Consumer marketing, benefits in the marketplace that exceed the costs and accreditation from an Health and Human Services-approved accrediting entity will influence the success of the federal health care exchanges, according to a study of current state exchanges like the California Public Employees Retirement System and financial exchanges.
“Based on this study, we should find better ways of tailoring health insurance to individual needs. Patients with a specific condition, such as heart disease, should be able to select a plan that has demonstrated high quality outcomes treating other individuals with that disease,” Robert Lieberthal, PhD, assistant professor at Jefferson School of Population Health, stated in a press release.
Liberthal and colleagues found one way to ensure success is to collect measurements and data from the new health insurance exchanges (HIXs) and adapt the plan toward more success in the future. The researchers also found that marketing, as with California’s exchange, is key to making it palatable to the consumer. A final factor affecting HIX success is to ensure the success of the accrediting bodies that play an important role in shaping the exchanges.
“URAC accreditation signifies an issuer has undergone and passed a rigorous, independent, top-to-bottom review of every aspect of its operation,” Marybeth Farquhar, PhD, coauthor of the study, stated in the release.
Liberthal and colleagues also studied financial exchanges and found they have similarities to health exchanges. As with the California Public Employees Retirement System, financial exchanges promote product standardization, which could result in lower cost to consumers. The researchers cautioned, however, this also could be a danger if the exchange limits the number of products offered to profit from high listing fees from companies that want to be on the exchange. They noted actuarial models for monitoring health plans could illustrate ways to alter or stop offering unsuccessful plans which would help the exchange as a whole.
Lieberthal R. HMPI. 2013;1(4):49-60.
Disclosure: The authors received a grant from URAC to conduct this research. One of the authors (Sikirica) received support from the Novartis/Jefferson School of Population Health Health Economics and Outcomes Research Fellowship.