- The Patient Protection and Affordable Care Act has brought a variety of changes for both insurers and healthcare providers with the establishment of health insurance exchanges holding a top place in reforming reimbursement between payers and providers. The new provisions of the Affordable Care Act as well as the operation of health insurance exchanges, however, have brought more of a financial loss for some payers selling health plans through the marketplace.
For instance, the major health insurer Aetna has stated that it lost $140 million in 2015 by operating through the exchanges. Humana expects to lose $176 million in 2016 due to the health insurance marketplace. Additionally, UnitedHealthcare is looking to stop operating in the health insurance exchanges by 2017 due to its financial loss.
Healthcare providers are also looking to form their own partnerships, narrow networks, and health plans in order to function more effectively in the new landscape created by the Affordable Care Act. For example, Memorial Hermann Health Solutions is one such organization that took the basic idea of the health insurance exchanges and formed its own consumer-centric platform to sell health plans in a more effective and engaging manner.
In fact, Memorial Hermann Health Solutions partnered with Connecture to enroll more than 8,000 members through its insurance exchange platform in a few, short months. To learn more about how this particular establishment has dealt with the changing reimbursement structures due to the Affordable Care Act and health insurance exchanges, HealthPayerIntelligence.com spoke with Neil Kennish, Associate Vice President of Marketing and Sales at Memorial Hermann Health Solutions.
HealthPayerIntelligence.com: What steps did your health insurance company take to improve consumer engagement?
Neil Kennish: “We tried to do a lot of things to change the way we approached consumer engagement for 2016. Historically, our health plan had been geared towards brokers as well as employers. Then the changes that accompanied the Affordable Care Act really put an emphasis more on the individuals and targeting consumers. Specifically, for 2016, I can speak to both sales and marketing because I oversee both these functions here at the health plan.”
“We made a lot of changes to really make sure that we were communicating and approaching individuals on a direct level. Our marketing materials allowed the individual consumer to get a better sense of what is health insurance. What does it cost them? And to try to get away from the vagaries around copays and deductibles. Simplify it for them as much as possible.”
“There are going to be a lot of challenges associated with understanding health insurance and how it works regardless of what segment you’re in - whether it’s individual, Medicare Advantage, commercial, or group insurance.”
“We tried to take an approach where we either did focus groups or did surveys of our existing customers to get a better sense of what critical benefits that they need to make sure are covered without them having to be concerned. What are benefits that need to be explained in detail so that people understand the difference between copays and coinsurance rates? We try to take away some of the questions and uncertainty around health insurance so that it is an easier decision for them.”
HealthPayerIntelligence.com: In what ways has selling health plans through the marketplace and your health insurance exchange platform benefited your organization?
Neil Kennish: “First and foremost, we had never really had the opportunity to compete on a retail level. By retail, I mean the opportunity to approach consumers in a marketplace environment.”
“Historically, if you wanted our individual insurance, you called us or you sent in a paper application and we had a very small presence in the individual marketplace. By participating in our own private exchange where people could go online and see all of our individual plans, consumers could actually look at every single one of those plans to see what their monthly premium would be, what their deductible is, what tier it is, and what their relevant benefits were across each dimension that mattered to them.”
“It truly opened up a marketplace for us. Although it was a private exchange where only Memorial Hermann insurance plans were showcased, it still gave consumers the power to choose from any one of our individual insurance plans. It affords people some choice and opportunity to really get a sense of the breadth of plans that we offer.”
HealthPayerIntelligence.com: Have you noticed greater patient satisfaction due to your new customized retail shopping experience? Why or why not?
Neil Kennish: “As far as the shopping experience, I would absolutely say that we got great feedback from consumers about their ability to look at every plan in detail and be able to do plan comparisons. This enabled them to see multiple plans at the same time so they can compare benefits, tiers, premiums, copays, and more.”
“From a shopping experience, the feedback we got was very positive. We did a lot of surveys and you can also analyze behavior online. The great thing for us was we partnered with Connecture and Connecture gave us that technology platform where from real-time, we could monitor how the shopping experience is being consumed by individuals.”
“We can monitor where they’re exiting the shopping experience and where they are spending a lot of time, so maybe we need to clarify something on that page. The beauty of an online enrollment system like what we partnered with Connecture to provide is that it gives us the ability to adapt on the fly and try to create a better shopping experience.”
“Part of the reason why we partnered with Connecture was they’ve done this for some of the biggest plans throughout the country. They’ve created an algorithm or formula that creates from a more idealized shopping experience for individuals.”
“Based on the 75 to 100 health plans that they’ve worked with, they’ve been able to go through that process and see what they learned from 2014 and made some improvements. They learned this from 2015 and made additional improvement. Then by 2016, which is the first year we offered individual plans through their online technology platform, it felt like a much better process than consumers have ever used before.”
“The analogy I would use is that it’s not unlike the travel industry. We used to have travel agents that were responsible for booking people’s flights, travel plans, and vacations. As online travel sites popped up, people began to feel more and more comfortable booking their travel online.”
“That is the start of the evolution in health insurance. That’s not to say that the brokers aren’t incredibly important and a valued partner for either an individual or an employer that’s trying to figure out which insurance provider to go with. Nonetheless, the opportunity where people can go online and research themselves the various different insurance options is a great thing for the consumer.”
HealthPayerIntelligence.com: What has Memorial Hermann Health Solutions done to reduce healthcare spending and bring more value-based, quality care to its consumer base? What type of contracts are you creating with your provider network?
Neil Kennish: “One of the great things about being part of a provider-sponsored health plan is that we are able to have those conversations directly with our partners at Memorial Hermann. Whether that’s the health system or our provider network, we’re able to directly contract with them and also have discussions about chronic conditions.”
“Let’s say we’re seeing a certain type of chronic condition that is existing within our individual block of business. Let’s say we’re experiencing a high preponderance of diabetics. We’re able to then get with our provider partners and health systems to talk about what type of diabetic programs we can activate to make sure that we’re appropriately providing the care that the population needs.”
“The fact that all of the different components of our system including the hospitals, providers, and health plans all under one roof working together with the same technology and electronic information being passed back and forth so that everybody has the same information, it makes us much more effective at coordinating care.”
“What ties into that is the fact that we have our own accountable care organization that has been recognized nationally particularly within the Medicare Shared Savings Program as the number one ACO in the country for the past two years. We’re able to really tap into that knowledge and expertise that they’re applying to their Medicare population and use it on our other lines of business to make sure that we’re delivering high-quality, coordinated healthcare at the most affordable price that we can.”