Noting how insurers have few incentives to invest in wellness and disease management programs that could take up to three years to pay off, two researchers have suggested multi-year HIX options to promote healthier living and a more efficient health care system in the face of “unintended consequences” from the Affordable Care Act.

HIX plans, as well as more competitive and transparent pricing, “might inadvertently counteract current efforts to shift the payment system toward one that rewards providers for providing long-term health care management for their patients,” said RAND Corporation’s Hangsheng Liu and Soeren Mattke in a recent Health Affairs blog.

Their proposal: a five-year plan with long-term benefits that, in turn, would lower costs and premiums gleaned from those savings. While there are no such contracts in the U.S., the authors cited self-insured plans as their “functional equivalent.” 

HIX enrollees might gravitate toward bronze-level plans when they’re healthy, knowing they can always step up coverage in the event that they become ill, the researchers reasoned. And just like carriers, the fear is that at least one incentive to live healthier could be lost in the shuffle. Another issue noted was that “the self-selection problem” could worsen since public exchanges offer only limited risk adjustment based on various demographic factors.

The fact that the ACA “allows two or more states to form health care choice compacts that would allow insurers to sell policies across state lines” could spur adoption of this approach, according to Liu and Mattke. They believe multi-year contracts could “align the interests of health plan enrollees and insurers by reaping long-term benefits of patient health management.”

The researchers also noted lessons to be learned from Germany and Australia, where citizens are discouraged from switching their health plans at a young age. For example, German youth contribute to a fund that subsidizes their premiums as they age, while Australians who buy their first policy past age 30 are charged 2% more than the community rated premium up to 70%.

Liu is a policy researcher, as well as a technology and population health practice leader for RAND Health Advisory Services, where senior scientist and graduate school professor Mattke is managing director. 

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