Adaptability and flexibility is and will continue to be the key to both survival and success
While the dust has somewhat settled from the nervous, chaotic launch of the public health insurance exchanges earlier this year, the second open enrollment period is approaching quickly. As the industry prepares for November 15, it's important to examine lessons learned, key trends and best practices to apply.
Preparation for year one was primarily about participation-not optimization-with the focus being on simple entry. Plans with the most foresight pursued solutions that provide flexibility for the future. Moving forward, flexibility remains critical and the focus will be on optimization as plans continue to roll with ongoing policy updates and market changes.
As we prepare for round two, here are our current observations and expectations:
Plans participating in the exchanges have approached the operational and technology investments necessary in one of three rough categories of operational preparedness:
Regardless of type, all payers participating in exchanges recognize that the cascading uncertainties of federal-level policy and funding; volume of membership; and state or federal exchange administration decision-making represent a foundation of sand upon which they must attempt to build a robust structure of new products and operational processes. While some may wish to wait for bedrock, the expectation is that competitive pressures will not accommodate such a surfeit of caution.
Some uncertainty will continue, but more importantly, plans will adjust to their revised forecasts of membership-both overall quantity and mix-and to significant challenges in the following areas:
Adaptability and flexibility is and will continue to be the key to both survival and success. Payers that have the agility to optimize for ongoing waves of change to the rules, technical requirements and regulatory standards related to the exchanges will reap the benefits and competitive advantages of restraining administrative overhead costs.
This in turn will allow for more aggressive pricing, better customer service and ultimately increased market share as more of the population moves towards the exchange world. The coming years will be a watershed for the health insurance industry, and as it all shakes out, many of the organizations leading thoughtful investments today may find themselves celebrating the decisions made over the coming months and years.
Brian Kim is senior vice president of account management at ikaSystems.
Sidharth Bathia is HIX business analyst manager at ikaSystems.
Paul Wann is senior director and solution arrchitect at ikaSystems.