When state insurance exchanges first emerged, their primary task was to facilitate and encourage enrollment in health plans--a task some were unable to accomplish. But for the state exchanges still standing, the focus has turned to not only singing up people for coverage, but also improving their health.
Here are some examples of how state-based exchanges are rethinking their roles in the healthcare system and their customers' lives:
Covered California, driven by the outspoken leadership of Executive Director Peter Lee, is increasingly using its leverage to push for changes in the healthcare delivery system. Newly announced contract provisions--which have already drawn some industry criticism--place stricter requirements on insurers and providers alike to improve care quality, coordinate care and engage patients in their health. For example, beginning in 2019, Covered California plans must exclude hospitals from their networks that fail to meet the government's target C-section rate or explain why they cannot, according to the new contract.
Access Health CT also benefits from an ambitious leader in Jim Wadleigh, who says he wants the exchange's focus on the enrollment process to become "a small piece of how we feel our role in the ACA implementation will play," according to the Connecticut Mirror. Instead, he says, the organization will strive to encourage individuals to use their coverage to access preventive care, push for changes in how care is delivered, make healthcare and insurance more affordable, and give customers tools to determine care costs.
Kynect, Kentucky's successful exchange with an uncertain future, is also working to improve consumers' healthcare literacy. Enrollment assisters called "Kynectors" developed educational materials designed to boost the healthcare knowledge of newly enrolled individuals, according to a Kaiser Family Foundation issue brief. The exchange created a "how to Kynect" brochure that offers a glossary, information on how to find a primary care provider and how to use care, and healthy living tips.
To learn more:
- here's the Covered California contract
- read the Connecticut Mirror article
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