8 th Annual Payer Networking Luncheon Monday, March 4, :30am-1:00pm

Transcription

1 8 th Annual Payer Networking Luncheon Monday, March 4, :30am-1:00pm DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Agenda Registration and Buffet Lunch 11:30am Welcome and Opening Remarks 11:45am Shelley Price, Director, Payer & Life Sciences, HIMSS Rose Cahill, Director, Account Management, Acxiom Michael Byers, CEO, HighRoads David Fitzgerald, Enterprise System Architect, Aetna and Chair, HIMSS Patient- Centered Payer Roundtable Presentation 12:05pm State of the State Preparing for the New Health Insurance Marketplaces/Exchanges Vaughn Kauffman, Leader, Healthcare Payer Advisory Practice Serena Foong, Senior Manager, Health Research Institute Q&A 12:40pm Closing Comments and Adjournment 1:00pm Shelley Price, Director, Payer & Life Sciences, HIMSS

3 Thank you to our Sponsors

4 HIMSS Patient-Centered Payer Roundtable HIMSS Patient-Centered Payer Cause Improve patient care, quality, and outcomes in a cost-effective manner. Foster collaboration and trust between providers, payers and all health care constituents. Advance health care productivity and efficiencies by leveraging information technology.

5 PCPR Roundtable Open to all HIMSS members (current membership: approximately 300 people) Will meet virtually 10 times/year Agenda for the meetings may include: Commencing with a short series of 2-Minute Drills presented various Roundtable and HIMSS members Topical discussion with key note presenter The 2-Minute Drill is based loosely on the sports analogy, and in this case is a fast-paced (short in length) presentation on a hot, emerging, or timely topic, news event (e.g. research paper, game-changing market or technology news), or recent and relevant event (e.g., federal public meeting, legislative/federal/judicial news, critical conference or educational event). 2-Minute Drills foster greater peer-to-peer networking, member engagement, problem solving, solution sharing, and education. If you are interested in presenting any drills, please contact Nancy or Shelley.

6 Health Research Institute State of the State Preparing for the New Health Insurance Marketplaces/Exchanges HIMSS Payer Luncheon March 4, 2013 Vaughn Kauffman, Principal Serena Foong, Senior Manager

7 Agenda Introduction The public and private faces of insurance exchanges An emerging customer base Health industry implications 2

8 Introduction

9 Section 1 Introduction The health insurance exchange marketplace is worth nearly $215B in premium revenue million members, 2023 Nearly $215B, 29 million members 4 million members, million members, million members, million members, About $40B, 9M members 2 million members,

10 Section 1 Introduction Health insurance exchanges will go in effect Jan 2014 December 14, 2012 States submitted blueprint and declaration letter to HHS regarding intent to create state-run exchange February 15, 2013 States submitted partnership blueprint October 1, 2013 Exchanges open enrollment for new consumers October 1, 2012 States began releasing requests for proposals for QHPs December 2012 Federal govt gave approval to all but one state based exchange and released key draft regulations to define operational rules January 1, 2013 HHS began to conduct readiness assessments in each state in preparation for October open enrollment January 1, 2014 Health benefit exchanges fully operational and coverage begins 10

11 Section 1 Introduction 11

12 The public and private faces of insurance exchanges

13 Section 2 The public and private faces of insurance exchanges Public and private exchanges will co-exist in several markets Public exchanges Core Functions Eligibility Enrollment Customer Service Plan Management Financial Management State run State/Federal partnership Federally Facilitated Exchange (FFE) State function State or federal function Federal function Private exchanges will have the flexibility to experiment with different approaches and innovate to meet consumer demands. Three general categories: insurer run, third-party run and retailer. 13

14 Section 2 The public and private faces of insurance exchanges Private exchanges run by insurers, retailers or other third parties may lead in innovation Insurer-run model Retailer-run model Third party-run model Individual insurers or groups of insurers operate exchanges to showcase plan options Companies outside of the health industry creating online marketplaces to sell insurance products plus other services External administrator links consumers to plan choices across multiple insurers 14

15 An emerging customer base

16 Section 3 An emerging customer base The new individual exchange population is new to the insurance market, lower income with fewer full time jobs, and heavily subsidized 16

17 Section 3 An emerging customer base Industries outside of healthcare are helping to shape consumer experiences Retail Airlines Banking Hotels Multichannel Customer preference analytics Incentives for immediate feedback Price comparison Data aggregators Auto notification of delays Mobile access for transactions Online history and records Itemized bill prior to departure One-stop room clean schedules 17

18 Section 3 An emerging customer base Providing a clear view of what s covered makes it easier for consumers to purchase insurance Top things health insurers can do to make insurance purchasing more user-friendly Source: Health Research Institute Consumer Survey,

19 Section 3 An emerging customer base Healthcare scores low on consumer willingness to share positive experiences 19

20 Section 3 An emerging customer base Nearly half of consumers surveyed read healthcare reviews, twice the amount of those who have written a review 20

21 Section 3 An emerging customer base Price will be a concern for both consumers and insurers, but quality could serve as a differentiator Price will be a leading factor in consumer decision making As consumers become more sophisticated insurers will need to differentiate through quality, benefits and customer experience 47% of consumers are willing to pay extra for ancillary services 21

22 Section 3 An emerging customer base An ideal experience prompts more than 1/3 of consumers to switch providers or insurers The ideal healthcare experience is increasingly defined by non-clinical factors, such as convenience, amenities and personalized service 22

23 Health industry implications

24 Section 4 Health industry implications Fundamentals for the future: How must the healthcare sector translate policy into action? Focus on the customer Better understand and guide consumers Focus on prevention and wellness Provide more targeted care Combine patient reported outcomes and experience feedback Shared risk leads to shared savings Seek out new payment models that allow shared savings Closely align with physicians to improve quality and efficiency 24

25 Section 4 Health industry implications Fundamentals for the future: How must the healthcare sector translate policy into action? Build scale Create shared services to reduce cost structure Seek opportunities to partner, merge, or acquire Increase consumer referral network by expanding the brand Go digital, go mobile Develop technology and informatics infrastructure to support accountable care payment models Share patient data at the point of care, and integrate data to manage patient populations 25

26 For more information To download the latest health insurance exchange and customer experience reports, please visit: pwc.com/us/healthindustries pwc.com/hri twitter.com/health Vaughn Kauffman, Principal U.S. Healthcare Payer Advisory Leader (216) Serena Foong, Senior Manager Health Research Institute (415) PricewaterhouseCoopers LLP. All rights reserved. "PricewaterhouseCoopers" refers to PricewaterhouseCoopers LLP, a Delaware limited liability partnership, or, as the context requires, the PricewaterhouseCoopers global network or other member firms of the network, each of which is a separate legal entity. Health This document Insurance is for Exchanges general information Long on purposes options, only short and on should time not be used as a substitute for consultation with professional advisors. 20

27 Closing Comments Communities Open House SHIFT #Payer ONC Listening Sessions C&BI and ICD-10 Knowledge Centers Education Sessions

28 HIMSS Payer Roundtable Leadership and Contact Information Chairperson: David Fitzgerald Enterprise Systems Architect Manager Aetna Vice Chairperson: Gary Austin Principal & Co-Founder, TranzformHealth HIMSS Staff Liaison: Shelley Price Director, Payer & Life Sciences Nancy Devlin Sr Assoc, Payer & Life Sciences 28

29 Thank You