Consumers today like options. Whether it’s carefully weighing the cost of airline tickets or a new tech gadget, shopping comparison sites like Kayak or Amazon help us feel confident that we are getting the best product at the lowest price possible. Savvy consumers will soon be able to apply the same approach to healthcare when health insurance marketplaces go into effect this fall.
States are required to have health insurance marketplaces — a key component of the Affordable Care Act (ACA) — up and running to accept participants for open enrollment by October of this year. Millions will become eligible for expanded insurance options under the ACA as states are now charged with making healthcare more accessible and more affordable for Americans.
Following the Supreme Court’s decision last June to uphold the ACA, states were given three paths to choose from: a state-based marketplace; a state/federal partnership; or a federally-facilitated marketplace. These government-sponsored portals are where people will compare and purchase health insurance plans for themselves, their families or their businesses.
No matter the model of marketplace states have chosen, however, they all share one common challenge: determining the most effective way to manage the influx of questions from citizens, who are seeking information about how the new marketplaces will affect their access to healthcare.
State governments have a big job ahead of them as they begin to educate the public. The next several months will likely be complicated and uncertain as marketplaces are established and benefit plans are finalized. Many people will need a degree of hand-holding to decide what healthcare option is right for them — and that means phones could be ringing off the hook in each of the 50 states.
According to a recent survey from the Kaiser Family Foundation, 48 percent of citizens are unsure whether or not their state will run its own marketplace.
It has become increasingly critical for states to fill the knowledge gap by making messaging accessible to consumers so they better understand the massive shift occurring in the healthcare system.
Most have been steadily adopting new technology-based innovations to achieve a “no wrong door” system, and nearly all offer in-person assistance in eligibility offices or a toll-free hotline to help consumers enroll in Medicaid or CHIP. For those citizens who want or need one-on-one support, states will still need to build on their existing base of citizen assistance resources, particularly call centers, to connect people to coverage.
As states implement these and other changes associated with the health insurance marketplace, there are four key elements to keep in mind:
- Create a consumer-friendly experience – In today’s mobile world, people are accustomed to having multiple communication options. That means citizens will look for a variety of choices, from the telephone to Web portals, to obtain accurate information about the new mandates. States should identify a partner with proven call center expertise, as well as a deep knowledge of healthcare policy and programs, to guarantee the most effective consumer assistance.
- Address underlying technical issues – States need a reliable system in place to help answer the many questions that consumers are likely to have as they join marketplaces. They must be prepared to complete applications over the phone for those citizens who cannot access a computer or don’t know where to access the application. Trained, professional agents and best-in-class technology will help ensure residents are well supported in making their healthcare selections.
- Connect all necessary parties – From healthcare consumers and insurance carriers, to banking partners and human resource departments, state governments must be mindful of the various individuals and organizations touched by these new processes. States need accessible, timely messaging to help all those involved better understand the necessary provisions and changes.
- Comply with associated regulations – States have very little margin for error in getting a marketplace ready to provide affordable care. Each state must begin open enrollment by October 2013, provide coverage by January 2014 and be self-sustainable by 2015. States must also coordinate services across all agencies, including Medicaid, CHIP, SNAP and TANF. It may prove difficult to manage parallel implementations, so states should be cognizant of the extra demand ACA regulations can place on resources.
One state successfully addressing these challenges now with a strategic plan that places strong emphasis on engaging consumers is Nevada. The state’s marketplace, Nevada Health Link, acts as a bridge between public and private healthcare programs. Sitting on one side of the “bridge” is Nevada’s eligibility system, its main location for Medicaid and CHIP systems information. On the other side is the Qualified Health Plan enrollment-related business operations system.
Nevada Health Link will provide a single point of entry for the state’s pre-existing Medicaid and CHIP programs, as well as its new health insurance marketplace, which will connect the eligibility and healthcare systems, allowing them to communicate with each other at several interfaces. In this way, all public and commercial program application, eligibility and enrollment will come through Nevada Health Link, making it the central hub for all the state’s health insurance programs.
Nevada Health Link will create a simplified experience for consumers and a flexible one for the state, which can maintain control over both the health insurance marketplace and its insurance market, while building in customizations and without sacrificing timeliness.
This makes it easy to see how health insurance marketplaces can serve as conduits between systems and important facilitators for streamlining and speeding health plan purchasing and other state eligibility processes. And with the right system is in place, states will have the foundation needed for a successful health insurance marketplace that best serves its citizens.
Will Saunders is group president of Xerox’s government healthcare solutions unit.
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