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The Politics of Health Care

Lessons Learned

Published March 7, 2016 6:23 PM by Michael Jones

[Editor’s note: this article was contributed by Mike Baker, senior vice president and GM of commercial products, and Maydad Cohen, senior vice president and GM of government solutions, at hCentive (]

Now that the annual open enrollment period is in the rearview mirror, what are the key takeaways from 2016? Here are five lessons learned:

1. ACA health insurance marketplaces aren’t going away.
Exchanges successfully connected people to health insurance in both the public and private marketplaces. More than 12 million people enrolled in the federal and state marketplaces during open enrollment 2016, and 7 in 10 consumers returned to this year. At the same time, new enrollees increased 42%. This demonstrates need for the marketplaces as well as its value.

2. The tech hurdle has been cleared.
Thanks to more mature technology delivered via off-the-shelf software, states are learning that custom-built systems aren’t necessary. As a result, they’ve shifted focus to providing a better customer experience and adding new benefits products, including dental. With smarter decision tools (like provider and prescription medication lookup), private exchange-inspired innovations and more effective contact center support, states are now able to enroll more members and turn their attention to eliminate waste and fraud.

3. Marketplaces are still evolving.
The recent open enrollment period prompted many states to actively explore private sector technology options to or the federally facilitated marketplace, which is a one-size-fits-all solution that is expected to cost more to states with looming federal fees. As states seek more control, they’ll explore proven, financially sustainable alternatives that cost less and have the flexibility to manage state specific policies and complexities.

4. Private health insurance exchanges are growing rapidly.
Public marketplaces got the most media attention, but private exchanges are growing quickly with 6 million enrollees in 2015 and a growth rate of 100% annually, according to Accenture. Employers value private exchanges for their superior cost management, benefits choice and user experience. Brokers are also using some private exchange “web broker” platforms to more efficiently enroll subsidy-eligible consumers.

5. Small and mid-sized companies are looking for new alternatives.
As they seek benefits to attract and retain the best and brightest, small and mid-sized employers are taking a fresh look at private exchanges. These employers are looking for ways to expand choices, simplify administration and make costs more predictable. Brokers who recognize the market potential are adopting technology platforms that allow them to serve this underserved but growing sector.

The health insurance marketplaces still have plenty of room for improvement, particularly on the cost and convenience side. But the recently concluded enrollment season revealed that exchanges are here to stay and that opportunities abound as the marketplaces evolve. 


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