The rocky implementation of the Affordable Care Act is mostly behind the industry, and all signs point to reform sticking around. “It’s just begun,” J.D. Kleinke, a medical economist, author, health care business strategist, and entrepreneur who provides business, product and technology strategy services to insurers and other health organizations. During Sun Life Financial’s Wake Up Summit last week Kleinke said the industry is currently in the "version 1.0" state of health care reform. “It’s going to take a lot of iterations, but at the end of the day, the insurance industry is not running from this," he said. "The insurance industry has embraced it; they want those 10-30 million new customers.”
Harvard Pilgrim is one insurer that has embraced reform. Doing most of its business in Massachusetts and having 98 percent of that market share, Harvard Pilgrim was fairly advanced in its health reform efforts. As Harvard Pilgrim’s sales and customer service leader, Vincent Capozzi, SVP, has been a part of the health insurer’s changes, including introducing a set of service standards that guide Harvard Pilgrim’s relationships with employer customers and developing and implementing the “New Partnership Model,” which engages employers and Harvard Pilgrim in a way that ensures the value of a health plan is maximized. Capozzi joined Kleinke on a panel at the event to talk about how the implementation has set the scene for Harvard Pilgrim. “A fair amount of health insurance exchange enrollees are currently not paying premiums and 70-75 percent of enrollees already had health insurance, so we didn’t solve the problem of the uninsured, at least with the first rollout, there’s a lot up in the air,” Capozzi said. “Strategically, health reform made sense, but the implementation wasn’t well managed. It’s been challenging. In our case, having to change products, implement new systems and IT integration that frankly doesn’t hook up well has been a mess. I can’t imagine how many hours our staff has spent trying to [make it all work].”
The panelists, including Rebecca Costa, author of “The Watchman's Rattle” and a sociobiologist who has researched how evolutionary thinking has contributed to the modern health care system, agreed that the biggest hurdle right now isn’t solely technology. “The snake in the grass when it comes to public and private exchanges is administration and education,” Costa said. “The state of Maryland just discovered it’s going to cost them $33 million more than they had on the budget just to administer their exchange. And we’re getting reports like this from every state.”
And this all filters down to the consumer. The consumer is completely overwhelmed at this point, Costa said.
The health insurance industry jumped into the consumer space before the consumer had the information to “act like a consumer,” Harvard Pilgrim’s Capozzi said. “That’s been a real problem. We were selling deductible products or various amounts of coverages long before the consumer knew how to act like a consumer. What we need to do now is provide the information around cost and quality to the consumer so the consumer can act like a consumer. One of the intents of ACA was to streamline product with the metal levels (the four levels of coverage - Bronze, Silver, Gold and Platinum insurers participating in the exchanges must provide). But the real problem is you put a consumer in a situation where they don’t have the information they need in the way they need to make the decisions.”
Capozzi said greater transparency and interactive tools are critical to leading consumers to the right product and ensuring success of ACA. The insurer provides “personal calculators” to learn facts — from heart attack or stroke risk to how many calories are burned doing chores — to help consumers make decisions about their health.
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Seventy-three percent of those consumers want the mobile application to provide alerts and reminders, as well as access to personal health records. They also seek access to specific disease information and products (69 percent), provider/specialist search (67.5 percent), and ability to track insurance claims (66.6 percent).
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