Guest host Barbara Bogaev leads “The Brave New World of Obamacare”

Listen to or download the Jan 2 podcast of “The Brave New World of Obamacare” on To The Point with Warren Olney.

I joined a panel of experts on exchanges, health care reform and insurance to give insights on ACA plans going into effect. To The Point tweeted key comments from each of us, including:

  • Bryce Williams, Towers Watson, @brycewatch:
    The ACA could be major boost to entrepreneurship
  • Sarah Kliff, Washington Post, @sarahkliff:
    36 hrs into Obamacare, vast majority can signon & signup w/in an hr
  • Susan Shargel, Shargel and Company
  • David Nather. Politico, @DavidNather
  • Gerald Kominski: UCLA Center for Health Policy Research, @UCLAFSPH

In the full podcast, you’ll hear comments on these points and more:

The New Year brought with it medical coverage for millions of Americans under the Affordable Care Act. On Jan 1, about two million people began to receive private health coverage through the state health exchanges or the federal website.

With one of the nation’s most sweeping changes to social policy in decades, no longer can insurers deny coverage to people with pre-existing conditions, or charge them more for their coverage than other customers. It’s also the first time they can’t legally charge women higher premiums for the same coverage as men, and the first time they can’t set a specific limit on the amount they spend on “essential health benefits” for individual policyholders.

But there are a lot of “if’s” in the implementation of Obamacare:

  • Will people be able to find a doctor who accepts their new plan?
  • Are the nation’s healthcare providers ready for the change in policy?
  • How will Obamacare shape the political climate this election year?

I’m proud to share some recognition in the fields of health care business and consumerism.

Exchange Solutions 2013 Healthcare's HottestModern Healthcare: 2013 Healthcare’s Hottest Companies
The Exchange Solutions segment of Towers Watson, launched with the acquisition of Extend Health, was recognized by Modern Healthcare for being one of the fastest growing health care companies in the U.S. – named 4th among a great group of companies.

Institute for HealthCare Consumerism: 2013 Innovator > See pg 63
Bryce Williams 2013 Innovator PG63I’m honored to be named among some very esteemed industry figures by the Institute for HealthCare Consumerism. See page 63 to learn a little about the early days of Extend Health and what’s it’s meant to my team at work and at home to be in the leading wave of health insurance exchanges in our nation.

I spoke with several journals about what the Liazon acquisition means for Towers Watson and the exchange space. This coverage pulls in opinions from across the industry as well as my highlights.

Private Health-Exchange Market Consolidates, David McCann
My highlight: “Towers Watson has plenty of good reasons for buying Liazon….The market is moving so rapidly, and there’s a sense that a tipping point is being achieved…It’s as if the music just stopped and we grabbed the last chair.”

Towers Watson expands private exchanges with $215M Liazon purchase, Jerry Geisel
My highlight: “Liazon has “the most sophisticated insurance platform by a mile in this market.”

Towers Watson’s private exchange division leader details advantages of Liazon purchase, Kathleen Koster
My highlight:
 “We want to be the leading player in private exchanges….A year and a half ago, they [Towers Watson] bought the leading retiree exchange in Extend Health. Today, they’re buying the leading active exchange technology company, Liazon….The acquisition gives Towers Watson the ability to hit the market very quickly with all the most sophisticated exchange technology out there.”

More on the acquisition
A closer look at Liazon

Recently I spoke with Marianne McGee of Healthcare Info Security about security considerations for health care exchanges.These range from regulatory requirements, technology best practices, the interests of employers who use exchanges to deliver a health insurance solution to their workers, retired or present, and most importantly the experience of the health care consumer.

Hear the podcast: Insurance Exchanges: Security Issues: Authentication a Key Factor, One Pioneer Says

All these requirements and interests are critical, and with the right focus, they can all be accomplished in a way that creates a premium experience for the ultimate user of the exchange – the consumer.

In this podcast, I speak with Marianne about

  • Technological considerations, including the trifold data security standards of the technology, banking and health care industries, which we have implemented on the Extend Health exchange.
  • User experience considerations, particularly the importance of designing robust consumer authentication that secures consumers’ accounts and personal health information.
  • Thoughts on the challenges that lie ahead for the state exchanges now developing their platforms and consumer interfaces.

For regular commentary on developments and trends in health care, technology and insurance, follow @brycewatch and @ExtendHealth on Twitter and check out www.extendhealth.com.

Knowledge is power — the power to think, to act, to buy, or even to not do any of the above. Our nation’s health insurers and health care providers need to figure out how to put power back into the hands of consumers. Consumers today have too many constraints when it comes to accessing decision-critical information about the cost of health care. That’s a hard pill to swallow when there’s so much at stake.

A recent post on The Health Care Blog featured a fascinating yet not unsurprising finding: The cost for appendectomies can vary by more than $100,000 between health plans and hospitals.

Dr. Renee Hsia of UCSF was asked what appendectomies cost by a friend who had to pony up over $50,000 in co-pays for one. Dr. Hsia’s research, which looked at pricing variability across the state of California and was published in the Archives of Internal Medicine,  found that an appendectomy could run from $1,529 to $182,955 — varying as much as $7,504 to $171,696 within one hospital.

The question of where to begin is starting to be answered by sites like FAIR Health’s Consumer Cost Lookup. It uses continually updated claims data from insurers and third-party administrators for 126 million people to benchmark costs. Visitors to the site can find typical rates for certain services in their area as well as what Medicare pays.

Fourteen other states have or are setting up searchable databases to help compare health care prices and quality.

The savings that can be realized are impactful not only for consumers but for health insurers themselves. Because half its members had no idea when they were being referred to out-of-network providers, Aetna launched a service to let members know if their outpatient surgery could be done by an in-network provider. In many cases, the surgery could be done less expensively, in-network reducing out-of-pocket costs for Aetna members, not to mention for Aetna.

