Health Plans are Preparing to Participate in Health Benefit Exchanges

09 Nov, 2012

More than two-thirds of health plan business leaders who participated ina KPMG LLP webcast poll in September say they have analyzed the operational impacts and developed a plan of action to become exchange ready (39 percent), or had started implementing required changes and are on schedule to meet the October 2013 open enrollment deadline to participate in an exchange (29 percent).

Additionally, 17 percent of those participating say they had analyzed customer opportunities and developed a market specific product strategy. Eleven percent say they have not started planning to enter an exchange but intend to participate. Just 7 percent say they don’t intend to participate in an exchange.

“Health plans need to focus on differentiating themselves to attract the individual market and small group employers that will likely migrate to exchanges,” says Cynthia Ambres, a principal, physician and U.S. member of the KPMG Global Healthcare Center of Excellence. “Strategically, insurers need to decide at what level they want to go after the individual market, and how they distribute their products to as many outlets as possible, including state health benefit exchanges, a federally facilitated exchange, private exchanges and direct commerce sites.”

Part of the Patient Protection and Affordable Care Act (PPACA) of 2010, the individual health insurance mandate requires virtually all Americans to obtain minimum health insurance coverage or pay a penalty. The health insurance exchanges, also mandated by PPACA, will allow the uninsured to obtain affordable health care coverage. By Oct. 1, 2013 states are required to have formed new organizations to operate the exchanges.

The exchanges must be operational by Jan. 1, 2014. So far, KPMG finds only slightly more than a dozen states and the District of Columbia have enacted authority to establish state-based health insurance exchanges.

KPMG is an audit, tax and advisory services firm. There were more than 130 health plan administrators who self-selected to participate in the webcast poll. Respondents consisted of senior members of these organizations who have awareness of, or responsibility for, their organizations’ IT or finance programs.

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