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HHS to issuers: You need to improve, too

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Managers of have to do a better job of running, but many of the coverage issuers need to do a better job of adapting to the new health insurance world that the Affordable Care Act created.

Officials from the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS), the HHS agency that runs and other ACA programs, delivered that message Wednesday at a issuer meeting in Washington.

HHS officials prefer to call exchange enrollment system the “Health Insurance Marketplace.”

HHS officials organized the issuer meeting to get ready for the 2017 individual health insurance open enrollment period, which is set to start Nov. 1 and run until Jan. 31.

HHS officials were also working to get ideas from issuers, have issuers share ideas with each other, and dispel the idea that the ACA exchange system, or online supermarket for health coverage, might be turning into a dead mall.

Some insurance agents and brokers may sell exchange coverage and want the exchange system to survive to help exchange plan sales, or sales of supplemental products. Other agents may be following exchange news solely because they compete against it and want it gone sooner, rather than later.

Related: 3 ways the ACA individual health market foundation cracked

HHS Secretary Sylvia Mathews Burwell and Andrew Slavitt, the acting CMS administrator, talked about good exchange news.

Burwell told attendees the ACA exchange system helped cut the U.S. uninsured rate to 8.6 percent, a new record low.

“We learned that marketplace consumers are just as satisfied with their coverage as people with insurance through their employer,” Burwell said, according to a written version of her remarks posted on the HHS website. “While we’re always working to improve affordability, we’ve learned that Marketplace products stack up well against employer coverage on that dimension as well.”

Burwell and Slavitt also talked about some of the problems hanging over 

Sylvia Mathews Burwell says HHS has listened to issuers' ideas about how to make the exchange system work better. (Photo: HHS)

Sylvia Mathews Burwell says HHS has listened to issuers’ ideas about how to make the exchange system work better. (Photo: HHS)

Burwell promises to work to improve

Burwell said HHS has listened to issuers and taken concrete steps to respond to their concerns. 

“Two words we heard a lot were ‘retention’ and ‘relationships,’” Burwell said.

Some consumers use exchange plan coverage to fill in gaps when they are between jobs, or when they are moving between different types of coverage, Burwell said.

In other cases, consumers have left exchange plans without ever paying any premium bills, Burwell said.

Burwell said managers have already improved their ability to retain enrollees who are facing problems with documenting their income or immigration status.

Burwell said HHS also has toughened enforcement of the applicant eligibility verification process and revised a program that shifts cash from issuers with what look like low-risk enrollees to issuers that appear to have higher-risk enrollees.

HHS will also be using Twitch, a live-streaming system, and other new tools to reach out to young adults, Burwell said.

Related: 3 peeks inside the PPACA risk-adjustment machinery 

Slavitt says issuers have weaknesses of their own to address. (Photo: Thinkstock)

Slavitt says issuers have weaknesses of their own to address. (Photo: Thinkstock)

Carriers should look at their own operations

Slavitt, the head of CMS, previously ran the Optum health care services unit at Minnetonka, Minnesota-based UnitedHealth Group. Before that, Slavitt ran OptumInsight, a software and information analysis unit.

UnitedHealth set the current bleak tone for the 2017 exchange shelf-filling period by announcing in April that it would withdraw from the ACA exchange system in all but a few states.

Slavitt said that, to compete under current rules, some health insurers may need to do a better job of using enrollee data.

Companies in other industries have gone through turmoil and come out looking better, and health coverage issuers can, too, Slavitt said, according to a written version of his remarks.

Rates might shoot up in 2017, for example, but “rates are right now about 18 percent below what was originally projected,” Slavitt said. “Would we all have preferred to be 10 percent higher, say, from the start, with more gradual increases? Of course. You bet we would. But rates will adjust, and, as they do, the ACA will protect consumers with tax credits and with rebates if rates go up too much.”

Issuers, meanwhile, have to take steps such as using analytical data to reduce the odds that new enrollees will make unnecessary use of the emergency room, Slavitt said.

If new-enrollee emergency room use is too high, “do you have your first-tier hospitals contracted to manage aggressive ER utilization, so people can get care in the right setting?” he asked. “Have you set up telemedicine, nurse lines and other convenient forms of both coaching and steerage? Is there free primary care and other incentives to detect health concerns early?”

Some companies are fighting that problem, and getting important information about enrollees, but conducting health risk assessments of enrollees when health coverage ID cards are activated, Slavitt said.

Solid onboarding processes for new enrollees, monthly “touch point” interactions and other initiatives can both increase enrollee stickiness and create opportunities to improve the enrollees’ health, Slavitt said.

People at issuers that do well in the ACA system “appreciate the joy and the meaning of delivering health and security to people,” Slavitt said. “They tend not to describe people as ‘populations’ or ‘pools’ or ‘diabetics’; they understand that in the new world, the job is taking on sicker people and doing it better. They are not only committed to making people healthier every year, but they actually see greater financial opportunity in reducing acute episodes, in getting individuals to the right clinic, in making sure babies are born healthy, in bringing peace of mind to families, and in helping people get health issues  diagnosed early. They are actually winning because, in the new world, they see how to replace underwriting with care management.”


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