SLIDE 1
Peter Nakahata Principal, PTN Consulting Group, LLC
Facilitating Informed Consumer Health Plan Choices: Web- Broker/Technology Companies
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- 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
Background on Web-Broker Channel
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- 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
Web-Broker Consumer Tools
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Example 1 – GetInsured Private Exchange – Consumer Inputs
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Example 1 – GetInsured Private Exchange – Personalized Plan Score
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Example 2 – Stride Health – Condition Input
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Example 2 – Stride Health – Plan Recommendations
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Example 2 – Stride Health – Drill Down on Recommended Plan OOPC
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Example 2 – Stride Health – Road Test Feature
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- 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
- n a greater role in serving as a front-end for the Marketplace.
Impact of Enhanced Direct Enrollment for FFE/SPE States
SLIDE 11
Contact Information:
Peter Nakahata Principal PTN Consulting Group, LLC pete@ptn-consulting.com 714.369.8894
Questions?
