Another bullish forecast about private HIX growth estimates that the roughly 2.5 million current enrollees (excluding retirees) could triple in the coming year.

Reenita Das, a partner at growth-strategies adviser Frost & Sullivan, made the prediction in a Forbes blog on 10 top health care trends. The list was compiled based on conversations with a team of health care futurists.

“While Healthcare.gov and the clunky roll out of the public insurance exchange got all the attention in 2014, the real action is in the private exchanges,” she wrote.

Also see: Envision Healthcare shares reasons, challenges in private exchange move

One industry insider who’s watching this trend closely is Barbara Gniewek, a principal in the health care practice of PricewaterhouseCoopers, whose Private Exchange Evaluation Collaborative includes the Employers Health Coalition, Midwest Business Group on Health, Northeast Business Group on Health and Pacific Business Group on Health.

“Many are watching private exchange enrollment to see when the ‘hockey stick’ uptick will take place,” she says, “because once it does, many expect a piling-on effect.”

PEEC’s latest employer survey, conducted in December 2014, indicates that 47% of respondents are interested in private exchanges, with 20% considering the concept for 2016. Based on these findings, along with private HIX growth among exchanges offered by health insurance carriers, new technology providers, pure-play companies and brokers, Gniewek believes Das’s hypothesis is reasonable and within the range of 4 million to 6 million enrollees she’s seen for 2015.

But others who study this emerging marketplace aren’t so sure that the number of people signing up will rise at such breakneck speed.

Also see: Is private exchange litigation only a matter of time?

Paul Fronstin, director of the Employee Benefit Research Institute’s Health Research and Education Program, expects the private HIX market to grow. However, he’s skeptical of bold predictions, notes that surveys showing interest don’t necessarily translate into enrollment and believes it will take many more years to reach critical mass when so many employers are still taking a wait-and-see approach to this market.

Fronstin also doubts Accenture’s estimate that 40 million people will enroll by about 2018. “I think it’ll be much smaller than that,” he says, citing enrollment in health savings accounts as a basis for comparison. “HSAs have been around 10 years and we’re at 20% enrollment, which is 23 million people. This took 10 years. It didn’t happen in four or five years.”

Another point to consider is how private exchanges are defined in the first place, which can significantly inflate the number of enrollees depending on that definition.

Also see: Time Inc. moves active employees to private exchange

For example, Fronstin wonders why the Federal Employees Health Benefits Program’s multi-carrier exchange, which dates back about 50 years, isn’t counted as part of the private HIX mix. “The federal government is the largest employer in the U.S.,” he says. “They cover 9 million people in their exchange.” He’s not sure it would be fair to include this exchange in the private HIX mix, though his larger point is that it certainly promotes choice and jibes with where the market is headed.

Bruce Shutan is a Los Angeles-based freelance writer.

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