Before eligible individuals and small employers begin shopping in the public health care exchanges in 2014, private retiree Medicare exchanges provide a glimpse of what public and private health insurance exchanges could look like.

In two years, brokers and other benefit advisers will help people choose appropriate plans from an array of insurance carriers. In particular, platform providers of multi-carrier Medicare exchanges believe they are in a unique position to help employees navigate the public exchanges.

"We see our role as the air traffic controller helping to organize these exchanges and information, and on behalf of those organizations, helping enroll early retirees and part-time workers to the plan that's right for them," says Bryce A. Williams, president and CEO of Extend Health, Inc., which operates a large private exchange in the U.S.

Williams, who has been meeting with several states on health care exchange development, anticipates 15-to-20 states will have a fully functioning exchange ready to offer a broad diversity of plans starting Jan. 1, 2014. Those leading the pack are Maryland, Oregon and California. States not ready at that time will have access to the federal government exchange.

"There will be an array of new choices for employees, part-time workers and early retirees with some of America's biggest companies to access guaranteed-issue individual plans for the first time," explains Williams.

For many new entrants, the exchange will be new territory, so advisers like Extend Health hope to provide information and direction to help individuals find the right plan at the right price.

PPACA "allows for external agents and brokers to connect into the system ... and get ready to place individuals into the exchanges where it's the right fit," and alert them if they qualify for subsidies, Williams adds.

Each exchange must establish a navigator program to fund outreach and education efforts. Community-based organizations and professional associations will act as navigators to help consumers understand the new health insurance options available through the exchange. Navigators are also tasked with raising broad public awareness around the exchange and providing referrals to relevant consumer assistance programs. Agents and brokers may also serve as navigators, provided they meet required standards.

 

The Massachusetts experience

The Massachusetts exchange, enacted through state law in 2006 under former governor and Republican presidential nominee Mitt Romney, will continue to play a central role in delivering health care to the uninsured. The state plans to improve the usability of its current website interface with federal support, as well as link seamlessly to federal databases.

"We will be building Web functionality that links to federal databases so that we can, in real time, evaluate people's eligibility for coverage in the exchange, including their eligibility for subsidies, and quickly route them through a crystal clear, cutting-edge, simple and comprehensible shopping experience," says Glen Shor, executive director of Massachusetts's Commonwealth Health Insurance Connector Authority.

In addition to its website, the Massachusetts Exchange will continue to provide a call center with "top-notch customer assistance" for help with the benefit selection and billing process, as well as help picking the best value plan, says Shor.

"We're going to work extraordinarily closely with brokers ... We want to make it easier and more efficient for brokers to assess the landscape of health insurance options for the small businesses they serve," he adds. The state is also working with nonprofit organizations to help low-income people enroll for health care and receive any possible subsidies.

In addition, a new wellness track feature helps small business employees and individuals using the Health Connector tool make healthy behavior choices. By participating in the wellness program, a subset of small businesses can qualify for a 15% rebate on the employer share of a health insurance premium, which can then put toward covering their employees.

To qualify for a wellness rebate, employers need a certain percentage of employees to get an annual physical. Outreach to small employers has already begun, and public education will escalate as 2014 approaches. The state introduced the Health Connector through employer road shows.

"We've learned in Massachusetts that outreach and public education, including around opportunities to access affordable coverage through the Health Connector, is critical to bringing people into the ranks of the insured and keeping them [there]," says Shor, adding that "in general, the Affordable Care Act gives us an opportunity in Massachusetts to [expand] what has been a very successful model," he says.

 

Exchange transparency

When Extend Health first introduced retirees to its private Medicare exchange six years ago, many people simply chose the cheapest plan - no matter their health status and needs. Once they realized how high their out-of-pocket costs were in high-deductible health plans, they would call the support team asking to switch plans.

In order to prevent that buyers' remorse, Extend Health now has 1,000 benefit advisers in call centers ready to take retiree questions and advise them on plan choices based on their health needs and medications.

For the public exchanges, Extend Health believes that trained, licensed advisers who have access to federal databases can be helpful in determining eligibility for employees and early retirees.

Individuals will either shop in the public exchange or get coverage from one of the 80 carriers on Extend Health's exchange platform.

Bryce says the company will provide "private and public exchange products from one platform, one call, one place." In addition, employers will be able to monitor in real-time when their population makes an exchange election or connects with an adviser.

 

Expectation of paternalism

"People have an expectation if they've just come off of a group plan of open enrollment selection," Williams says. "Employers have an expectation of paternalism; they expect that everyone is going to get coverage."

Four employers have used the beta version of Extend Health's BenefitView tool, each successfully completing their pilot test. Extend Health is now rolling out the tool to all its employer-clients. The tool helps ensure that every retiree is contacted and advised on choosing the best plan that meets the individual's needs. BenefitView assures that the employer-client has full transparency on the status of the transition of its retirees' from group coverage to individual coverage.

Employers can monitor engagement of specific population segments and reach out more aggressively to groups not making appointments with advisers or benefit selections.

The Web platform also shows the HR department how many plans have been selected over how many carriers, and the average insurance premium. It can also give HR statistics about the anticipated or past wait times for the call center.

U.S. retirees and Medicare-eligibles at International Paper entered the Extend Health exchange in July 2012, and over 10,000 people have selected 806 different plans among 66 different carriers.

The company started communicating about the new process in February and has monitored retirees' progress.

"We wanted to make sure [participants] were getting the information they needed, because this is a very different animal for them as opposed to the one-size-fits-all methodology that we had in the past from our medical plan," explains Melissa (Missy) Hartfiel, benefits planner, International Paper.

 

Lessons learned

By watching what communication efforts retirees were responding to and what modes weren't engaging, the company was able to make adjustments and prod groups that weren't getting involved. The best part: HR could gather information itself and present it immediately to executives when needed.

"As an HR professional, it's nice when you can pull your own information. Through BenefitView, I could look at any population, day or night," says Hartfiel.

Reflecting on its marketing campaign, Hartfiel advises sponsors to start strategizing and communicating early about the public exchanges.

"Once you start parsing down [to communicate to different group populations], it takes time to really craft that message," she explains.

Another user of the exchange agrees: "You need to overcommunicate to make sure you reach the intended audience that you're trying to reach," says Scott McIntyre, manager of employee benefits, Oak Ridge National Labs.

McIntyre and the Extend Health advisers were able to contact 99% of the company's retirees, and 3,360 were enrolled in 68 different plans from 30 different carriers.

"If I'm an employer and I'm going to subsidize the health care cost [for employees or early retirees], I certainly would want a mechanism to ensure that employees enroll in plans that they are interested and comfortable in," McIntyre says.

Hartfiel explains that using Extend Health's model - even though it's a retiree Medicare exchange - has "given us an idea of how [the public and private] exchanges will work as we start planning our strategy for the 2014 exchanges."

International Paper plans to analyze its population health data later this year to decide whether it will engage any segment of employees in the future public or private exchanges.

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