Today is the deadline for open enrollment in the new health insurance marketplace. While the post mortems roll in on enrollment results – total enrollees, newly covered Americans, variations in enrollment by age and by state – it’s not too early to identify what should be improved next year with the consumer experience.
Our experience enrolling consumers is a microcosm of this new world. ConnectedHealth’s private exchange – Smart Choices™ Marketplace – was offered to consumers through employers, brokers, and aggregators, such as payroll companies and health plans. Here are the highlights of what we’ve seen and five things that will be different in November, 2014:
- While we’ve read the forecasts of small employers (less than 50 employees) dropping group coverage because of costs, we’ve witnessed a strong financial commitment to employees from these employers, even when they don’t offer group insurance. Employers who didn’t offer a group health plan invited their employees to shop for individual insurance. Through payroll integration, more than half of those employers offered a significant monthly contribution to their employees to encourage them to purchase health insurance. The lesson learned? Employers’ role as the gateway to benefits continues and mechanisms that make it easy for employers while reducing administrative hassles will be used.
- There has been a shift from self insured to fully insured on the part of some employers who want more predictability in benefit costs (e.g., Walgreens and other participants of the AON/Hewitt private exchange). At the same time other small and mid-size employers are pursuing the opposite strategy to see if they can achieve a new level of cost savings by shifting to a self-insured model. Both trends will continue and will result in broader adoption of private exchanges with more contribution transparency from employers to employees. What do both of these strategies demonstrate? There is value in showing an employer’s contribution to the employee’s benefit plan and that will continue whether employers are self or fully insured.
- Consumers expect purchasing insurance online to be as easy as buying shoes from Zappos. Technology needs to be improved to create a seamless experience with the federal exchange and with carriers. In its absence, a “high touch” option has to be offered. We have more work to do across the industry before the entire process – from searching, shopping, to payment – can be described as a “wow experience.” Still, consumers are shopping and results vary in terms of what they select. In our experience, the magic number is $50 per month differential. Specifically, we found that if consumers can save $50 or more per month on their portion of their health insurance premiums, the majority are willing to switch to a high deductible health plan and take on additional financial risk. Walgreen’s experience this year, as described at last week’s ACHE meetings, was mixed: 30% of associates “skinnied” down their coverage from the prior year and 30% bought richer coverage. We’ll all use these data to find the most effective (personalized) package of services for shoppers in the coming year. Watch for even greater integration of health insurance with other voluntary products.
- We have increasing evidence that price is not a reliable signal for quality in healthcare. As traffic on social media increases and consumer experiences become more public and visible, we may find that brand and customer loyalty become less compelling in healthcare. Look for even more useful information on quality, outcomes and service from a range of sources – all of which Americans will use to help guide their decisions.
- Finally, more Americans are worried about finances – for health expenditures, for retirement, for everyday living. Look for more discussion about the relationship between health and wealth – our friend Jane Sarasohn-Kahn nailed it with DIYs recent survey noting that people who save money (and not huge amounts) report a higher health status.
This year’s enrollment was noteworthy for many reasons, but the real transformation has yet to come.