Understanding Marketplace Enrollees: Insights and Strategies
Gain insights into the population enrolled in the marketplace, including higher incidents of chronic conditions and increased medical costs. Explore strategies for managing this complex population, such as innovative benefit designs and participation in value-based programs. Learn how to keep enrollees healthy and informed about their benefits.
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Presentation Transcript
Experiences with the Marketplace Alliance for Health Reform Briefing Alliance for Health Reform Briefing July 15, 2016 Justine Handelman Vice President, Legislative and Regulatory Policy, Blue Cross Blue Shield Association Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.
2 Overview of BCBSA Marketplace population AGENDA Recommendations for a viable private market 16-354-W20
3 Covering a new population: Observations about Marketplace enrollees Higher incidents of chronic conditions Source: Health of America Report, Newly Enrolled Members in the Individual Health Insurance Market After Health Care Reform (based on claims data from 2014 and 2015) 16-354-W20
4 Covering a new population: Observations about Marketplace enrollees Average medical costs for individual members were 19% higher than employer- based group members in 2014 and 22% higher in 2015 Driven by health status as well as medical trend, including national increases in prescription drug costs Source: Health of America Report, Newly Enrolled Members in the Individual Health Insurance Market After Health Care Reform (based on claims data from 2014 and 2015) 16-354-W20
5 Covering a new population: Observations about Marketplace Enrollees Special Enrollment Periods (SEP) Have Contributed to High Costs among Marketplace Enrollees SEPs allow people to enroll outside of the open enrollment period for reasons such as a change in family status, loss of minimum essential coverage, and change of residence. SEP enrollees have been significantly more expensive than OEP enrollees 57% 2014 2015 People can use SEPs to effectively enroll for health insurance on demand . 47% 41% SEP enrollment has been high relative to total marketplace enrollment SEPs accounted for about 20% of members enrolled at the end of 2015. 24% 10% After applying risk adjustment to 2014 paid claims data, loss ratios for SEP enrollees exceeded OEP enrollees by an average of 28%. First Month First Three Months Full Year The problem is getting worse: SEP costs increased from 2014 to 2015 16-354-W20
6 Keeping people healthy New strategies to manage a complex population Innovating around benefit design, e.g. services before the deductible Focusing on prevention and wellness Participating in value-based programs like ACOs and Medical Homes Educating new enrollees about their benefits 16-354-W20
7 What s Needed for a Viable Market Government must be a good business partner Premiums must cover the cost of providing medical care Must ensure rules promote continuous coverage and affordability Need to continue to promote innovation and a robust competitive private market 16-354-W20
8 SHAPING THE FUTURE 16-354-W20
