Facilitating Informed Consumer Health Plan Choices: Web- - PowerPoint PPT Presentation

Facilitating Informed Consumer Health Plan Choices: Web- Broker/Technology Companies Peter Nakahata Principal, PTN Consulting Group, LLC

Background on Web-Broker Channel  Web-based health insurance brokers operate private online health insurance marketplaces - examples include: eHealth, GoHealth, Getinsured, Stride Health, Gravie, etc.)  Marketplace roles:  Direct to consumer  Enrollment platforms for agents/brokers  Consumer shopping platforms for some health insurance carriers  Consumer shopping platform for some state-based Exchanges  Web- brokers sign CMS WBE agreement; use ”Direct Enrollment”, through which consumers can start on a web-broker website and enroll in ACA coverage (FFE/SPE states only)  This session will cover examples of consumer decision support tools used by web-brokers  Also will touch on Enhanced Direct Enrollment and implications for WBEs and their role in the FFE and SPE marketplaces

Web-Broker Consumer Tools  Web-broker consumer decision support tools are intended assist consumers in focusing health plan choices to those that might best meet their needs  Consumer Inputs:  Physician/provider input  Prescription drug input  Expected utilization (extent of customization varies)  In some cases, network type broad (PPO) vs limited (HMO)  Recommendation Outputs:  Estimated cost to consumer (monthly premium plus out-of-pocket cost or ordering of plans based upon scoring system)  Indication of in- network participation of consumer’s identified provider  Indication of coverage of drug identified by consumer  In some states, plan quality rating metrics

Example 1 – GetInsured Private Exchange – Consumer Inputs

Example 1 – GetInsured Private Exchange – Personalized Plan Score

Example 2 – Stride Health – Condition Input

Example 2 – Stride Health – Plan Recommendations

Example 2 – Stride Health – Drill Down on Recommended Plan OOPC

Example 2 – Stride Health – Road Test Feature

Impact of Enhanced Direct Enrollment for FFE/SPE States  Direct enrollment consumer experience has been challenging due to multiple redirects between web-broker site and Healthcare.gov.  PY 2018 – CMS permitted approved WBEs to complete ACA application and select a plan all on the WBE’s website using new direct enrollment ”proxy” pathway.  PY 2019 - CMS will make available suite of back-end web-services (Enhanced Direct Enrollment); replaces “proxy” approach, providing full single -site experience .  WBEs will be able to provide a broad range of consumer-facing exchange functions (application, plan selection, consumer status, coverage maintenance, notice and document upload/download, etc.)  Web- brokers will be able to extend the Marketplace’s reach and take some of load off Healthcare.gov, particularly during peak Open Enrollment periods.  May increase use of web-broker consumer decision support tools if their platforms take on a greater role in serving as a front-end for the Marketplace.

Questions? Contact Information: Peter Nakahata Principal PTN Consulting Group, LLC pete@ptn-consulting.com 714.369.8894