Slideshow 6 questions to consider when selecting a private exchange

Published
  • June 11 2015, 5:02am EDT
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From data integration capabilities to long-term ROI, there are six key questions that need to be answered before choosing a private exchange for your client or organization, says Bruce Sherman, medical director of Buck Consultants at Xerox’s private exchange RightOpt.

1) Data integration

Does the private exchange have the ability to integrate data from multiple health plans and vendors to support the health management strategies and tactics of those entities — and vendors of related health benefits offerings?

Integrated data may well be the best way to identify population health management issues, particularly when the data includes medical and pharmacy claims, health risk assessments, biometric screening and utilization of consumerism tools, Sherman says. “Additionally, an integrated data platform can serve as a data hub to provide information feeds between the different vendors to inform risk stratification and targeting of high-risk individuals,” he adds.

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2) Population well-being

How can the exchange address and/or support individual and population well-being? What about business performance?

Sherman explains that inclusion of well-being questions — either as part of the health risk assessment or as a separate survey — can facilitate identification of well-being concerns. These issues may well represent greater personal priorities than physical health concerns, such as financial stress or caregiving for a family member. Only once these priority issues (a different type of symptom) are effectively addressed might individuals be willing to address their physical health concerns.

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3) Consumerism

How will the exchange offering support health care consumerism — beyond cost and quality transparency tools?

While cost and quality transparency tools certainly have a role, upstream priorities exist to ensure that individuals are appropriately using available transparency resources, he says. These include consumer engagement in their own health care, as well as decision support tools to help individuals identify the available treatments best suited for their specific needs. “Exchange offerings that include these components as part of a broader approach to consumerism are likely to derive more effective use — and value — from their transparency tools,” Sherman adds.

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4) Impact on population health

How will the exchange offering impact population health, in terms of preventive care compliance, chronic condition gaps in care, clinical outcomes and avoidable hospitalizations?

An exchange offering should be able to provide reporting to demonstrate improvements in the quality of evidence-based care delivery, which includes better adherence with preventive care and recommended chronic condition management, as well as ambulatory sensitive hospitalizations and emergency department use, Sherman says. Reductions in health care costs should not be a function of reduced utilization of appropriate services.

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5) Outcomes

In addition to the near-term savings from ‘buying down’ of health plans and network discounts, what population health management utilization and cost outcomes can be achieved?

Depending on each company’s baseline data, Sherman says, the magnitude of potential improvements in health status and health care cost reduction may vary. “The bottom line is that employers should ask prospective exchange partners to estimate projected health care cost savings and provide the source of those anticipated savings,” he adds. “The key is to gain an understanding of the impact of the exchange on population health improvement and the associated reduction in use of high-cost services.”

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6) Cost curve

What is the differentiator in the private exchange that makes the cost trend bending more likely relative to current health plan design and care delivery?

Employers should ensure that their private exchange partner can ensure improvements in population health based on a series of objective measures, he says. “If compliance with preventive care, and in particular, chronic condition management guidelines improves, reductions in health care cost trend are likely to occur,” he adds. “For most employers, current approaches to health benefits and the extent of vendor operational integration are insufficient to generate the desired magnitude of health care cost trend reduction.”

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