Positioning for continued growth in public exchanges

With four million people enrolled in public health exchanges as of the end of 2014, most payers competing in federally facilitated marketplaces or state-based exchanges have moved beyond the initial stages of implementation and are envisioning taking their plans to the next level. This “next level” means delivering more consumer-oriented offerings and engagement approaches, with the support of efficient operations, sophisticated data analytics and appropriately estimated risk management models.

This latest enrollment period was much more stabilized, compared to the previous year when so much regarding the exchanges was still evolving. Now, as the next enrollment season looms on the horizon, what can we expect?

Data will continue to matter.

Now is the time to ensure your data is validated and as accurate as possible, and that CMS understands what you’ve provided and is using it correctly. Also, since plans are still filing rates with very little data, you should keep a close watch on estimates to ensure that they’re coming in as expected.

Consumer engagement steers the ship.

Ensuring that the consumer experience — that regular connection with the member — is maximized from an efficiency standpoint is critical to this entire process. But how the consumer understands how to enroll and who to call are just some of the challenges facing both payers and states. States are challenged with how to handle the volume that’s coming in, which trickles down to payers. You need to know that the enrollment you think you have matches the enrollment that the state thinks you have, and monitor that on a consistent basis. And if you’re a payer on multiple state exchanges, you need to know the impact of each state on your expenses and operations.

Two weeks’ notice

Bumping up the enrollment date in 2015 — by two weeks — is significant, and reduces the time you have to prepare for open enrollment. Operational processes, case management, advertising and consumer engagement functions all need to have earlier steps to support that earlier date.

Consumer retention is also warranting more attention industry-wide. What steps are you taking to keep your membership more guided toward your plan and the policies you offer on the exchanges?

For an in-depth discussion on these points, listen to our on-demand webinar, “Public Exchange 2.0: Positioning for Future Growth.”

About the authors

Jeffrey K. Lowry, BS, MHA
Vice President, Payer Exchange Consulting, Optum

JeffLowry_100Jeff brings 30 years of experience from both the provider and payer sides to his role at Optum, most recently setting up an Exchange Health Plan (individual products) on the State of NY Marketplace.  Jeff leads Optum’s strategy development and consulting delivery implementation work across both public and private exchanges.

Craig Howarth
Senior Director, Payer Consulting, Optum

Craig HowarthCraig brings 15 of years of experience in the healthcare industry, focused on process improvement and customer experience enhancement.  He specializes in large scale transformations around operational improvements, data management, segmentation, and campaign management.  Most recently, Craig led Optum’s consulting work on both the MA and VT health exchange solutions.

Kecia Rockoff, FSA, MAAA
Actuarial Director, Payer Consulting, Optum

kecia_rockoffKecia brings 25 years of experience in the financial aspects of health care management.  She specializes in developing predictive solutions to measure the actuarial and financial impact of market changes such as ACA’s 3Rs and ICD-10, for example.  Most recently she has participated in a variety of consulting roles on the MA, FFM and VT health exchange solutions.

Michael Nestor
Vice President, Payer Consulting, Optum

MikeNestor_picMichael Nestor is a Vice President in the Optum Payer Consulting group. A successful executive with almost 20 years’ experience, Mike has led complex enterprise business and technology initiatives to deliver innovative new products and technology solutions that enhance customer satisfaction, drive revenue growth, and reduce operational expenses.

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