Health Plans Prepare to Participate in Exchanges

Spurred by the individual health insurance mandate and the prospect of adding thousands to their rolls, a majority of health insurance leaders are already preparing or implementing plans to participate in health insurance exchanges, according to a poll conducted by KPMG LLP, the U.S. audit, tax and advisory services firm.

More than two thirds of health plan business leaders who participated in poll in September had developed a plan to become exchange ready (39%) or had started implementing required changes and are on schedule to meet the October 2013 open enrollment deadline to participate in an exchange (29%). Seventeen percent had analyzed customer opportunities and developed a product strategy. Eleven percent had not started planning to enter an exchange but said they intend to participate. Just 7% don’t intend to participate in an exchange.

Clearly, health plan leaders are increasing their focus on the retail side of operations and are moving to put into place the operational pieces required to participate in an exchange and interact directly with consumers, said Joe Parente of KPMG’s Healthcare. They are also taking a much closer look at their networks and redefining their strategy to be more competitive.

More than 75% of health plan leaders see their biggest growth coming from consumer-directed or high deductible plans. Cynthia Ambres of KPMG said plans need to focus on differentiating themselves to attract the individual market and small group employers that are likely to migrate to exchanges. Insurers need to decide at what level they want to go after the individual market and how they distribute their products to as many outlets as possible, including state health benefit exchanges, a federally facilitated exchange, private exchanges and direct commerce sites. For more information, visitwww.kpmg.com/us).

Last Updated 7/11/2017

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