Skip to main content

Insurers Must Guide Individual Market in 2014

 |  By jfellows@healthleadersmedia.com  
   November 28, 2012

A new survey shows consumers willing to participate in the new individual insurance market in 2014, yet unwilling to take some personal responsibility to drive down healthcare costs. How can consumers be made to connect the dots? Part of the answer lies in how insurers approach them.

This past June, the consulting firm Accenture surveyed three consumer groups expected to make up the largest chunk of the individual market that will participate in the health insurance exchanges: adults under 65 who are uninsured, individually insured, or insured through an employer with less than 100 workers. The survey found that 72% cited affordability as their main concern when it comes to health insurance.

These results aren't surprising considering the recession Americans have been weathering. But that same survey found consumers reluctant to change their behaviors to save money. For example, less than half—43%—said they'd switch to a cheaper prescription, and only 23% said they'd switch primary care doctors.

Perhaps the biggest indicator that reducing overall healthcare costs will remain a hurdle is the entrenched behavior of those eligible for subsidies. Among that group, 81% said they wanted help getting healthier, but only 40% consider regular primary care checkups a priority.

The findings of Accenture's survey expose both the knowledge and behavior of U.S. consumers about healthcare as a chronic weakness. Similarly, a poll from the Kaiser Family Foundation released last month reported 41% of consumers saying they were "confused" about healthcare reform.

Are they the only ones?

No. Employers' understanding is lagging, too. A Deloitte survey in July showed 51% of employers describing themselves as having "some," "limited," or no understanding "at all" of the Patient Protection and Affordable Care Act. The larger the organization, the more likely the executives were to understand the scope of healthcare reform, but consider that only 26% of benefits administrators said they had a "good" understanding of PPACA.

So what do these survey findings mean when considered as a sum? Clearly, there is a lot of confusion among employers and consumers about what's coming. However, it also opens the door for insurers who are prepared to offer easy access to simple information that puts them in the role of educator instead of seller, at least initially.

Jean-Pierre Stephan, healthcare senior executive for Accenture, says what insurers will likely struggle with is gauging what consumers want.

"It's one thing to have a transparency tool deployed to market because an employer group requests it or requires it," he says. "It's another thing to have the consumers decide whether or not they're going to use it or choose you for your transparency tool. I think they [payers] realize the game has changed and the requirements for these tools and information have gone up, because it's really about the individual consumer now."

While the PPACA puts new wrinkles into the already complex government regulations insurers have to deal with, they are in the best spot to help consumers understand what's available.

The question for each insurer is whether they are ready to capitalize on consumers' shallow grasp of what healthcare reform means for them personally? Stephan says it's a major transformation.

Insurers are "going to now start to worry about this holy grail of healthcare around consumer engagement," he says, "because the behaviors of these consumers, once they have them as members, are pretty different from the behaviors of their current population right now."

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

Tagged Under:


Get the latest on healthcare leadership in your inbox.