More and more insurers are trying to help people locate services and compare costs, like UnitedHealthcare’s postcard campaign, which lists costs for common lab services at in-network and out-of-network facilities in members’ local areas and its online tool for estimating the costs of over 100 common treatments.So what’s central to all of these stories? Information.

In the California appendectomy story the information was too hard to get: too many sources, too many different plans. And, technically Aetna didn’t offer consumers (and network doctors) anything they didn’t already have access to. The information was just too hard to piece together and act on.

What these stories show us is that health care consumers today need access to information, plus tools and services to make sense of it all. Like Aetna, United Healthcare and other insurers who have developed cost-comparison tools for consumers, the insurance side of health care has been making cost information more available to aid consumer decision-making. We look to healthcare providers and hospitals to start doing the same.

Bringing transparency to the costs of services and products can supercharge consumer decision-making, forcing healthcare providers and hospitals to be more upfront with price information and to work on getting a better handle on costs for “incidents of care.”

Extend Health Medicare Exchange Interface

Extend Health Medicare Exchange Interface

The Extend Health exchange platform is a great example of transparency in an insurance shopping site. It delivers information on thousands of private Medicare plans to our customers — and it does it in an easy-to-understand way. Our system supports benefit and cost transparencyby allowing customers to compare plans side-by-side and estimate their prescription drug costs for the year. These tools, along with the opportunity to speak with a benefit adviser if they wish to, help ensure that our customers find the plan or plans that meet their health needs and the needs of their budget.

Massachusetts and Utah already offer the ability to buy health insurance online through their state exchanges. The upcoming Supreme Court decision on the Patient Protection and Affordable Care Act will determine if citizens in every state will have the same opportunity. If all or part of the ACA is struck down, health insurance exchanges — a forum whose effectiveness is based on transparency in costs, benefits, services and products (such as drugs) — could be in jeopardy.

Related articles

For regular commentary on developments and trends in health care, insurance, and health IT, follow @brycewatch and @ExtendHealth on Twitter and check out Extend Health online.

Read my latest post for Fast Company on the opportunity health care reform offers insurance companies to compete for new customers. Can insurers adapt quickly enough to take advantage of this tremendous market opportunity? To find out, read “Can Health Insurance Become Customer-Friendly And Web-Savvy?

The road map for state exchange health plans in 2014 was just released. Posting it here to make the whole report available.

Essential Benefits Package (IOM Oct 6 2011)

In early May, the Psilos Group released its third annual outlook report highlighting trends in the health care marketplace, 2011 Outlook on Healthcare Economics & Innovation. Psilos invests in innovative healthcare companies, (frank and full disclosure: Extend Health is one of Psilos’ investments), and its team has reliably insightful commentary about health care market trends.

This year’s report predicts dramatic shifts in the health insurance market. According to the report, “Psilos believes that the PPACA will accelerate sweeping changes to consumer-oriented business models and distribution channels, as well as increase the competition among insurance companies.” In a few short years, the Patient Protection and Affordable Care Act (ACA) will allow many consumers to play an expanded role in the purchase of their own insurance. State-based Health Insurance Exchanges will be places for millions of new insurance consumers to make educated, informed decisions about their insurance options, and insurance carriers will have to intensify their commitment to the consumer experience dramatically.

But as Psilos points out, carriers will be forced to compete in an entirely new business environment, as “The most likely distribution channel for the exploding individual insurance market will be a new landscape of Internet and call center-based public and private health insurance exchanges (HIXs)….” As individuals begin finding health insurance through exchanges in 2014, and businesses send their employees there over time, insurers will have to shift from selling business-to-business—marketing group plans to employers—to selling business-to-consumer. In a new world of consumer-oriented private and public Health Insurance Exchanges, carriers will deal directly with their consumers from the very beginning of the relationship. This change will force efficiencies throughout their business model, and create competition based on cost, quality and service—all of which will be newly transparent.

As I read the report, I was struck by the similarities between Psilos’ prediction for the evolution of a successful insurance company in the new dispensation, and the business model that Extend Health currently uses to help over 350,000 retirees find health plans. Our exchange allows retirees to choose the right Medicare plan for them, the first time. We are inherently a consumer-facing organization, and our ability to help retirees navigate the insurance market usually results in lower out-of-pocket costs and higher satisfaction levels.

One of our most important “secret weapons” is our unparalleled and innovative proprietary technology that facilitates a friction-less transition from group coverage to individual Medicare plans. The efficiencies gained from our significant investment in technology, including our telephone system, online insurance exchange, and back-end integration with carrier partners, improve the customer experience for our retirees, and (along with the advice and guidance of our licensed and certified benefit advisors) help them find and enroll in the best plan for their health needs.

Psilos is right that carriers who want to remain competitive in the evolving health insurance market will need to improve their efficiency dramatically. Insurance carriers today have first-rate IT systems for claims processing, but the market has not yet demanded sophisticated technology to assist with plan choice, enrollment and ongoing customer service. While some carriers will step up to the plate, this role will often be filled by private and state-based exchanges.

Exchanges will bring new transparency to the cost and quality of health plans offered, and the new health insurance market will mean greater interaction between consumers and carriers. The regulatory environment is also demanding new efficiencies. Just this week [May 19th], the Federal government finalized a proposal to require insurance companies to publicly disclose and justify premium increases of 10% or more. Carriers will have to meet these expectations, AND become much more efficient and consumer-friendly for first-time insurance purchasers, to thrive in the coming health care market environment.

Visit Extend Health — the nation’s largest private Medicare exchange.

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