While recent financial news among insurers, such as UnitedHealth Group’s announcements gives some insurers good reason to view the individual health plan market warily, others are finding success and profitability in the individual market.

We kicked off the session with an audience poll and the answers were not surprising: Attendees reported almost unanimously that results for their organizations in the individual marketplace in 2014 were worse than they expected.

Yet, change is underway. Looking toward the next open enrollment season at the end of this year, our featured speakers, Koleen Cavanaugh, Director of Consumer Marketing and Member Experience for Independence Blue Cross (IBC); and Scott Osler, SVP of Business Development for GetInsured, shared practical insights for using insurer-led private exchanges to increase sales and grow customer engagement.
Koleen Cavanaugh highlighted that the marketplace has matured as the Affordable Care Act has been implemented over the last three years. For example, the first open enrollment period ran for six months and still resulted in a flurry of enrollment activity at the very end. This year’s open enrollment period was down to three months, with the bulk of enrollments completed well in time for January 1 coverage. While initially no documentation was required to qualify for special enrollment periods (SEP), the Centers for Medicare and Medicaid Services (CMS) has now taken steps to tighten definitions and limit SEPs. These favorable signs indicate that insurers are in a better position to drive their individual line of business forward.

For IBC, understanding the barriers that keep individuals from purchasing health insurance, such as lack of knowledge, perceived lack of need, mistrust of insurance companies, financial concerns and logistical challenges, has helped them address these challenges head-on. Using their own private exchange, IBC is creating a 360-degree view of members and their consumer journey from building awareness all the way through renewal and ongoing engagement. This approach drives programs and services that improve performance in the individual market.

As a regional insurer, IBC has been creative in how they engage prospective members. For example, they continue to implement detailed segmenting and targeting using data from their private exchange to give members the right information in bite-sized amounts. Through secure text messaging they guide members to take proactive steps, such as getting their flu shot, or toward better use of their benefits, such as convenient, non-emergency providers or generic medications.

Scott Osler rounded out the session with insights GetInsured has gained as a national web broker entity (WBE) that represents a variety of carriers and products. They have seen tremendous growth in enrollment with regional carriers over the last three years. Challenges still persist with managing enrollments without standard identification numbers and reporting processes. And, in their experience, consumers still struggle to understand insurance terminology and concepts.

However, according to Osler, despite the challenges consumers want to make decisions based on more than just premium. When consumers shop using the insurer’s private exchange, details can be readily available during plan comparison about total cost of care, provider networks (including mapping), and drug benefits. Because consumers tend to accept the plan recommendations presented, it’s critical that these recommendations be personalized with utilization and medication history as much as possible.

With that in mind, Osler noted several key features of insurer-led private exchanges that make all the difference for consumers, especially intuitive decision support at every step. It should be fast and easy to both estimate and claim the consumer’s subsidy while shopping. Plus, the process needs to go beyond simple eligibility to offer information about potential options for public healthcare coverage, even for different family members. At the same time, the process needs to minimize the disruption caused by the “double redirect,” whereby shoppers go from the insurer’s exchange to the public exchange and back again.

With insurer-led private exchanges, insurers can succeed in the individual market and shift sales of QHPs away from the public exchanges.