Exchanges make progress for the future

Though political banter has focused on website failures and lengthy customer service wait times, the new insurance marketplaces established by the Affordable Care Act (ACA) will prove their enduring worth.

SherwinSeveral anecdotes are already emerging of Americans who will no longer face bankruptcy when a family member falls ill, and personal tales are cropping up of individuals able to access life-saving procedures and medications previously out-of-reach. Despite the rocky operational launch of the marketplaces, these stories lay the groundwork for the future historian’s perspective of ACA’s effect on the nation.
For now, marketplaces will remain strictly focused on connecting the uninsured with coverage that meets their healthcare needs. As the marketplaces collectively assess the first six months of operation and review the numbers of newly insured patients, they will not only strive to increase interest among small businesses and continue to enroll individuals eligible for Medicaid, but begin to shift focus to longer-term goals: improving health and reducing costs.

Stakeholder opportunities

Healthcare consumers-Pent-up demand will keep physician offices and pharmacies busy as consumers possess greater “buying power” in the healthcare economy. Access to care should offer an unprecedented opportunity to empower individuals to follow their physicians’ recommendations with lessened financial burden.

Hospitals, physicians and other care providers-Providers’ revenue stream depends on paying customers. The marketplaces have introduced more than 3 million new paying customers into the healthcare economy through the end of January. Hospitals and physicians will undoubtedly find themselves explaining deductibles, coinsurance, networks and other coverage components. It is in healthcare providers’ best financial interest to work with the new marketplaces to raise awareness among all patients, especially the newly insured, about how to use insurance to stay healthy, both physically and financially. Additionally, hospitals are now uniquely positioned to turn persistently uninsured low-income patients into paying customers with presumptive eligibility: If the patient provides information about their family and income indicating they’re likely eligible for public coverage through Medicaid, the hospital can be paid for the services provided as though the patient were insured.

Insurance marketplaces-The health insurance marketplaces will develop new features and support tools to help customers navigate plan choices in a meaningful way, including quality data comparisons and provider directories.  The federal and state websites can also be a useful tool for providing health information back to customers to help them better manage their own healthcare and also to provide people with public health information, prevention strategies and additional health information. Patterns that emerge from customer interactions with the marketplaces will drive innovation in insurance products-innovations vital to achieving the ACA’s objectives of lowering costs and improving quality.