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Under HIX, Quality Ratings May Be 'Market Movers'

Margaret Dick Tocknell, for HealthLeaders Media, June 16, 2011

Howard, Dhan Shapurji, and Gregory Scott, a director and a principal, respectively, at Deloitte Consulting spoke during an AHIP session that addressed the key operational challenges and potential solutions posed by the HIX.

Gregory Scott said the HIX offers health plans the opportunity to really think at the individual level. "That's very different from how health plans work today."

He added that the HIX will also allow health plans to develop data for individuals that can be leveraged for other products. "Tracking, reporting, and capturing data for this market will be expensive, so health plans will need to look at how the data can be used elsewhere."

Scott told the gathered insurance professionals at the AHIP conference that health plans should expect HIX customers to be more engaged in the coverage and health plan they select. "Quality ratings haven't been very important for health plans because it's really the physician network and pharmacy benefits that drive health plan selection." But he cautioned that with the advent of health insurance exchanges "health plans need to consider that quality ratings could become market movers.

Shapurji recommended that health plans work with the states to make sure they have access to any information that the exchange collects on potential customers. "You'll want to know what customers looked at you plan and if they didn't select your plan then you'll want to know which of your competitors got the business."

Scott noted that for a number of reasons states aren't picking up as much of the cost of the HIX as health plans had hoped. "States having financial problems and setting on a health insurance exchange isn't among their core competencies."


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