Private vs. Public Exchanges


Posted by Kenton Bohn - 21 May, 2013

By Ken Pedersen, Executive Management and

Kenton Bohn, VP & Healthcare Practice Lead

The growth and maturation of private health insurance exchanges is happening more rapidly than many people expected - and for good reason.

While serving valuable economic and operational purposes in managing major group policies, many private health insurance exchanges are delivering a significant secondary benefit: helping payers understand the dynamics they will face once the state-sponsored exchanges are opened.

As with all technologies and business processes, the first versions are typically a bit rough around the edges. The same should certainly be true for the early private health insurance exchanges.

The testing of policies, procedures and technologies in these controlled, private exchange environments is providing a clear roadmap for scale. These tests are helping payers identify key areas for improving policyholder education and policy management that would be too expensive and too disruptive to conduct within the public exchanges.

Some of the key areas we see our clients consistently testing include the following:

New Policyholder Communications

Private exchanges provide an opportunity to understand exactly how much information a prospective policyholder needs to make an informed decision - and how much information they can handle in the decision process. Testing copy, single vs. multi-step enrollment processes and interstitial progress confirmations can have a material impact on enrollment efficiency and policyholder satisfaction. The opportunity to learn why a prospective policyholder does not enroll in a plan in a timely manner can be invaluable.

Key questions include the following:

  • What are the key factors contributing to a delayed enrollment?
  • Was the process overwhelming? Is there too much information?
  • How can a prospective policyholder’s existing experience with online registration processes and wizards be leveraged to encapsulate this complex registration process?
  • How can the steps completed and the steps remaining be clearly presented to minimize the instances of confusion and registration abandonment?
  • What positive reinforcements and real-time help options are needed to keep prospective policyholders on track with their registrations?

These questions can be quickly answered and refined in a heavily controlled environment. This is an excellent opportunity to test and identify the best messaging and communications strategies to achieve your financial and operational objectives before the public health exchanges launch.

Policyholder Plan Selection and Enrollment Process

Private exchanges enable payers to quickly see which plans prospective policyholders gravitate towards (and why) when they are available in a direct comparison model.

  • Are decisions being made only on cost?
  • Are prospective policyholders aware of the opportunities available between different policies?
  • Does the physical placement of one policy vs. another within the enrollment process materially impact selection?
  • How do comparison/recommendation methodologies impact conversion, speed of enrollment and plan selection decisions?

Support Operations

Another key learning area, perhaps the most important from a cost perspective, is support. Can existing sales, account management and/or customer service representatives support these new enrollment processes? Are additional staff or systems necessary to meet conversion goals and service-level agreements?

A very common test of a support system is the following:

  • If clearly visible support/contact information is available each step of the way, will prospective policyholders use it to ask questions, ignore the offer of help and continue incorrectly, or simply abandon the process in frustration?

Additionally, it’s important to identify the steps necessary to engage policyholders via online support. Most people aren’t in the habit of managing their insurance policies online, or of revising their purchase(s) on a regular basis. The establishment of this habit will have a meaningful impact on policyholder satisfaction and understanding of benefits.

If you only learn one thing from a private exchange project - and that one thing is an understanding of the impact an exchange will have on your support operations, you're verly likely going to come out ahead.

Systems Integration Requirements

Most private exchanges are being architected, developed and deployed under an MVP (Minimum Viable Product) model. The opportunity to gain valuable insights into unknown technical and operational requirements, at minimum cost, is hard to ignore. Instead of guessing, private exchanges can give you tangible, real-world insights into exactly which existing systems need to be integrated (and how they can best be integrated) to achieve financial and operational objectives. Whether your objective is to deliver the highest enrollment conversion rates or deliver the highest possible level of customer service at the lowest cost, private exchanges are providing tremendous Petri dishes for payers to identify brand new system integration requirements.

Cross-Platform Requirements

The fact that everyone has smartphones and tablets and is exposed to news, promotions, etc., around the clock means that the need to continually engage existing and prospective policyholders is more important than ever. The private exchange experience will provide valuable information in helping payers identify how existing and prospective policyholders utilize these devices to make purchase decisions and manage their policies. Providing a simple and powerful mobile experience may present significant opportunities to lower customer care costs and improve retention.

Policyholder communications, plan selection and enrollment processes, support operation impacts, system integration requirements and cross-platform implications are just a few of the key areas of learning we’re seeing available to health insurance companies via their private exchange initiatives.

You undoubtedly have a number of things you’d like to test and learn about healthcare exchanges, too.

How can we help you capitalize on this opportunity?

We would welcome the opportunity to speak with you. Please complete the inquiry below and we’ll be in touch.

Topics: leadership, software development

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