Health insurance exchanges: Strategic planning


Before payers participate in any exchanges, they must strategize the implications such involvement will have on multiple aspects of their business, particularly their enterprise strategy, competitive strategy, and growth and profitability. To gauge whether a health insurance exchange complements payers' goals in these areas, they should determine the answers to these key questions:

  1. How will the exchanges fit into the overall enterprise strategy (short and long-term)?   
  2. Does the preliminary exchange strategy prioritize geographies and/or market segments?
  3. What are the anticipated risks and rewards of participating in the exchanges with so many unknowns?
  4. What are reasonable growth and profitability targets? How will this impact cost structure and premiums?