Focus Magazine - Winter 2014 - 15

VIEWPOINT

Health Insurance Exchanges:
Guess What's Next?
I By Kyle Valby and Christine MacAdams

H

ealth insurance exchanges
(marketplaces) have been the
center of controversy and
debate for the better part of a year. How
did we get here, and what's going to
happen as they become the main
vehicle for millions of people to obtain
health insurance coverage?

The History
A key provision of the Affordable
Care Act, the exchanges were created to
help the uninsured obtain coverage
through an online marketplace. From
the start, many thought they would
never launch.
Despite the skepticism, the
exchanges opened for enrollment on
October 1, 2013, amid a myriad of
technical problems. Long wait times,
web page crashes and poor usability
plagued the sites and frustrated users.
The federal exchange, which services
36 states, generally performed worse
than the state-run exchanges, and the
federal government quickly admitted
to usability and server issues that
prevented people from signing up.

The Implications
Despite the initial glitches, a
reported 20-28 million may be getting
coverage through the exchanges by the
year 2018. For pharmaceutical
companies, this could mean more
people with access to pharmaceutical

products. For
payers, the
challenge will
be managing
risk and
controlling
costs -which
can lead to
narrow
provider
networks,
increased
utilization
Map provided by HealthLeaders-InterStudy.
controls such as
prior
authorizations
Which raises the question: With
and step edits, and shrinking
more of the responsibility for
formularies for prescription drugs. For
healthcare falling to the consumer, will
healthcare providers, it will likely mean
consumers bargain shop for care? Will
managing bad debt, as people who sign
they push for generic and over-theup for benefits may still not be able to
counter medications, or increasingly
pay the out-of-pocket costs.
choose no treatment at all? A recent
survey conducted by Manhattan
Research affirmed that 20 percent of
Our Guess...
online consumers asked a doctor to
The retail model for health
prescribe a generic instead of a brand
insurance is continuing to gain
name prescription drug after finding
momentum. Cracks in employerinformation online.
sponsored insurance are beginning to
So what's next? Our guess is that
appear as consultants and carriers are
with more consumers in the driver's
promoting "private exchanges" in
seat, it will become increasingly
which employers contribute a dollar
important for pharmaceutical
amount and employees shop for
companies to make their case directly
coverage in a marketplace. It may not
to consumers. A strong "consumer
be long before we're all surfing for
value story" will become critical to
insurance the same way we buy airline
success. I
tickets and consumer products.

Kyle Valby is associate director, field sales management development, Boehringer Ingelheim Pharmaceuticals. Christine MacAdams
is key account director, sales training, PINSONAULT. This article represents the individual viewpoints of Kyle Valby
and Chrstine MacAdams and are not representations by their respective companies. Email the authors at
kyle.valby@boehringer-ingelheim.com or cmacadams@pinsonault.com.

