A study produced by the Deloitte Center for Health Solutions compared people who obtained insurance through an exchange with those who have it through their employer or Medicare or Medicaid. It found that HIX enrollees better understand their benefits and costs and are more likely to compare providers and services on price and, to some extent, quality. They also are willing to switch plans, thrusting carriers into a new arena of having to continually win over this segment based on price, product and service.
“The signal here is that the exchanges are not only attracting more individual purchasers into the system, but people who may be bringing a shopper’s mindset,” says Greg Scott, principal, Deloitte Consulting LLP, and vice chairman and national sector leader for the health plans practice. “This could be another force that pushes health care to a more customer-centric model, one that runs on information, transparency, customer service and disruptive delivery models.”
The report found that 51 percent of the HIX individuals surveyed used an online tool to compare and negotiate prices among doctors and hospitals, versus 45 percent for those with employer-based coverage and 36 percent for those on Medicare. Similarly, 63 percent of respondents used an online tool to determine how much their plan would pay for services, versus 53 and 51 percent for the employer and Medicare respondents, respectively.
When it comes to the possibility of switching plans, only 30 percent of the HIX respondents are satisfied with their current product, compared to 42 percent for those on an employer plan and 58 percent for those on Medicare. Among those who had HIX coverage in 2014 and renewed for 2015, 45 percent switched to a new plan. This includes 29 percent who chose a new option within the same company and 16 percent who went with a new carrier.
The report also found that consumers don’t have strong trust in any one source of help in finding a plan, but that the exchanges rated about as well any of the 11 sources measured by the survey, including family and friends, providers and consumer organizations.
“The ACA individual market is still a new phenomenon that is up for grabs,” says Paul Lambdin, director, Deloitte Consulting LLP, and exchange practice leader for the plans sector. “Loyalty is not locked in like it is in other industries – there could be a significant opportunity for traditional players and new entrants to seize market share by listening to what consumers say about product, price and service.”
What the HIX population is saying about out-of-pocket costs could be a start. Thirty-four percent of those respondents covered in 2014 expressed difficulty paying these fees. Money concerns also led 16 percent to skip seeing a doctor when sick or injured, slightly higher than for those with employer plans and double the rate reported by the Medicare enrollees.
At the same time, the exchanges seem to be improving access and making inroads into preventative care. Nearly two-thirds of the HIX respondents say they used their plans to seek services and purchase medication with nearly 75 percent of those saying they may not have been able to afford it without their coverage. Regarding preventative care, 76 percent have a professional they consider to be a primary care provider – twice the rate of the uninsured – and nearly 60 percent report visiting a doctor for a well visit in the past year, similar to people covered by their employers.
“One way to bend the cost and quality curves is to shift the health system to more of a wellness model versus waiting to treat people after something bad happens,” says Scott. “It’s simple in concept yet difficult in practice. How do you change human behavior? It will be interesting to see if exchange products and coverage can help move this concept forward.”
The report presents several implications for insurers and the exchanges. Plans could attract new customers and reduce turnover by focusing on benefit-price tradeoffs and tailoring products to consumers’ differing coverage preferences. Exchange customers may be especially receptive to benefit structures that incorporate incentives and tools for pursuing healthier lifestyles and chronic care management.
Exchanges and plans should also consider using both online and personal methods for engaging consumers, as a substantial number still value phone and face-to-face conversations in picking a plan.
“I think for year three of open enrollment we’ll see carriers get more personalized and creative in how they appeal to targeted segments of consumers who show signs of becoming discriminating shoppers,” says Lambdin. “Insurers in the last two years have been building up their capability to think and act more like a retailer, so we will likely see more tangible examples of execution in the marketplace.”
