.

To learn more:
- read the NHCC statement
- view the YouTube interviews

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