Network Health exclusive: Public and diversity awareness fuels exchange success


With 19 states, plus Washington, D.C, approved to fully or partially run health insurance exchanges, insurers must prepare for the new consumer population entering the marketplace.

To find out what it takes to successfully sell plans on exchanges, FierceHealthPayer spoke with Deborah Gordon, vice president and chief marketing officer of Network Health, about her experience working with Health Connector, the Massachusetts exchange, and how the new marketplaces can help rein in healthcare costs.

FierceHealthPayer:  What makes a successful health insurance exchange?

Deborah Gordon: Going back in time to when the exchange was established, there were a few key things that made the exchanges particularly successful.

First, there was tremendous collaboration and cooperation. From the government sector to private sector, from the providers to the community, there was great sense of "we're all in this together," that we have common goals--to increase access to insurance and healthcare services for our citizens. And by focusing on that common goal, it was quite easy to work together and put our common interests at the forefront.

Second, we have a massive opportunity and challenge to raise public awareness. Everyone had their own messages, but we did it in a collaborative way. We all knew that for the exchange to be successful we all had to contribute to increasing the public's awareness about the exchange itself and new products.

Third, I would advise having a strong stomach. At the beginning, things are going to move fast. What states experience at the beginning will not necessarily be the steady state.

For example, in Massachusetts, in the early days, we did experience pent-up demand for services. We had thousands of people who had not been covered previously, suddenly with access to insurance and healthcare, and they did seek care. And that's the point--for people to get the care they need, but over time. That pent-up demand and increased utilization regressed to the median.

Know that this is a start-up enterprise, and it's going to take a lot of work, collaboration, energy, effort, patience, determinate. On the other side of it, you have a system where more people have access to the care they need, which ultimately leads to a better system of care. 

FHP: What role do providers play in exchange efforts?

DG: The formal, official relationship in the exchange is between state authority and health insurance plan, but you can't have that equation without providers. While healthcare providers may or may not play a formal role, their interests are very important.

More hospitals entering the insurance market, and specifically intending to operate health plans on the exchange. Certainly this is true with the ACO trend, but the line between insurance company and provider system are graying, and I think we'll see more of these hybrid entities operating on the exchanges.  

FHP: When implementing exchanges, what works and what doesn't work?

DG: One thing our exchange, the Health Connector, did extremely well was they remained very open and transparent. They have a board of directors that meets publicly, for example, so that all stakeholders have insight into what's happening and how they're making decisions.

Transparency and collaboration are key, so we have a very positive, constructive working relationship with the Connector at Network Health. Of course, they're our regulator, but we see them in a true partnership capacity. They have set that tone and lived up to that model. What that does, from an implementation standpoint, is it puts all parts of the system on the same page.

We all want this to work; we all want our exchange to be effective. If we're having open dialogue and channels of communication, we're able to address concerns, work through challenges and give and receive feedback.

FHP: How have regulatory guidelines affected competition?

The exchange in Massachusetts has encouraged innovation and enable competition through the rules and guidelines they set. Each year, we bid to participate on the exchange in the subsidized market. We just recently went through a seal of approval process to enter the commercial exchange market. Through the bidding, they'll set an actuarial target range. There are rewards for plans that come in at the low end. That fosters a sense of innovation--how can we get to that low price point.

A couple of years ago, Network Health lowered our premiums by 15 percent and saved the government significant amounts of money, offered a lowest price to the consumer and actually had phenomenal membership growth. So it's really thanks to the Connector that we were able to create such a win-win-win situation.