Chances are the answer is yes. Who has had time to focus attention on products in this age of health care reform and great uncertainty in the marketplace? For the last five years stakeholders in the US health care market have wrestled with more questions than answers, all the while preparing for the largest market reform to hit the nation since MediCare. Significant questions loomed about whether or not states would build their own marketplaces or outsource the risky endeavor to the federal government. When the marketplaces were being built we waited on pins and needles for a ruling from the nation’s highest court and a pivotal presidential re-election to direct us where to go next-- and then we raced against time to meet aggressive deadline.

But recently, the smoke is starting to clear and we are starting to see a path forward.

 Building and running an exchange is harder than some predicted and as hard as others imagined. At The Tori Group we had the unique experience of having run (and eventually retired) the nation’s largest non-profit small business exchange. Few know better than we do how difficult it is to build product portfolios, drive membership and retention, and most importantly build, a sustainable marketplace to withstand the real risk: insurance risk. Too many leaders have fallen into the trap most of our industry remember all too well from the 1980’s: big membership doesn’t mean anything if the membership is unhealthy. The answer to the question of whether or not the marketplaces are going to make it in the long run will take a few more years to figure out-- after we have more experience and early membership and retention numbers to gauge our thinking. For sure the exchanges have had the best open-enrollment they will ever have by now.

The first two years of the ACA marketplaces were the best funded and most media covered events the marketplaces will ever have.  While the numbers are impressive in some states (California, Florida and Kentucky) no exchange has established itself as the leader in consumer-purchased coverage. In the case of California the marketplace is a winner for subsidy eligible consumers but for professional non-subsidy eligible purchasers, buying direct from a carrier is more appealing. So what does that mean for product portfolios in this new market? What are consumers and businesses looking for from their health insurance carrier? All good questions but perhaps the most important question and the one we need to be certain to answer correctly is: How can we take delivery and reform initiatives and build new products and powerful portfolios to take advantage of these reforms? How do you take cost saving innovations and translate them to better performing products, and bundle those into winning portfolios that deliver quality care at affordable costs? These are the new questions to be debated. For the right answers and strategies, you need an experienced, informed and clever partner to lead your organization and create new solutions. That is where we can help.

Contact us now to schedule a short demo of Brightside, our proprietary tool we use to help plans assess the strengths and weaknesses of the current portfolio, to build successful strategies.

by David Greene, Senior Principal, The Tori Group

Your kid doesn't come with a manual either:

I've read a lot of studies and research driven papers over the past few months about challenges health exchanges across the country are facing. At the most summary level, these reports generally are rich on data about state-by-state exchange enrollment figures released across the country this past Spring and focus on topics such as preparation for the current open enrollment period and the pros/cons of "active" vs. "passive" exchange approach.* This is good information to consider for relative benchmarking. But just as the circumstance to which every child is born and raised is unique, so is the raising of an Exchange.

Don't discount either one... it's both a Nature and Nurture thing.

Like the double-helix defining our DNA make-up, there are a set of basic building blocks that make up all Exchanges. Again like the double-helix, the organization of these building blocks can seemingly be infinite in complexity. Between the initial penning of the ACA and the uncountable mutations brought on by State legislators, Insurance Regulators, and self-imposed Exchange rules, it's agreed some Exchanges may at first look distinctive from others, but they are really more similar than not. And, important to note, they have all hung on to the instinctive quest to expand coverage availability and seek enrollment. This is the nature part of the beast.

While Exchanges are similar enough in appearance and share an innate drive to seek enrollment, they do have different environments in which they are striving to reach maturity. Because of this, it's easy to see that while they are all very young, we see them developing at different rates.

With tremendous respect to the structures in place that define the genetic make-up of an Exchange and the importance of this never forgotten, I want to share some about one aspect of nurture Exchange development - while Exchange development is still in toddlerhood.

All kids need to be taught the same stuff from scratch.

No matter how many children you may have had a hand in helping raise, you come to see that each one has to learn over time how to become self sufficient. To add, it is only in retrospect you realize how much you have learned over this same time and how no matter how much you know, you will still at times be stumped.

All the above can apply when you help an Exchange take on its work. Organizationally, the Exchange is itself in a new environment for those working to make it the best it can be - Exchange staff. For its staff, it's a new experience where countless decisions need to be made each day on subject matter few, if any of them, have deep experience. Consider it all: Deciphering usually unclear policy and regulations; data transfer protocols with new entities, 2.3 million and counting ways to slice enrollment data, benefit design impact on enrollment risk-mix, potential enrollee decision processes, working to anticipate media/special interest group response (to whatever!), provider and hospital network coverage assessment, and while there are many others - another new area for most all Exchange staff is the establishment of sales channel outreach and marketing disciplines that combine consumer direct, broker, and community organizations.

The progression of juggling all the examples offered above - and more - is hard enough at any start-up looking to gain customers (i.e. for Exchanges, membership during its first open enrollment). Now, think of this start-up doing all this within a government setting. Not easy. Exchange staff as a whole are working to make it all happen. And in working to accomplish all this, they are doing something very interesting: Exchanges are learning much of what it's like to be a health plan.

Maslow was on to something

Rare is the new insurance company launching in this environment (but those trying are seriously applauded!). And for those few working to bring innovation to a significantly changing coverage marketplace, name one who now or in the past has seen an explosion of growth in a manner equivalent to an Exchange? Just when the Exchanges are looking to perform lesson-learned reviews of the last open enrollment, a whole new something is now here: Renewals. How does the Exchange manage added complexity of working to bring the right value to new enrollees while remaining a value to existing enrollees in subsequent open enrollment periods? It's much like being on point for getting multiple kids ready for school every day: You work to build a routine to make it smoother, but they keep finding new ways to make it never quite go very smooth.

However, just as parents somehow manage to get the kids to class so they keep learning, so can and will people help Exchanges evolve. In supporting Exchanges at this juncture be on path to realize their potential, those called on for help who are experienced and knowledgeable in managing price and health services availability for large numbers of people over long periods time have responsibilities. These include providing decisive direction while creating an environment where those progressing along the learning curve are allowed to engage, try, and learn. This transfer of knowledge is key to healthy growth and we must provide this as a basic tenet to Exchanges operating as efficiently as their environment will allow.

All parents have expectations. And the high expectations our country has for the ACA and each and every Exchange (public or private) is for them to become reliable conduits for improved health of us as a population. "Live, Learn, and Pass it on" is a good mantra for anyone having a hand in raising kids. It's no different for raising Exchanges.

( * Actually, all exchanges are - recognized or not - on some continuum of "active".)