Public Exchange Realities: Why One Size Does NOT Fit All (and Why It Matters) AHIP Institute June 15, 2016

Transcription

1 Public Exchange Realities: Why One Size Does NOT Fit All (and Why It Matters) AHIP Institute June 15, 2016

2 Presenters Phil Poley Managing Director, Public Sector Health North America Accenture Loren McCaghy Director Consumer Engagement and Product Insight, Accenture Health & Public Service Mila Kofman, J.D. Executive Director, DC Health Benefit Exchange Authority Copyright 2016 Accenture. All rights reserved. 2

3 Public Exchange Context The Good News 12.7 million people enrolled/reenrolled though public marketplaces in 2016 OE 1 Uninsured rate has dropped to 11.5% 2 Consumers are actively participating: 59% of re-enrollees actively re-enrolled 1 43% of re-enrollees on FFM switched plans or carriers million new enrollees in Ongoing Challenges There are still significant numbers of subsidy-eligible uninsured (7M as of 3/15 3 ) More challenging populations to reach (e.g., millennials, minorities) and less motivated (e.g., healthier) Exchange market is still seeking equilibrium Some payers find HIX profitable while others are struggling/exiting State exchanges have not solved fully for sustainability Payer retention challenge: 51% of HIX consumers indicated they were likely to shop for new insurance 4 1 March 11, 2016 Assistant Secretary for Planning and Evaluation (ASPE) report 2 Health Insurance Coverage and the Affordable Care Act, , ASPE, March 3, New Estimates of Eligibility for ACA Coverage among the Uninsured, Kaiser Family Foundation, January 2016 Copyright 2016 Accenture. All rights reserved. 4 Accenture 2015 Health Consumer Survey 3

4 Requirements for Sustainability (and Profitability) Payers and Exchanges have sustainability priorities that mostly align but not always exactly Marketplace Priorities Grow enrollment Stabilize rates Increase simplicity and standardization Reduce administrative costs Support changes in consumer needs and expectations Retain consumers on HIX coverage (even if not subsidy-eligible) Improve coordination with state Medicaid Payer Priorities Grow profitable enrollment Establish predicable risk and appropriate pricing Increase ability to maintain brand and differentiate Reduce manual effort to administer Manage high-cost utilization and gaming Retain profitable members as they move in/out of HIX coverage The bottom line: payers and exchanges need to work together to solve for the sustainability challenge Copyright 2016 Accenture. All rights reserved. 4

5 Key Touchpoints with Consumers The touchpoints that matter most to promotion (and loyalty) for Individual consumers (HIX and Non-HIX) are Buy Insurance, Decide Treatment, See Doctor, and Follow Care Plan. Key Touchpoint Buy Insurance Decide Treatment See Doctor Follow Care Plan Most Important Factors to Consumers Expected out-of-pocket costs are presented with clarity and accuracy Options are easy to understand and compare Advice on choosing the right plan is trustworthy and unbiased and available when needed My treatment options are summarized in a clear and easy to understand manner Advice on choosing the right treatment is trustworthy and unbiased Expected out-of-pocket costs for treatment are presented with clarity and accuracy My visit takes place at a location or in a way that is most convenient and appropriate for me I have a clear understanding of what I need to do next (followups, referrals) I understand how recommendations are tied to my desired outcome and the potential consequences of not adhering to the plan My progress is actively monitored and changes are made as necessary so I don't have to worry Source: Accenture Consumer Research and Analysis. Copyright 2016 Accenture. All rights reserved. 5

6 Consumer HIX Challenges Attracting the Unaware HIX issuers face challenges with attracting young and healthy consumers many of whom find health care coverage to be confusing and don t understand what they may be eligible for in terms of a subsidized coverage. 49% Half of subsidy-eligible uninsured do not know if they qualify I Don t Knows are younger, healthier and less experienced than the overall HIX population 41% are millennial adults 85% no chronic or serious illness 75% never/not recently insured 64% but believe that insurance is too expensive or not a good value Find them where they are Educate and inform, don t sell Get them to a live person to assist with the process Base: Subsidy Eligible Copyright 2016 Accenture. All rights reserved. Source: Accenture 2015 Health Consumer Survey 6

7 Live Assistance is Important Even to Digital Consumers Live assistance continues to be critical to the marketplace even typically digital consumers rely on live help. The need for assistance will increase as HIX reaches deeper into the pool of chronically uninsured. Online on a website How did you complete the enrollment for your 2016 healthcare insurance coverage? 59% 56% Millennials 61% indicated there were too many plan options available 63% indicated they could not distinguish one plan from another Live Channel (In Person / Phone) 34% 32% Less digital (general) Highly digital (general) 45% of new HIX consumers enrolled online 66% indicated it was difficult to determine which plan was right for them 61% indicated they needed help from a live person because the information found online was confusing Base: 2016 HIX shoppers and purchasers, Non-HIX15 weighted Copyright 2016 Accenture. All rights reserved. Source: Accenture 2016 Consumer Survey for Public Health Insurance Exchanges 7

8 HIX Challenges Managing Elective Dropouts Payers and Exchanges are missing opportunities to identify, engage and change behaviors of HIX drop-out consumers who are at risk of continuing with poor utilization behaviors while moving in/out of coverages. Elective drops have serious or chronic illness at 2x the rate of overall HIX population 70% of elective drops from HIX coverage also had coverage through an employer during 2015 Utilization behaviors carry across HIX and non-hix coverages Base: HIX15, Elective HIX Drop-outs WEIGHTED Copyright 2016 Accenture. All rights reserved. Source: Accenture 2015 Health Consumer Survey 8

