Many Blue Cross Blue Shield plans are taking steps to better understand the individual consumer so they can successfully operate within the new individual market and health insurance exchanges.
When the exchanges go live in 2014, which will allow individuals to directly purchase health plans, insurers will be dealing with a very different market and, therefore, must make significant changes to their current operations, according to AIS Health.
"This shift requires a deeper level of understanding on how individuals want to shop for, purchase and use health care," said John Janney, senior vice president of marketing services at Independence Blue Cross.
Perhaps most importantly, Blues plans are increasing their retail investments in preparation of an expected "significant increase" in retail sales. "Our industry was built with a view toward businesses and employer groups being the customers," Janney told AIS. "We must also prepare for the large number of individuals who already are and will increasingly be purchasing health care directly from us."
Independence Blue Cross is making a "serious investment" in understanding individual customers, an effort that includes partnering with the Blue Cross and Blue Shield Association to effectively pool the best information they have gathered regarding the individual consumer. Independence Blue Cross also is evaluating their product development, communication channels, customer service and claims processing to determine whether changes are needed to help facilitate the move to a retail marketplace, AIS noted.
Likewise, Blue Cross Blue Shield of Tennessee (BCBST) hopes to prepare for retail markets and individual consumers by developing informatics and better utilizing claims data. The insurer is looking to "build out capabilities to allow better insights into consumer behavior and better participate in the exchanges," Danny Timblin, vice president of strategy and execution at Blue Cross, told AIS.
BCBST, which considers the retail store a necessary part of preparations as the industry becomes more consumer focused, hopes to open its first retail store later this year in the Nashville area. "Regardless of whether reform ultimately gets fully enacted, we believe that consumers will more and more begin to view health care and health coverage in the same way they view other consumer services," Roy Vaughn, vice president of corporate communications for BCBST, told The Tennessean. "We need to reach our members in ways that are meaningful and convenient for them, and that is what we are doing by looking at a retail presence."
Other Blues payers will gear up for the individual market by adding plans with narrower networks and lower costs to consumers, developing more wellness programs and establishing patient-centered medical homes and accountable care organizations.