He may be new on the job, but Hawaii Health Connector CEO Jeffrey M. Kissel isn’t holding back. Speaking exclusively with EBA in Washington Tuesday, Kissel, who was appointed CEO in October 2014, says many public health care exchanges largely failed in their initial rollout.

At the time, most exchange leaders didn’t understand you cannot flip a switch and expect everything to work on the first try. “It never has; it can’t under the present circumstances,” he says. “Look at all the great technology-based websites. They have introduced more and more features over time; they haven’t gone with the big bang theory. Anybody who has tried that has failed.”

Kissel, who before joining the exchange was CEO of Hawaii Gas, says that besides Kevin Counihan, who was head of Connecticut’s public exchange and is now CEO of Healthcare.gov, few exchange leaders understood that point.

For exchanges to be successful, he explains, their value proposition must be built around “human need” — a concept he picked up through a long business career that at one point included being an insurance broker. Approaching exchanges from the human need perspective ensures “the fundamental objective is to help people have a better quality (of) life,” he says. “From a business prospective, that translates into increased business productivity and a value proposition that insurance companies and the government can buy into.”

Hawaii Health Connector was relying on technology to do the job when Kissel arrived, he says, which is the wrong approach. “We immediately turned … from a computer-facing interface to a human-facing interface.”

That means using the technology as a support tool for people running call centers and performing community outreach, he says.

Helping the consumer

Hawaii’s Prepaid Health Care Act, passed in 1974, requires businesses in the state provide health insurance to employees who work more than 20 hours per week for four or more weeks. That has kept Hawaii with one of the lowest uninsured rates in the country. According to the Kaiser Family Foundation, Hawaii has the second lowest uninsured rate of the 50 states, at 6.7% in 2013.

Therefore, Kissel says, many “well-intentioned” people think Hawaii does not need the Affordable Care Act. But, he says, “that is the same kind of thinking that allows people to die of prostate cancer, because it isn’t economical to treat them all.”

With the ACA, he says, no one should be left out of the system. Full inclusion has a human impact, but it also has a business impact, he says. He provides the example of a Hawaiian who works as bellman and barman but has no employer-sponsored insurance, and as a result, won’t seek treatment if something goes wrong. “It’s not just uneconomical, it’s inhuman,” he says. “And from a business prospective, it’s foolish.”

He adds, “That’s why I think even in states with relatively small population and low uninsured rate, the benefits of the ACA are substantial enough to warrant investment.”

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