Some of the most challenging aspects for payers to prepare for operating on the exchanges have to with the basics, such as products, rates and service models.
In an effort to prepare itself for those challenges, Florida Blue has set a pathway for itself for product development and strategies to reach out to targeted populations.
Products and rates would seem pretty easy for payers since it's been their business, but the whole environment has changed, said Joyce Kramzer, Florida Blue senior vice president of business operations.
"With reform, the change in business is really having us change and expand our different skill sets and competencies," she said during a recent World Healthcare Congress conference.
Insurers must have products on the exchange - qualified health plans with essential benefits - that meet the needs of individuals and employers of all sizes.
"So we have to have a myriad of products that meet all those needs, what has been mandated through healthcare reform as well as products that are richer and meet the needs of different employer groups," she said.
As for rates, this has been the
toughest year to determine rates, she said, noting that insurers had to file in March the rates for the exchange for January 2014. "There is a huge amount of uncertainty, so the industry had to make some assumptions."
And service also has to be very different going forward, she said. Some new members will never have had insurance before.
John Kaelin, senior advisor of Avalere Health, said that concentrating on enrollment and service to newly insured populations will be key. "Populations will have characteristics that in some places are like Medicaid," he said at the same conference.
The health status of the likely exchange population may not be quite as stable as for the generally-insured population. And cost-sharing with co-pays and deductibles, even with a premium tax credit, may influence whether they will stay enrolled and pay their premiums.
Once consumers are aware of the coverage programs, it's important that they find it easy to get information and enroll, so payers will have to step up to the plate to communicate.
"This really drives home the point that the clinical model being aligned to the needs of those who will become eligible is the way you're also going to communicate with these individuals," Kaelin said.
Florida Blue is trying to make sure that it doesn't use insurance jargon when explaining its information. It is focusing on how best to communicate with individuals coming into the system, with a particular emphasis on social media tools, although talking to a real person is still important to patients.
From its focus groups, Florida Blue learned that if members have questions about their plan, they don't really want to talk to a person, Kaelin said. Self-service will do. However, if they have questions about a diagnosis, they want to talk to a person.
As it makes changes to meet the changing environment, Florida Blue is testing how to best service members. For instance, it has put into operation 11 retail centers across the state where folks can go in and talk about benefit plan selection and medical issues.
Strategies such as those Florida Blue is trying are a good start, said Minoo Javanmardian, partner and leader of pay/provider practice at consulting firm Booz and Co., but - regardless of participation decisions - payers must become even more consumer-centric through member-directed products and services while developing lean operating models.