Upload
audrey-noel
View
52
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Preparing for Health Reform: The Role of the Health Insurance Exchange. Bob Carey RLCarey Consulting March 11, 2010. Agenda. Level setting Developing a baseline Types of Exchanges Funding and operating an Exchange Subsidizing health insurance Importance of outreach and enrollment - PowerPoint PPT Presentation
Citation preview
Preparing for Health Reform:The Role of the Health Insurance
Exchange
Bob Carey
RLCarey Consulting
March 11, 2010
Agenda Level setting Developing a baseline Types of Exchanges Funding and operating an Exchange Subsidizing health insurance Importance of outreach and enrollment Mitigating risk of adverse selection Conclusions/Recommendations
2
Level Setting
State-based exchanges
Federal guidance, but state flexibility
Oversight/enforcement handled (initially) by the states
3
Developing a Baseline
Uninsured
Current publicly-subsidized health coverage programs
Insured
4
Uninsured
Size of the population Demographics Geographic/regional variations Family income Employment status and ESI availability Eligibility for publicly-subsidized health coverage
programs
5
Public Health Coverage Programs
Types of programs available Eligibility criteria Take-up rates Distribution methods Capacity Potential impact of Exchange on existing programs Particular focus on premium subsidy programs for
“non-traditional” groups
6
Insured Demographics Geographic/regional variations Employment status Types of coverage Distribution methods Carriers and market share ESI premiums and % paid by employees Take up rate of ESI Role of brokers/intermediaries, by market segment
7
Why the Baseline?
Identify potential for program consolidation or elimination
Highlight areas to focus “crowd out” efforts Leverage existing infrastructure Optimize capacity and avoid duplication Inform outreach and marketing strategy
8
What Type of Exchange? Three basic models
Weak Strong(Range of government involvement in commercial market)
Ultimate Goal – shift the individual and small group markets from competition based on avoiding risk into competition based on price and quality.
9
Market Organizer & Distribution Channel
Sets standards of quality and soundness for insurers’ participation
Offers all plans and all carriers that satisfy quality and soundness criteria
Serves as impartial source of information Facilitates plan/carrier comparisons Streamlines administration and simplifies
enrollment Brokers insurance
10
Selective Contracting Agent Offers “structured choice” of health plans
and carriers Promotes competition among insurers, but
does not “negotiate” premiums Serves as impartial source of information Facilitates plan/carrier comparisons Streamlines administration and simplifies
enrollment Brokers insurance
11
Active Purchaser Sets benefits package and procures
health insurance on behalf of enrollees Negotiates premiums with carriers Limits choice of plans/carriers Attempts to act like large employer
Viability contingent on covering large – and “risk neutral” or better – pool of members
12
Funding and Operating an Exchange
Model selected will impact:Roles and responsibilitiesAdministrative structure/governanceStaffing
Resource needs affected by model selected AND capabilities of existing public and private entities
13
Building or Renting Administrative Capacity
Medicaid agency to process eligibility for premium subsidy?
Private sector intermediaries (third party administrators) to provide administrative services?QuotingEnrollmentCustomer servicePremium billing, collection, remittanceAccount management, etc…
14
Revenues to Support Operations
Retention of a portion of the premiumsTypically 3% - 5% of premium
Add-on fee to premiums
Annual Appropriation
15
Subsidizing Health Insurance Two main options
Stand-alone Medicaid-like health coverageo Commonwealth Careo Texas’ CHIP and Medicaid Buy-In programs
Premium subsidies for commercial insuranceo Maryland’s Health Insurance Partnershipo Insure Oklahoma
16
Outreach and Enrollment O&E efforts will likely determine success
and sustainability of the Exchange Will impact risk selection and potential
for administrative efficiencies Use of health insurance brokers may be
key, particularly for small group market Need to leverage multiple sources of
information to reach consumers
17
Mitigating Risk of Adverse Selection
Learn from past mistakes Need to attract large risk pool Exchange as sole source distribution
channel for SG/NG?– If not, rating rules and underwriting
guidelines must be comparable inside and outside of Exchange
Brokers have significant influence
18
Conclusions/Recommendations
“First do no harm” Each market – and each state – is different Need for consumer information that is
understandable, meaningful and actionable Leverage existing infrastructure Focus on end goal – shifting competition from
one based on avoiding risk into one based on price and quality
19
20
Questions?