Sixty-five percent of health care payer executives expressed a lack of confidence that health benefit exchanges would be operational at the onset of open enrollment on October 1, according to a recent poll conducted by KPMG LLP, the audit, tax and advisory firm. Specifically, one quarter of the respondents shared that they are not as prepared as they would like to be.
In the KPMG poll, which consists of more than 80 executives from the health care payer community and was conducted in the weeks leading up to implementation, 32 percent said “No” when asked if the exchanges would be ready on October 1. Thirty-three percent responded “Maybe, but I have my doubts,” and 35 percent were confident that the exchanges would be fully functional on October 1.
Nevertheless, 35 percent of respondents characterize health care benefit exchanges as necessary change for America’s health care system. Twenty-six percent viewed health care benefit exchanges as a risk management issue that needed to be carefully managed, while 12 percent thought it provided a way to improve their business. Twenty-seven percent were still unsure of the impact of health care benefit exchanges.
When asked about expected short-term challenges, 51 percent of payers cited a mix of issues surrounding eligibility, customer service, enrollment and payment processing, and potential financial impact as the greatest operational challenge to their businesses once the exchanges go online. Of those choices, one quarter singled out new patient eligibility as the biggest operational obstacle.
“With the potential of more than 30 million Americans being added to our health care infrastructure, determining who is eligible and what they are eligible for presents a significant short-term burden to the new system,” said Joseph Parente, principal and management consulting leader for KPMG’s Healthcare and Life Sciences practice. “Companies must get the set up right or make quick adjustments in order to prevent future bottlenecks in the system when enrollment and payment processing starts to take shape.”
When it comes to their customer service preparation, payers for the most part feel ready to handle the incoming wave of interactions through a mix of methods. The largest portion of payers (42 percent) said they will be ready for enrollment by 2014. Those that outsource their customer service indicated that their service partners are ready for open enrollment and will continue to work with them on a “going forward” basis (26 percent).
Payers that expressed confidence when asked about how exchanges would perform over the next 12 months believed that exchanges would lead to more efficient and effective cost structures, the creation of more standardized products and services, greater data integration, and the addition of more customers and upselling possibilities.
“The next 12 months will present significant challenges for health care payers,” said Ed Giniat, national sector leader of KPMG’s Healthcare and Life Sciences practice. “Not only will they need to react to the changing landscape, they also will have to develop strategies that get them closer to their customers and take advantage of the new tools that can help separate themselves from competitors.”
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