Health insurance exchanges are coming
What’s the fix?
Customers expect a seamless experience from product selection to enrollment and member services.
Once you’ve established an overall game plan for entering the health insurance exchange arena, you will need to address three questions that focus on optimizing competitive advantage in the transforming marketplace:
- Can you acquire and retain customers? The new exchange marketplace will require you to think differently to communicate brand and value directly to consumers. You will need to: The technology and processes that enable the efficient operation of health insurance exchanges must have:
- Shift sales and customer channels from B2B to a B2C model
- Provide a seamless experience from product selection to enrollment to delivery of services and care
- lign loyalty, satisfaction and metrics to drive member behavior, maximize retention and minimize risk
- ssess and enhance privacy and security strategy and management to meet exchange capabilities
- Are you ready to operate? To enable efficient and cost-effective operation within exchanges, your technology and processes will need to reflect:
- Scalable and compliant batch-enrollment processing
- Enhanced billing and revenue reconciliation processes
- Effective management of new regulatory requirements, risks and controls
- Targeted data-reporting capabilities to promote adherence to new requirements
- Maturity of business intelligence capabilities to measure performance and outcomes
- Can you manage and deliver care? Population health will be more important than ever in managing the care delivery of exchange members. As you develop additional processes, controls and reports to effectively manage care and cost outcomes, you will need to:
- Evaluate the demand capacity of your primary care network
- Identify new high-risk exchange enrollees to manage quality and cost from the onset
- Improve medical management capabilities
- Partner with accountable providers to effectively manage the exchange population
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- Bill Fera
Principal, Advisory Services
+1 412 644 0551
- Thomas D. Morales
Global Risk Leader
+1 212 773 8508
- Amy Dowd
Manager, Advisory Services - Performance Improvement
+1 503 414 7921
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