9 HIX Consumer Churn The public marketplace is designed to enable competition and encourage shopping. Payers need to understand the factors that drive consumers to switch and it isn t just about price. Consumers Retained by Insurer 83% Received great customer service when had issue / question 75% Was able to understand cost of care in advance of treatment 26% Out of pocket costs for diagnosis and treatment of illness or injury was higher than expected Consumers who Switched Insurer 77% 62% 39% Millennials #1 reason for switching insurers: Member service representatives were not knowledgeable (37%) Baby Boomers #1 reason for switching insurers: I wasn t getting a good value for my money (46%) Base: HIX 2015, weighted Source: Accenture 2016 Consumer Survey for Public Health Insurance Exchanges Base: Recent HIX shoppers who chose to switch insurers, weighted Source: Accenture 2016 Consumer Survey for Public Health Insurance Exchanges Copyright 2016 Accenture. All rights reserved. 9

10 DC Health Link Experience Copyright 2016 Accenture. All rights reserved. 10

11 DC HEALTH LINK Private-public partnership Although last state to start building IT, was 1 of 4 states that opened on time and stayed open (Bloomberg News) Congress and the President enrolled ACA is working in DC: uninsured rate dropped by 20% (9/2015 Census); tied for 3 rd lowest uninsured Since October 1, 2013, over 220,000 people have come through DC Health Link (includes156,046 people determined eligible for Medicaid coverage; private enrollment includes SHOP customers) 2016 HEALTH INSURANCE OPTIONS THROUGH DC HEALTH LINK Choices: HMO, PPO, POS; high deductible & zero deductible plans Plans: 136 Small Group Plans and 26 Individual (2 catastrophic) Insurers: Aetna (group only); CareFirst BlueCross BlueShield; Kaiser Permanente; United HealthCare (group only) Also offer Dental Coverage and Vision 11

12 WHAT S NEW AT DC HEALTH LINK? New decision support tools: All Plan Doctor Directory DC Health Link Plan Match (anonymous) New Plan Shopping New tools for employers bill pay, quick renewals, budget estimator Simple and fast enrollment Reduced from 28 to 11 screens (indiv. full pay enrollment) Reduced from 22 to 5 screens (employer application) Reduced from 26 to 6 screens (employee shopping, account set up, and plan selection) Added progress bar (shows % complete similar to commercial websites) (Individual QHP and employee enrollment) 1.45 seconds average page load time Moved to open source code and agile approach 12

13 OUTREACH EVENTS Boyz 2 Men Barbershop Days; Girls 2 Curls Spa s Enroll at the Bowls College Football Championships Sweet 16 (brackets and enrollment 1 st open enrollment) NHL Winter Classic & Rock the Riverfront Festival with DC Brau Clubs and midnight dinner at The Diner; Café Crawl Air Jordan Nike Wizard s Game; DC United; Nationals (ads) Movie Nights - Star Wars & Hunger Games with ads on 16 movie screens and concession area; information tables NBC 4 Health and Fitness Expo Valentine s Day Flowers ( roses are red, violets are blue, DC Health Link has the right health insurance plan just for you! ) 24 Hour Plus Marathon-Relay 13

14 . But if you ordered pizza from Pizza 17 in D.C. last night, you probably did hear about health insurance from the District's health exchange. DC Health Link tucked fliers reminding football fans that the Feb. 15 coverage deadline is coming up. POLITICO PULSE 14

15 From the Pulpit to the Pews Each One LINK One Campaign One Touch Enrollment Events and Storefronts Shape Up, Sign Up: Partner with LA Fitness Interactive Social Media Outreach: Facebook, Twitter, YouTube, Instagram Mobile Outreach: Text messages LED Ad Display: Verizon Center Metro Ads OUTREACH CAMPAIGNS 15

16 RECOGNITION Out2Enroll s: Key Lessons for LGBT Outreach and Enrollment Under the Affordable Care Act Kaiser Family Foundation: Taking Stock and Taking Steps: A Report from the Field After the First Year of Marketplace Consumer Assistance Under the ACA White House Briefing: The Affordable Care Act and the LGBT Community (7/24/2014) White House Summit: Healthy Young America Conference (1/15/2015) PR Week: DC Health Link Finalist for the Community Relations Campaign of the Year KFF: ranked 1 for sign-ups of eligible enrollees (2016) 16

17 Individual Marketplace - Age Age NEW CUSTOMERS EXISTING RENEWED CUSTOMERS < % 9.1% % 4.6% % 35.2% % 21.6% % 14.8% % 13.7% % 1.0% 17

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22 Wrap-up / Q&A Copyright 2016 Accenture. All rights reserved. 22

23 Wrap Up Consumer insight is critical there is no one solution While Digital mechanisms are key to success, payers and exchanges need to target in-person interventions to encourage enrollment/re-enrollment and then develop strategies to pivot consumers to less costly channels over time Collaboration between exchanges and payers must strive to create a customer experience that is seamless across the entire range of coverage programs Medicaid, HIX, ESI Beyond encouraging enrollment and retention, a seamless consumer experience will enable more cross-program strategies aimed at encouraging efficient utilization For more information and related content, please visit Questions? Copyright 2016 Accenture. All rights reserved. 23