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Health Plans Ramp up for Healthcare Reform

 |  By Margaret@example.com  
   May 02, 2012

There has been quite a bit of surveying centered on how hospitals and physician groups are preparing for healthcare reform.

Last week I spoke with Eric Paternoster, the CEO of Infosys Public Services, a Washington, DC-based business consulting and technology company that just released survey findings based on responses from 100 executives from 20 health plans.

In addition to how they are progressing in the implementation of healthcare reform, the executive responses provide insight into health plan priorities and the steps they plan to take to achieve those priorities.

Health plan executives have kicked healthcare care reform into gear. More than 80% say they are already implementing some type of reform measures or plan to implement them this year. The remainder say they are in the planning stages. No one responded that they haven't yet taken any steps toward healthcare reform.

However, readiness levels for key provisions of the Affordable Care Act—accountable care organizations and health insurance exchanges (HIX)—vary considerably. Some 39% of health plan executives said they implemented ACOs in 2011 or will implement them this year. Only 12% said they were taking similar steps for HIX.

Paternoster says the HIX number surprised him because early in the healthcare reform process health plans seemed more interested in HIX than ACOs. He says payer organizations devoted planning and development resources to product design and data exchange to be used as part of HIX.

Of course, politics may have played a role in the softening in interest. The exchanges have been stuck in a quagmire as some states refused all federal overtures, including big bucks, to help establish state-run HIX.

Paternoster says he sees signs that interest in HIX is rebounding as payers look to form their own commercial exchanges. Even if the Supreme Court throws out the ACA legislation, he says payers still see huge potential in the individual market and view HIX as a viable way to bring insurance to the uninsured.

Meanwhile, payer interest in ACOs seems to be cruising along, as insurers such as Aetna developcommercial ACO and ACO-like relationships to shift traditional payer-provider relationship from rate-based to value-added-based. The company expects to have at least 20 ACOs under contract by the end of 2012.

With all the talk about the vaunted triple aim of healthcare: better care, better health, and lower cost, it shouldn't come as a huge surprise that health plans tapped improving the customer experience as their top priority for 2012.

Paternoster says that reflects a shift in the health insurance market from a wholesale (employer-sponsored) to retail (individual) approach to selling insurance. It also reflects how choice will play a critical role in payer and product selection.

The survey indicates that member portals and e-commerce are among the big ideas where payers plan to invest to improve the consumer experience. Embracing multi-channel commerce, mobility, and social media are also on payers' agendas.

Payers have been working on these elements for several years but now are focused on wrapping up that work.  Paternoster says, "They know these items are key. Payers know they need to get their technology on board so they can shift from historical to real-time analytics. They need to be able to quickly change how they engage individual members. They also need to be able to monitor what is happening in their provider networks so they can react in real-time to changes there."

Rounding out the list of top health plan priorities is provider collaboration, integrated care management, and health exchanges.

Paternoster notes that the priorities are all related in some way to improving the customer experience. "I think payers recognize that if their providers work together and there's integrated care management then their members will be happier."

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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