Before eligible individuals and small employers may purchase insurance coverage through state and federal-run public health care exchanges in 2014, private retiree Medicare exchanges provide a glimpse of what public and private health insurance exchanges could look like.

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 expensive 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 any medications.

For the public exchanges, Extend Health believes that trained, licensed benefit 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 that “are furiously building new private insurance products that will also be guaranteed issue [and] may be the right fit for the person,” says Bryce A. Williams, the president and CEO of Extend Health, Inc., which operates the nation’s largest private exchange. 

He adds that they 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 someone in their population makes an exchange election or connects with an adviser. With the BenefitView interface, HR can be sure their retirees are taking advantage of the new framework, and can expect the same transparency for employees in public exchanges, Williams says.

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

This solution “pushes [visible tracking] to real time,” details Brian Bohlig, chief marketing officer, Extend Health. “The problem we had in the past is with the translation latency between us and our clients,” he explains. 

Four Extend Health employer-clients have used the beta version of the BenefitView tool, each successfully completing a pilot test. Extend Health is now rolling out the tool to all of 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 HR how many plans have been elected, how many carriers are being utilized, and the average insurance premium. It even tells HR 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 more than 10,000 people have selected 806 different plans among 66 different carriers. The company started communicating about the new process in February and monitored retirees’ progress with BenefitView.

“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.

By watching what efforts retirees were responding to, and what modes weren’t engaging, International Paper was able to make communication adjustments and prod groups that weren’t involved. The best part: HR could gather information when it was convenient 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.

When reflecting on their own 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 HR user of the exchange agrees: “You need to over-communicate to make sure you reach the intended audience,” explains 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 enrolled in 68 different plans from 30 different carriers.

McIntyre stresses the need for transparency in the public exchanges based on his experience with BenefitView. “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,” he maintains.

Hartfiel explains that even though it’s a retiree Medicare exchange, by using Extend Health’s model “it’s 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 their population health data later this year to decide whether they will engage any population in the future public or private exchanges.

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