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3 paths to health product selection wisdom

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Some consumers who are shopping for Medicare plans or public exchange plans this fall may see dozens of options on the local menu.

Consumers who are shopping major medical coverage off-exchange may see even more major medical options and entries for short-term health insurance, hospital indemnity insurance, critical illness insurance, short-term and long-term disability insurance, long-term care insurance, life insurance, dental insurance, non-insurance dental discount plans, pet insurance, identity theft protection, and, probably, something else. Maybe homeowners’ insurance. Maybe cell phone loss protection.

Medicare program managers are so concerned about Medicare Part D prescription drug plan choice overload that they’ve worked to reduce the number of choices issuers offer.

Meanwhile, surveys have shown that many consumers barely know what a deductible is, let alone how to compare health plans. The public exchange system has been slow to develop even the bare-bones commercial plan quality rating system that the Patient Protection and Affordable Care Act (PPACA) promised consumers. And the exchanges and insurers have no interest whatsoever in paying agents and brokers a little more to develop and share information about how health plans really work in their area.

Meanwhile, the producers who do want to stay in the individual or major medical markets, even simply to serve existing clients, or keep attractive opportunities to cross-sell  the clients other products, are trying to position themselves as trusted advisors.

How do you provide sage counsel on which customers should buy which plans when, really, you’re barely being paid enough to know how to get into your agent account?

Organizations are offering to help. Here’s a look at a little of what they’re offering.

Jay Silverstein

1. Predictive analytics

Some companies are trying to help you with decision support tools that somehow match prospect characteristics with the plans available.

In some cases, the systems may simply take the prospect’s age, ZIP code and primary care doctor information and filter the options that way.

See also: Dealing with the Data

Picwell is an example of the kind of decision support tool company that tries to harness the power of the kinds of statistical might inside the pricing of a health plan to help consumers choose health plans. Jay Silverstein, the chief executive officer (pictured above), is the front man for a team that includes a chief data scientist, Jonathan Kolstad. Kolstad has a bachelor’s degree from Stanford, a doctorate from Harvard, and more than the average ability to calculate a tip. The company says its system analyzes more than 900,000 variables when coming up with recommendations.

The company says its system can use simple demographic and address information to offer a broker a list of personalized recommendations to suggest to the client. The company can also plug its own system into other organizations’ public or private exchange systems.

One way to test these systems: Come up with a sample of your own customers, feed their information into the system, and see whether the system suggests a reasonable option most of the time or seems to work only about as well as a roll of the dice.


2. New types of plan quality rating reports

The Medicare Advantage plan market already has a — controversial — quality rating system.

One problem with shopping for major medical insurance in the age of PPACA — and especially an exchange QHP, at a time when no one has good data at all on how the QHPs are working — is that consumers without large numbers of friends enrolled in PPACA-compliant plans are lost.

Many consumers are still sheltering in the warm embrace of large self-insured plans that are largely untouched by PPACA, or in grandfathered or grandmothered plans of various kinds.

Even if you know how the plans are really working, carrier and exchange contract terms and regulatory requirements may interfere with your ability to be honest about how bad a bad plan really is.

In California, for example, the California Office of the Patient Advocate has made a small start by releasing a new collection of quality report cards for health insurance plans and health maintenance organization (HMO) plans in the state.

Of course, one problem is that few, if any, of the report cards now available use good data on how plans are working in the real PPACA world.

For producers, the best strategy might be to work with agent groups, patient advocacy groups and employer groups to hold regulators’ and exchanges’ feet to the fire and get them to publish quality reports based on current enrollee information.

See also: Exchanges, QHPs can keep 2015 enrollee grades to themselves


3. Traditional text guides, on paper or on the Web

Federal agencies have posted guides of all kinds on the Web. The big accounting and benefits accounting firms have made efforts. The company that publishes LifeHealthPro also publishes a book about PPACA, 2014 Healthcare Reform Facts.

Other vendors are also taking a stab at the task. In some cases, they are creating specialized guides covering topics such as dental insurance or voluntary benefits of all kind., for example, lets you enter a ZIP code, click search, and see a list of available plans, without giving your age, sex, and great-great-grand-aunt’s maiden name.

Most of the guides explain some aspect of PPACA World, rather than serving as a guide to the quirks of the specific plans available to specific consumers, but some may be helpful with some aspects of product selection.

Purchasing Power, for example, has come out with a guide on using voluntary benefits to offer workers a path to financial wellness.

FinFit, a company that makes loans through the worksite, offers personal financial assessment tools to workers through the Web in exchange for a chance to offer them credit.

With all these tools, steps to take include understanding what the providers want to sell, finding out how they expect to get paid, predicting how helpful you think the guides would be to your clients, and seeing whether you can get paid for getting clients to sign up for the service.


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