HealthConnect Systems

Transcription

1 HealthConnect Systems Health and Benefits Sales Automation Multi-Carrier Quoting Primarily Small Group and IFP Primary Clients: o Agents o General Agents o Carriers o TPA s

2 Exchanges Overview Part of PPACA Opportunity for Agents/GA s Expansion of Market Projected payments to operate exchanges o $1 billion upfront o $3 5 billion annual recurring Attracting many players o Government o Commercial HealthConnect Systems o Considerable time evaluating o Fundamental positioning: Agent/GA friendly

3 Today s Discussion Nuts and Bolts Agent and Carrier Survey Strategy Recommendation o Agent o General Agent

4 Nuts and Bolts

5 What is an Exchange? A portal and call center established by each state where individuals and small business can compare and purchase commercial health insurance and obtain government subsidies to defray the cost of the purchase.

6 Why is an Exchange necessary? Creates mechanism to disperse subsidies Simplifies insurance options and creates clearinghouse Aggregates individuals and small group employees into a single risk pool Exchanges are politically supported by both parties and was one of the few non controversial items in healthcare reform

7 How will an Exchange get set up?

8 How will an Exchange get set up? State

9 How will an Exchange get set up? State Advisory committee - Interview stakeholders - Recommend structure

10 How will an Exchange get set up? State Advisory committee - Interview stakeholders - Recommend structure Governmental entity - Operate Exchange

11 How will an Exchange get set up? State Advisory committee - Interview stakeholders - Recommend structure Governmental entity - Operate Exchange Hire subcontractors Government Commercial

12 How will an Exchange get set up? State Advisory committee - Interview stakeholders - Recommend structure Happening Now! Governmental entity - Operate Exchange Hire subcontractors Government Commercial Sub-contractor hired per RFP

13 How will an Exchange be funded? Exchange Operations - Initial - Federal Government ($1 bil) - Ongoing - 2.5% override from carrier - Portion to subcontractors - Exchange must be self-sustaining after initial funding Subsidies - Federal Government

14 Key Operational Aspects - Call Center - Portal - Community outreach

15 What will an Exchange do?

16 What will an Exchange do? 1. Market to individuals/families and small businesses (employers/employees) - Direct (call center) - Third parties agents navigators (community outreach)

17 What will an Exchange do? 1. Market to individuals/families and small businesses (employers/employees) - Direct (call center) - Third parties agents navigators (community outreach) Key questions: - Services - Compensation - Plans/Rates/Benefits In versus out of exchange

18 What will an Exchange do? 1. Market to individuals/families and small businesses (employers/employees) - Direct (call center) - Third parties agents navigators (community outreach) 2. Traditional GA functions o Work with agents o Carrier submission o Carrier interaction

19 What will an Exchange do? 1. Market to individuals/families and small businesses (employers/employees) - Direct (call center) - Third parties agents navigators (community outreach) 2. Traditional GA functions o Work with agents o Carrier submission o Carrier interaction 3. Additional functions o Subsidy o Billing o Technical: Single Multi-carrier

20 Expected Timeline late 2011 mid-2012 mid /1/14 Policy/committee Legislation/vendor discussions RFP issue & contract awarded Implementations Soft launch Exchanges must be operational

21 How big is the opportunity? Set up: Ongoing: $1 billion $3 $5 billion annual recurring (25-40 million people and roughly $6 - $8 PEPM)

22 Who will operate the exchanges? Government MMIS: EDS (HP), ACS (Xerox), CSC System Integrators: Perot, Anderson Call Center: Maximus Eligibility: HMS Other: Lots and lots Commercial Sales Automation: HealthConnect Systems, ehealth Benefits Administration: Word & Brown, Ceridian, Digital Insurance Software: Microsoft Others: Lots and lots

23 QUESTION: As an agent, what should I do about Exchanges?

24 Agent Goals Maintain current distribution system Don t disadvantage current system versus exchange o Mandates/consumer protections o Plans/pricing Role for broker in the exchange system o Sales/service o Same compensation in/out

25 Agent Positioning Key Points - Exchanges offer subsidized commercial health insurance o Distribution and services dominated by experts (Group 90%, IFP 70%) o MMIS/government contractors have limited/no experience with small group and IFP - Exchanges must be self-sustaining (after initial Federal funding) o They must work! o Need balanced risk pool (agent compensation) - Success/failure of Exchanges will be highly (politically) visible o Membership/uninsured number disclosed o Constituent use of Exchange o Health insurance is an experience (versus search) good o Local servicing vs. government call centers

26 QUESTION: As a General Agent, what should I do about Exchanges?

27 GA Positioning Key Challenges Policy makers have a poor understanding of the key role played by general agents. Companies most likely to operate exchanges view GA s as competitors Compensation (initial versus long-term)- Exchange operators initially plan to bid cost to operate exchanges at a very low rate.

28 Key Structure Exchange Operations Traditional GA Functions Work with agents Case submission Carrier interaction Other - Billing - Subsidy/eligibility - Technical (single multi)

29 Key Structure Exchange Operations Traditional GA Functions Work with agents Case submission Carrier interaction Have state/government entity allow for multiple general agency servicing entities!! Other - Billing - Subsidy/eligibility - Technical (single multi)

30 How will an Exchange get set up? State Advisory committee - Interview stakeholders - Recommend structure Happening Now! Governmental entity - Operate Exchange Hire subcontractors Government Commercial Sub-contractor hired per RFP

31 BUT Exchange Operations Traditional GA Function Initial total compensation $6 - $8 PEPM* Other * This is NOT a typo!