Succeeding in the World of Private Exchanges: This New Benefits Delivery Model Demands All Eyes on...
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© 2007-2014 Change Healthcare Corporation WPCH011 09/03/14 3 to 5 years 1 1 in 4 employers are considering moving to a private exchange in the next Americans may purchase benefits through an exchange by 2018 2 The Changing Benefits Landscape 40M For employers and consumers alike, private exchanges hold tremendous promise. For employers, they promise reduced administrative burdens and greater control over costs. For consumers, they offer increased choice and flexibility in benefits selection and a simple, retail-like shopping experience. For health plans, however, private exchanges mean something entirely different. For this group, White Paper September 2014 Executive Summary The implementation of the Affordable Care Act and growing focus on the individual market are creating an increasingly consumer-centric and competitive healthcare environment. To achieve success in this environment, health plans participating on private exchanges or creating their own single-carrier exchange, must differentiate themselves. Doing so with tools that empower consumers to make value-based purchasing decisions — both pre-and post-plan selection — supports member acquisition and retention, and provides a non-plan design-driven way to optimize utilization and manage medical loss ratio (MLR). The Situation Private exchanges are experiencing hyper- growth. Recent surveys indicate that one in four employers is considering moving to a private exchange in the next three to five years 1 . As many as, 40 million Americans may purchase employer health benefits through a private health insurance exchange by 2018 2 . Succeeding in the World of Private Exchanges: For Health Plans, This Benefits Delivery Model Demands A New Level of Competitiveness - And All Eyes on the All-Powerful Consumer.
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The implementation of the Affordable Care Act and growing focus on the individual market are creating an increasingly consumer-centric and competitive healthcare environment. To achieve success in this environment, health plans participating on private exchanges or creating their own single-carrier exchange, must differentiate themselves. Doing so with tools that empower consumers to make value-based purchasing decisions – both pre- and post-plan selection – supports member acquisition and retention, and provides a non-plan design-driven way to optimize utilization and manage medical loss ratio (MLR). Learn more in the latest white paper from consumer engagement and cost transparency leader Change Healthcare.
Transcript of Succeeding in the World of Private Exchanges: This New Benefits Delivery Model Demands All Eyes on...
© 2007-2014 Change Healthcare CorporationWPCH01109/03/14
3 to 5 years1
1 in 4 employers are considering moving to a private exchange in the next
Americans may purchase benefits through an exchange by 2018 2
The Changing Benefits Landscape
40M
87%of consumers want tools to help project their healthcare expenses4
56%of consumers want tools that raise awareness of personal health status and related health risks5
What Consumers Want
Population Acting Upon Cost Lookup Searches.
Claims-Verified Savings™ Results
/yr$516
/yr$453
Population Acting Upon Ways to Save Alerts ®
For employers and consumers alike, private
exchanges hold tremendous promise. For
employers, they promise reduced administrative
burdens and greater control over costs. For
consumers, they offer increased choice and
flexibility in benefits selection and a simple,
retail-like shopping experience.
For health plans, however, private exchanges
mean something entirely different. For this group,
White PaperSeptember 2014
Executive Summary
The implementation of the Affordable Care Act and
growing focus on the individual market are creating
an increasingly consumer-centric and competitive
healthcare environment. To achieve success in this
environment, health plans participating on private
exchanges or creating their own single-carrier
exchange, must differentiate themselves. Doing
so with tools that empower consumers to make
value-based purchasing decisions — both pre-and
post-plan selection — supports member acquisition
and retention, and provides a non-plan
design-driven way to optimize utilization and
manage medical loss ratio (MLR).
The Situation
Private exchanges are experiencing hyper-
growth. Recent surveys indicate that one
in four employers is considering moving to
a private exchange in the next three to five
years1. As many as, 40 million Americans may
purchase employer health benefits through a
private health insurance exchange by 2018 2.
Succeeding in the World of Private Exchanges:For Health Plans, This Benefits Delivery Model Demands A New Level of Competitiveness-And All Eyes on the All-Powerful Consumer.
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© 2007-2014 Change Healthcare CorporationWPCH01109/03/14
private exchanges mean a completely redefined
health-benefits environment, where, for the first
time, they must compete for business one consumer
at a time. To safeguard their market share, health
plans must be positioned to go head-to-head on
price, service and value. Their new customer?
The consumer – and he/she demands a new
level of support.
The Challenge: The Ill-Equipped Consumer
As private exchange enrollment expands,
consumers are increasingly expected to become
decision makers in their own healthcare. They are
being told to make “value-based decisions” and to
shop for healthcare like they would shop for a car,
but studies show they need help.
According to the U.S. Department of Education,
only about 10% of American consumers have a
proficient level of health literacy – meaning they
could understand and use health-related information
in daily activities. And only 14% of consumers
understand common health benefits concepts,
3 to 5 years1
1 in 4 employers are considering moving to a private exchange in the next
Americans may purchase benefits through an exchange by 2018 2
The Changing Benefits Landscape
40M
87%of consumers want tools to help project their healthcare expenses4
56%of consumers want tools that raise awareness of personal health status and related health risks5
What Consumers Want
Population Acting Upon Cost Lookup Searches.
