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Next-generation 2018 health policies may be spawning now

allison bell | lifehealthpro | 1 november 2016 

To read the full article in LifeHealthPro, click here.

A consultant says some big insurers are out of the individual health market this year, or partly out, because they need time to redesign their products.

Some of the insurers that will "reduce the size of their footprints" in the individual commercial health market in 2017 could be back with galoshes in 2018.

Proteus Duxbury, a Denver-based health care consultant, gave that assessment Monday in an interview about the current state of the market.

Duxbury, who now works for London-based PA Consulting Group, watched the previous round of plan building up close. He was the chief technology officer at Connect for Health Colorado, Colorado's state-based Affordable Care Act exchange.

He had to help managers of Connect for Health Colorado connect with federal ACA exchange systems, and he watched carriers learn how to build, and hook up, ACA-compliant individual major medical plans in Colorado.

Neither task was easy, given that the Centers for Medicare & Medicaid Services (CMS), the arm of the U.S. Department of Health and Human Services in charge of implementing ACA programs, tends to be a cautious organization, and the ACA required CMS, the state-based exchanges and the insurers get the exchange program up and running only about 18 months after the U.S. Supreme Court had declared core ACA provisions to be constitutional for the provisions to take effect.

This year, now that some of the new, underpriced, ACA-inspired carriers have left the market, "I think there's a feeling of stabilization," Duxbury said.

In spite of all of the reports about individual health service area cutbacks, "I think there's optimism," he said.

The established players will be back, as early as 2018, with leaner, cheaper plans that are better tailored to the needs of the modern individual market, Duxbury said.

"It's too early to tell if they'll be successful," he said.

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He said it may also be hard for agents and brokers to get in on the ground floor.

In some cases, the insurers may have small, pilot-program versions for the next-generation plans out in the market, but, in other cases, the next-gen plans are still in the lab, Duxbury said.

Some of the issuers may still hope to develop next-gen plans, web systems and robots that will handle the whole sales process without live-human intervention, he said.

But he noted that brokers were critical to the fact that Connect for Health Colorado got off to a smoother start than some other state-based ACA exchange programs.

When consumers shop for individual coverage today, "they're completely overwhelmed," he said. "It's so complicated buying health insurance."

Hospitals, and provider groups that include both hospitals and physician group practices, have tried to start health plans in some markets. "They moved too early and got burned," Duxbury said.

Given the challenges would-be "payviders" have faced, the main creators of the next-gen health plans are likely to be traditional insurers, not providers, Duxbury said.

But, for the traditional insurers, "it's an exciting time," he said. "There's still a population health crisis in this country."

The country still needs to find ways to get consumers to keep themselves healthy, and to get patients to do a better job of shopping for care, and insurers with the right mind set and the right analytical tools are in a good position to get that done, he said. 

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