Health Plans Share Their Roadmaps to HIX

Margaret Dick Tocknell, August 7, 2013

While health insurers intend to participate in public health insurance exchanges, the general strategy is to wait and see. Payers are looking to private exchanges and even proprietary exchanges to enable them to more efficiently serve their customers.

During their second-quarter earnings calls in July and August, senior executives at the major health plans expressed cautious optimism as they prepared for health insurance exchanges, the centerpiece of healthcare reform.

While they plan to participate in the public HIX, the overall strategy is to wait and see. Insurers are looking to private exchanges and even proprietary exchanges in the case of Aetna and Cigna, to enable them to more effectively and efficiently serve their customers.

Medicare Advantage and Medicaid remain promising and yet challenging investments in the face of state and federal funding and budget woes. To maintain revenue streams in these markets, insurers are looking to more collaborative care among their providers and providing more in-home services to prevent costly hospital stays.

Here are some of the highlights:

Aetna is in the process of developing its own proprietary health insurance exchange, which is expected to focus on population management and will include the ability for consumers to select products and services based on their individual needs.

The insurer is taking what CEO Mark T. Bertolini describes as a "cautious approach" to public health insurance exchanges, but expects to be part of up to 14 or 15 public HIX. In recent weeks Aetna has announced that it will not participate in the California, Connecticut, Georgia, or Maryland exchanges.

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


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