With the hype of marketplace exchanges going live in 2013 (well, on life-support anyway), much of next 12-18 months will be spent stress testing the Affordable Care Act. Behind the scenes there are improvements to be made and glitches to be fixed: public/private integration, technological and administrative repairs, product mix refinements, user experience streamlining, and of course a list of unknown unknowns.
Health plans and brokers will need a robust post-enrollment learning agenda to understand which customers entered the market, who stayed out, how they shopped and what their risk mix looks like. And on the competitive front, what do the 80 new market entrants who showed up mean to your business (e.g., newly authorized CO-OPs, provider-sponsored plans, expanding Medicaid managed care companies).
Lets face it, if only a fraction of health reforms promise of access to care for the uninsured comes true, we will see millions of underserved, high-risk health-care consumers enter the insurance and medical delivery systems ready to use their shiny new insurance card. For insurers, elimination of pre-existing condition exclusions and tight pricing parameters threatens profitability and has actuaries in panic mode to reengineer risk management toolkits.
For consumers in a marketplace defined by personal responsibility, it means dealing with intimidating, complex benefit and health care decisions. If carriers and brokers are asking customers to step-up and take control of their health care destiny by making upfront benefit and medical choices and stay involved throughout care delivery, they need to be educated and supported as they navigate through these delicate decisions.
Will ACA be successful? Who knows. Detractors claim operational complexities, people gaming the system, and consumers inability to shop for health insurance make it unsustainable. Promoters argue that with 48 million Americans without health insurance, dont underestimate Americans ability to manage a health care budget, comparison shop, and purchase whats right for them. Backing up these claims, advocates point to the escalating popularity of health benefit private exchanges among large employers (employee uptake is estimated to top 39 million in five years).
One thing is for sure, 2014 will see fast-paced action and unforeseen market surprises. With competitive rivalry at all-time high, keep a close watch on the trends impacting your business and take a proactive approach to managing change. And remember, entrepreneurship trumps bureaucracy!
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Resnick is chief marketing officer of KBM Group: Health Services. He is a frequent blogger (
