Health-risk information lacking on exchange population

Insurers step up efforts to assess new members, encourage screenings and PCP visits

Health insurers need to know the health status of exchange enrollees to determine premium prices for next year. But under the healthcare reform law, enrollees don't have to disclose pre-existing conditions.

So, insurance companies are reaching out to their new customers for information about their medical conditions, medications and lifestyle factors, such as smoking and drinking, The Wall Street Journal reported.

To get this information, Blue Cross & Blue Shield of North Carolina is asking enrollees to fill out health-risk assessments, even offering gift cards to those who fill out the form.

The goal is to quickly assess whether new members are typical or different, Betsy LaForge, director of healthcare programs at Blue Cross & Blue Shield of North Carolina, told the WJS.

For the roughly 4 million people who have signed up for an exchange plan, insurers know age and gender. Humana, for example, found 21-40 year olds represented 37 percent of its new enrollees at the close of January. And as of Feb.1, overall marketplace enrollment consisted of 55 percent women and 45 percent men.

But those statistics alone don't shed light on enrollees' potential risk, the WSJ noted. The lack of health-risk data creates a time crunch for insurers, which soon will have to start the process for submitting plan data and getting plans certified for 2015, as FierceHealthPayer previously reported.

To step up the rate-setting process, Cigna, Florida Blue and North Shore-LIJ CareConnect Insurance Co. are calling enrollees to ask about their health status, encourage screening tests and set up primary care appointments. "What it gives us upfront is an early look into chronic conditions that are out there," Jon Urbanek, a Florida Blue senior vice president, told the WSJ.

To learn more:
- read the WSJ article

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