This article originally appeared at Healthcare Dive on Jan. 20, 2016.
A new study by the Blue Cross Blue Shield Association suggests health insurers are adapting their strategies in the ACA marketplaces to better serve customers and manage risk.
ACA marketplace experience is expected to prove beneficial in the program’s third year. Insurers are applying more data, including the actual healthcare costs of newly-enrolled members, to design plans that precisely match the needs of their customers, the association says.
“Insurance companies also know more about how these new members choose a health plan and what the most important factors are in their purchase decision,” Robert Elfinger, BCBSA’s senior manager of media relations, wrote to Healthcare Dive.
Despite the availability of early marketplace data, however, participation is arguably still highly experimental.
“As our report says, this is still a market in transition,” Elfinger said. “This transition reflects the challenge of serving many members with previously unmet, ongoing healthcare needs by providing greater care coordination and cost-effective choices that enable consumers to have lower out-of-pocket costs.”
One of the biggest questions will be how payers are likely to regard the marketplace in 2016, following mixed responses in 2015, when UnitedHealth suggested it might exit the market in 2017 due to high losses. In addition, Aetna voiced its intent to “stick it out and work with it.”
BCBS companies are among those who appear to be in it for the long haul.
“BCBS companies’ participation in the Affordable Care Act marketplaces remains broad and deep, providing millions of consumers with the security and stability of health insurance, as we have for generations,” Elfinger said.
“It has always been known that it would take time to make the transition to this new system in which everyone can obtain health insurance regardless of their age or health status,” he added. “It is clear this is still a market in transition, and we need to make sure we are taking steps to create a more stable market, so people have continuing access to affordable healthcare coverage.”
In order to help make that possible, BCBSA recently provided a comment letter to CMS Acting Administrator Andy Slavitt on the proposed Notice of Benefit and Payment Parameters for 2017, which outlines the association’s concerns and recommendations regarding market instability.
Among their views in the Dec. 21, 2015, letter:
- Some people have been able to purchase coverage only when needed, resulting in higher premiums that overall discourage customers from maintaining ongoing coverage and care to manage chronic illnesses, etc. “Keeping premiums affordable for everyone is crucial to increasing participation and coverage among healthier individuals, who help balance the overall risk pool and stabilize the market,” the association wrote. The issue now appears to be moving forward per Slavitt’s recent announcement that special enrollment will be restricted in the future to reduce system abuse.
- States “are best suited for determining network adequacy” and therefore CMS should defer to model created by The National Association of Insurance Commissioners (NAIC).
- CMS rules should promote plan innovation, choice, and competition. The association rejects CMS’ proposed standardization of benefits and cost-sharing, as well as a proposed system of automatic re-enrollment.
“As we approach the fourth year of the new market, it is critical that the Final Rule for 2017 encourage everyone–especially those who are younger and healthier–to maintain continuous coverage to ensure premiums are affordable and people get the ongoing care they need,” BCBSA wrote.
“The current risk pool is out of balance — with a disproportionate number of people who need significant healthcare services — making health insurance more expensive for everyone. A course correction is needed now or this unsustainable trend will only get worse in the future.”