Managed Care - August 2012 - (Page 16)

For Health Insurers, Retail Space Available! Under health reform, consumers will be the new buyers in public and private exchanges, meaning care management programs will need a sharper focus on return on investment By Joseph Burns Contributing Editor way for consumers and businesses to buy health care coverage. At its most basic, an exchange is a marketplace where consumers can purchase insurance from different carriers and different benefit plans at the point of enrollment, according to Vince Ashton, president and CEO of HealthPass New York, a private exchange in New York City. S uccess in any retail business comes from offering buyers what they want. Given that insurers will be selling to new retail buyers in the coming years through public and private insurance exchanges, it will be important for health Private versus public plan administrators to identify these buyers’ needs, says Ken Sperling, national health exchange stratPrivate exchanges have been operating for years egy leader for benefit consultant Aon Hewitt. “The in some 20 states, according to Kaiser Health News. exchange is a consumer marketplace, meaning Others are being established now. Both old and new health plans will be selling in a retail channel,” he private exchanges will work alongside the public explains. “The employer may not be the buyer anyexchanges that the states or the federal government more. When the consumer is the buyer, care manwill establish by 2014 under the ACA. If any state fails to start a public exchange, the law agement programs that do not deliver a return on investment will not survive. allows the federal government to do so. “Therefore, care management proThe differences between the public grams will need to help lower the price and private exchanges are significant. of the health plan itself,” Sperling adds. Public exchanges will serve individuals “If they lower prices, they will become and small businesses that are likely to extremely attractive because it can be eligible for federal subsidies designed make the health plan more competito make insurance more affordable and tive. The days of selling care managewill offer insurance coverage through ment programs and charging 50 cents Qualified Health Plans (QHPs). Under per employee per month are over. In- “We have designed an exchange the ACA, a QHP is an insurance plan that provides essential health benefits, stead health plans will be creating care to be totally ACA-compliant but sets limits on cost-sharing, and meets management programs that can reduce not ACA-dependent,” says Ken Sperling, of consulting company other requirements. Public exchanges overall premiums by 3 percent, which Aon Hewitt. in a competitive marketplace will be a in each state will certify QHPs as meetbig deal.” ing the state’s minimum standards. Conversely, private exchanges will be under no Not yet fully operational, the Affordable Care obligation to offer QHPs and will serve employed Act is already having a significant effect on the sale and marketing of health insurance. Health plans people and small businesses that are unlikely to are changing how they sell it, and employers are qualify for federal subsidies. changing how they buy it. While continuing to At least one new private exchange will serve sell to executives in human resources and finance large businesses but most will serve individuals departments at companies large and small, health and small businesses. Under the ACA, Congress plans also are developing relationships with private assumed that large employers did not need an exchange, at least not initially, says Timothy S. Jost, JD, health insurance exchanges, thus providing a new 16 MANAGED CARE / AUGUST 2012

Table of Contents for the Digital Edition of Managed Care - August 2012

Managed Care - August 2012
Editor’s Memo
Legislation & Regulation
News & Commentary
Medication Management
Evidence Review
Compensation Monitor
Private Exchanges: Practice Makes Perfect
Hospitals and Providers Ganging Up on Plans?
Q&A: Kaiser Permanente’s Sharon Levine, MD
God Save the Health Care System!
Future Points to Greater PBM/Plan Cooperation
Formulary Files
Plan Watch
Tomorrow’s Medicine

Managed Care - August 2012