Anyone who thinks private exchanges are a new fad should speak with Choice Administrators, the organization that runs CaliforniaChoice. It’s been around close to 20 years, since 1996. With a portfolio that now includes ChoiceBuilder, an ancillary exchange, and CaliforniaChoice 51 plus, Choice Administrators' president and CEO Ron Goldstein talks with EBA about the business model and how grandmothered plans under the Affordable Care Act could make a big impact in the new year. 

What is the structure of your exchange? What makes it different?

The most critical piece is as a small-group program, we are multi-carrier employee choice defined contribution, which is really the foundation of our program. We have seven health plans, four-to-five ancillary programs with dental, vision, life — everything is one consolidated bill. A 10-life group can come to us and every employee can have a different carrier, different benefit level. It’s very robust. We are just introducing what we call our business  solutions suite, which has flex plans, COBRA administration. When an employer comes here they can get everything done. 

How do you recruit clients?

We work strictly through brokers and have no direct sales force. Our entire sales force is dedicated to  making the broker experience the best possible experience in the marketplace. That will include online tools like online enrollment and automated choice profiles so people get a good feel, based on health conditions, which carrier to look at.

We have an aggregated provider directory. If I want Dr. Jones, I can find out that Dr. Jones is with three of my carriers, he is on the platinum plan on one, the silver plan on another, etc., and  he can admit me to certain hospitals. We put all these tools together for a broker so when he goes out to see a client, a client can make a better educated decision then just saying, “I want to be on BlueCross because its BlueCross.”

What is your relationship with brokers?

100% broker-driven. All we do is train, educate and we have our sales force go out with brokers, help present the sale. Will enroll with the broker. We do everything that a carrier does except for the network contracting and claims. We are a full-service TPA for the brokers.

How does 2015 open enrollment compare to 2014?

We keep looking this because of grandmothering of Affordable Care Act plans in the fourth quarter this year. We think ’15 could be a bigger year for us, because if they don’t do any grandmothering for 2015, all that business will be up for grabs. There’s a tremendous amount of business — probably over a third of the California businesses I know are grandmothered. They are non-ACA plans, come end of 2015, most of  these people will have to move to ACA plans, which puts in a very good position looking at 2015 forward.

Where do you see private HIXs fitting in the health care game moving forward?

The difference between us and what you are hearing under a private exchange moniker is that most private exchanges are single carrier exchanges with technology — outside of Connecticut, where they have the small business association, which is multi-carrier exchange. If you really look at the exchanges out there today, they are really single carrier with some technology. It really depends on that state and what the market is looking for. There’s a place for it. If ACA is going to stay around, I would love to see states be in a position where their program is successful because it just brings better competition into the marketplace.

Editor’s note: This story is the fourth in a series of one-on-one interviews with private exchange leaders and top decision-makers across the U.S. Know of an exchange expert who should be profiled? Email Brian.Kalish@sourcemedia.com.

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