FOCUS | WINTER 2014 | www.spbt.org

15


http://www.spbt.org

Focus Magazine - Winter 2014

Table of Contents for the Digital Edition of Focus Magazine - Winter 2014

Focus Magazine
From the President: Career Paths to Success
Table of Contents
Table of Contents
Guest Editor: The New Frontier
Front of the Room: Swaying an Audience
Viewpoint: Health Insurance Exchanges
Racing to Success: 2013 Medical Device & Diagnostic Trainers Summit Recap
Redesigning Learning: Astellas Gives 'Live' a New Look
Sleights-of-Learning: Neuroscience, Attention and Memory
Measuring Experience: Scorecards & Simulations
Virtual Impact: Converting to VILT
Member Solutions: Developing Field-Based Trainers
What Makes Virtual Leadership So Hard?
Facing Negativity in Sales
Virtual How: Learning Management System Trends
Member News
Ad Index
Focus Contacts
5 Questions with Dr. Beverly Kaye
Focus Magazine - Winter 2014 - Intro
Focus Magazine - Winter 2014 - Focus Magazine
Focus Magazine - Winter 2014 - Cover2
Focus Magazine - Winter 2014 - 3
Focus Magazine - Winter 2014 - 4
Focus Magazine - Winter 2014 - From the President: Career Paths to Success
Focus Magazine - Winter 2014 - 6
Focus Magazine - Winter 2014 - Table of Contents
Focus Magazine - Winter 2014 - 8
Focus Magazine - Winter 2014 - Table of Contents
Focus Magazine - Winter 2014 - 10
Focus Magazine - Winter 2014 - Guest Editor: The New Frontier
Focus Magazine - Winter 2014 - 12
Focus Magazine - Winter 2014 - Front of the Room: Swaying an Audience
Focus Magazine - Winter 2014 - 14
Focus Magazine - Winter 2014 - Viewpoint: Health Insurance Exchanges
Focus Magazine - Winter 2014 - Racing to Success: 2013 Medical Device & Diagnostic Trainers Summit Recap
Focus Magazine - Winter 2014 - 17
Focus Magazine - Winter 2014 - 18
Focus Magazine - Winter 2014 - Redesigning Learning: Astellas Gives 'Live' a New Look
Focus Magazine - Winter 2014 - 20
Focus Magazine - Winter 2014 - 21
Focus Magazine - Winter 2014 - 22
Focus Magazine - Winter 2014 - 23
Focus Magazine - Winter 2014 - 24
Focus Magazine - Winter 2014 - Sleights-of-Learning: Neuroscience, Attention and Memory
Focus Magazine - Winter 2014 - 26
Focus Magazine - Winter 2014 - 27
Focus Magazine - Winter 2014 - 28
Focus Magazine - Winter 2014 - Measuring Experience: Scorecards & Simulations
Focus Magazine - Winter 2014 - 30
Focus Magazine - Winter 2014 - 31
Focus Magazine - Winter 2014 - Virtual Impact: Converting to VILT
Focus Magazine - Winter 2014 - 33
Focus Magazine - Winter 2014 - Member Solutions: Developing Field-Based Trainers
Focus Magazine - Winter 2014 - 35
Focus Magazine - Winter 2014 - 36
Focus Magazine - Winter 2014 - 37
Focus Magazine - Winter 2014 - What Makes Virtual Leadership So Hard?
Focus Magazine - Winter 2014 - 39
Focus Magazine - Winter 2014 - 40
Focus Magazine - Winter 2014 - 41
Focus Magazine - Winter 2014 - Facing Negativity in Sales
Focus Magazine - Winter 2014 - 43
Focus Magazine - Winter 2014 - Virtual How: Learning Management System Trends
Focus Magazine - Winter 2014 - 45
Focus Magazine - Winter 2014 - 46
Focus Magazine - Winter 2014 - Member News
Focus Magazine - Winter 2014 - Ad Index
Focus Magazine - Winter 2014 - Focus Contacts
Focus Magazine - Winter 2014 - 5 Questions with Dr. Beverly Kaye
Focus Magazine - Winter 2014 - Cover3
Focus Magazine - Winter 2014 - Cover4
https://www.nxtbook.com/nxtbooks/LtenFocus/2017winter
https://www.nxtbook.com/nxtbooks/LtenFocus/2017fall
https://www.nxtbook.com/nxtbooks/LtenFocus/2017summer_supp3
https://www.nxtbook.com/nxtbooks/LtenFocus/2017summer_supp
https://www.nxtbook.com/nxtbooks/LtenFocus/2017summer
https://www.nxtbook.com/nxtbooks/LtenFocus/2017spring_supp
https://www.nxtbook.com/nxtbooks/LtenFocus/2017spring
https://www.nxtbook.com/nxtbooks/LtenFocus/2016winter
https://www.nxtbook.com/nxtbooks/LtenFocus/2016fall
https://www.nxtbook.com/nxtbooks/LtenFocus/2016summer_supp2
https://www.nxtbook.com/nxtbooks/LtenFocus/2016summer
https://www.nxtbook.com/nxtbooks/LtenFocus/2016summer_supp
https://www.nxtbook.com/nxtbooks/LtenFocus/2016spring
https://www.nxtbook.com/nxtbooks/LtenFocus/2015winter
https://www.nxtbook.com/nxtbooks/LtenFocus/2015fall
https://www.nxtbook.com/nxtbooks/LtenFocus/2015summer_supp
https://www.nxtbook.com/nxtbooks/LtenFocus/2015summer
https://www.nxtbook.com/nxtbooks/LtenFocus/2015spring
https://www.nxtbook.com/nxtbooks/LtenFocus/2014winter
https://www.nxtbook.com/nxtbooks/LtenFocus/2014fall
https://www.nxtbook.com/nxtbooks/LtenFocus/2014summer
https://www.nxtbook.com/nxtbooks/focus/2014spring
https://www.nxtbook.com/nxtbooks/focus/2014winter
https://www.nxtbook.com/nxtbooks/focus/2013fall
https://www.nxtbook.com/nxtbooks/focus/2013summer
https://www.nxtbook.com/nxtbooks/focus/2013spring
https://www.nxtbook.com/nxtbooks/focus/2013winter
https://www.nxtbook.com/nxtbooks/focus/2012fall
https://www.nxtbook.com/nxtbooks/focus/2012summer
https://www.nxtbook.com/nxtbooks/focus/2012spring
https://www.nxtbook.com/nxtbooks/focus/2012winter
https://www.nxtbook.com/nxtbooks/focus/2011fall
https://www.nxtbook.com/nxtbooks/focus/2011summer
https://www.nxtbookmedia.com