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Health insurance exchanges: 3 steps to prepare payers

Health insurance exchanges, along with the roughly 30 million new consumers and $200 billion in premiums they bring, are coming in 2014. To successfully operate within these drastically new marketplaces and reap their rewards, payers must take steps now.

One compelling reason payers should aim to thrive within the exchanges is public perception and the resulting corporate image. A November 2011 PwC Health Research Institute survey found that 34 percent of consumers would have a less favorable impression of an insurance company that didn't participate in their state's exchange. Another 37 percent think exchanges will make it easier for them to find and purchase a competitive health plan.

Since the exchange rule defers a lot of the decision-making to the states, payers that operate in more than one state will be facing a range of rules and restrictions, from states that exercise relatively little control to others that implement strict requirements, including controlling premiums.

That's why as payers evaluate which steps they should take to prepare to sell plans in multiple exchanges, they must begin with "understanding the level and trajectory of exchange development in each state and exploring their own exchange objectives and impacts from a market, strategic, and operational perspective," Dhan Shapurji, director with Deloitte Consulting, told FierceHealthPayer.

Ultimately, payers can begin preparing themselves to sell insurance in exchanges by evaluating key markets and developing strategies for all reasonably possible scenarios in order to align objectives, product offerings, and desired consumer segments and determine the best possible way forward, advised Shapurji.

Because of the dramatic impact that exchanges will have on all aspects of payers' organizations, Shapurji recommended that senior leadership be involved in decision-making during the preparatory process. "It is important that plans find the right frequency and ability to get in front of their boards and senior leadership to address the many open strategic, market, and operational issues posed by the exchanges," he said.

To increase enterprise readiness, he outlined questions within three key dimensions--strategic planning, market evaluation, and operational and technical readiness--that payers should address. "Depending on the type and nature of the plan, various functional teams and most likely a dedicated reform team should be continually assessing reform/exchange open questions and how it will impact the plans' future direction," Shapurji said.

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