Claims-Verified Savings™ Results
/yr$516
/yr$453
Population Acting Upon Ways to Save Alerts ®
including deductible, co-pay, coinsurance and out
of-pocket maximum3.
Fortunately, consumers want help in making better
healthcare decisions. A recent survey by Accenture
reveals that 87% of consumers want tools to help
project their healthcare expenses4 and 56% want
access to tools that raise awareness of personal
health status and related health risks5 .
The Solution: Decision-Support Tools that Help Attract and Retain Members
Consumers shopping for health coverage on a
private exchange are undoubtedly comparing the
cost of premiums, co-pays and deductibles from
one plan to the next. Increasingly, however, they
are also looking for added value – features that
help differentiate one plan provider from another.
Decision support tools designed to help consumers
make the most of their healthcare dollars, not just
during plan selection, but post-plan selection as
well, deliver tremendous added value – and can help
health plans attract and retain members.
Take for example Change Healthcare’s Ways
to Save® Alerts, which deliver immediate value
to members by proactively notifying them of
opportunities to save on their most common and
recurring healthcare services and prescriptions
– things like maintenance medications, physical
therapy and chiropractic care. When one Change
Healthcare client recently deployed the tool to those
covered under its plan, 66% of the population acted
© 2007-2014 Change Healthcare CorporationWPCH01109/03/14
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data, claims history or data from health and wellness
programs, these highly targeted messages support
specific initiatives centered on wellness, chronic
care management, medication adherence and point-
of-care optimization.
Targeted Engagement Alerts also provide an
effective mechanism to support plan efforts to
improve Medicare Advantage Star ratings, and
may qualify as a quality improvement activity
under the MLR calculation. In addition, the solution
supports initiatives focused on accreditation
or reaccreditation for URAC and NCQA for disease
management, case management, wellness
and health promotion.
Summary
To remain successful now and into the future,
health plans must differentiate themselves from
their competitors with decision-support tools that
encourage member recruitment and retention, and
cost-savings all around. Tools like those offered by
Change Healthcare do just this, while also improving
population health and delivering measurable ROI.
on an alert. Claims-Verified Savings™ resulting from
their actions averaged $516 per purchaser per year 6.
Change Healthcare’s Cost Lookup tool also helps
health plans deliver added value to consumers
looking to maximize the value of their healthcare
dollar and better predict their healthcare costs.
The web-based tool empowers users to search for
prescription, medical, dental and vision services,
and to determine the price they would pay at a
specific provider based on their individual plan,
network and location. Integrated quality information
further simplifies the user decision-making process
and ensures that the consumer can truly make a
value-based decision.
One client that recently implemented Cost Lookup
saw 55% of its covered population log in and search
for healthcare services. Claims-Verified Savings
resulting from these acted-upon searches averaged
$453 per purchaser per year6.
To help consumers increase their awareness of
personal health status and related health risks, and
to support cost savings for members and health
plans alike, there are tools like Change Healthcare’s
Targeted Engagement Alerts. Using demographic
Population Acting Upon Cost Lookup Searches
Claims-Verified Savings™ Results
/yr$516 /yr$453Population Acting Upon Ways to Save Alerts®
© 2007-2014 Change Healthcare CorporationWPCH01109/03/14
888.920.5234 • [email protected] Centerview Drive, Suite 300 • Brentwood, Tennessee 37027
www.changehealthcare.com
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www.linkedin.com/company/change-healthcare-inc
www.trendsparency.net
WPCH011 © 2007-2014 Change Healthcare Corporation
1 “National Survey of Employer-Sponsored Health Plans,” Mercer, March 2014
2 “Are You Ready? Private Health Insurance Exchanges are Looming,” Accenture, 2014
3 George Loewenstein, Journal of Health Economics, September 2013
4 “Private Health Insurance Exchange Survival Guide,” Accenture, 2013
5 “Consumer Health Mindset Study,” Aon Hewitt/National Business Group on Health /Futures Company, February 2014
6 “Proactive Engagement Drives Claims-Verified Savings,” Change Healthcare, 2013
Jack BrunerChief Marketing OfficerChange Healthcare Corporation [email protected]
Laura Alabed-Olsson Sr. Manager, Marketing and CommunicationsChange Healthcare Corporation [email protected]
About Change HealthcareEstablished in 2007, Change Healthcare is on a mission to transform the way Americans purchase and utilize healthcare services by driving sustainable engagement at the individual level. With a national client base of health plans and employers covering lives in all 50 states, and approximately 7 million users on its platform, Change Healthcare is the premier national provider of healthcare cost transparency and consumer engagement solutions. To learn more, visit www.changehealthcare.com.
