HealthPlan Services Blog

Private Exchanges and Affinity Groups—the Value Proposition

Posted on May 2, 2013 by David Holton

David Holton - Vice President Consumer Sales

The attraction to any affinity group—whether professional, social or political in nature—is directly proportional to shared interests and the value members are able to glean from their association. That’s why the mission of these organizations is to deliver programs, services and resources that benefit members in a tangible way to build loyalty and increase brand visibility.

As the healthcare landscape continues to evolve into a more consumer-driven model, the ability of affinity groups to provide access to healthcare as a value-added benefit will become increasingly advantageous. Navigating the current and future healthcare landscape can be overwhelming for the average consumer seeking Medicare options, private health plans and other insurance products.

To address this need, many groups are moving to a consumer-driven private exchange model, where members can quickly and easily access a tailored menu of insurance products to shop, compare and ultimately purchase their insurance benefits. Private exchanges have been introduced into the marketplace as a flexible alternative to traditional health plan models, allowing offerings to be customized to fit the needs of a particular group.

The value proposition of private exchange/marketplaces for affinity groups is high; member groups are able to offer alternative health insurance options to its members while, at the same time, increasing value and loyalty to the group. Provided through a private link on an organization’s website, these customized private exchange/marketplaces can be set up where the members can simply research and purchase from a menu of offerings on their own time and at their own price they choose. And while the choice for a private exchange/marketplace offering should be an easy one, many affinity groups will not be able to dedicate the resources needed get this kind of initiative off the ground and maintain it for the long haul.

Affinity groups will need to leverage the know-how of an experienced partner in this process. Recognizing this need, HealthPlan Services℠ has developed, MyConsumerLink℠, a comprehensive turn-key offering to address the complexities involved in setting up customized private exchange/ marketplaces. From front-end licensed sales professionals and call center support to the technological infrastructure required for back-end processes, the heavy lifting is already done.

Our experts simply work with affinity groups to design an offering that makes sense for their membership by allowing them access to a platform of fully-vetted Quality Health Plans, as well as dental, vision, life, Medicare advantage, PDP, Medicare supplement and other supplemental products. As members access the exchange through a private link on the group’s website, skilled sales professionals take it from there. As partners in this process, the MyConsumerLink business model also allows avenues for affinity groups to generate additional revenue.

Click here for more information on MyConsumerLink or call 877-504-2164.

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Posted in health insurance, healthcare reform, insurance, insurance exchange, Private Exchange | Leave a comment

Taking a Seat at the Private Exchange Table

Posted on April 25, 2013 by Jay Mclauchlin

Jay Mclauchlin

The introduction of private exchanges as a new alternative in the marketplace offers a unique opportunity for agents to position themselves competitively for the future. In the wake of uncertainties and fears over how public exchanges will impact customer base and revenue streams, agents should consider how to leverage a private exchange offering to their best advantage.

Currently, employers of all shapes and sizes are looking for solutions through this new business model. It’s no wonder since industry projections suggest that by 2020, exchanges will be the main channel for purchasing health insurance for as many as 30-46 million people. As employers continue to face annual double-digit rate increases from carriers, many are moving towards offering a “defined contribution” as opposed to a “defined benefit” health plan. Under this scenario, employees would be given a set dollar amount and with a private exchange vehicle, choose health coverage that best fits their circumstance. Agents proactively working to develop private exchange capabilities should view this as a huge emerging-market opportunity.

The reality is that agents play a key consultative role in the sales process, and there is no reason why new market conditions should diminish or minimize this role. Who knows the consumer better than the agent, and who is better equipped to design and communicate the value of an exchange to employers or a particular demographic?

Agents with limited resources may be overwhelmed by the prospect of trying to establish a private exchange that can truly compete against larger players. And the reality is that most may not be equipped to offer the technological infrastructure, sales support and advanced consumer tools that will be needed to be successful.

That’s why agents will need a partner in this process. HealthPlan Services℠ has already identified the need for comprehensive turn-key offerings to address the complexities involved in setting up a private exchange. Our new MyConsumerLink℠ is a fully customizable private exchange that offers agents access to a full suite of top-name products, front-end sales and call center support as well as the technological infrastructure required to help agents successfully compete in this important market.

By leveraging a third-party private exchange infrastructure, like MyConsumerLink.com, agents are able to take advantage of HealthPlan Services established relationship with a variety of strong carriers and develop a flexible exchange that will display products that make the most sense for their customers. A unique web-based offering is created with the agent in mind, clearly defining the private exchange as a value-added service to clients and providing a method for establishing loyalty. As important, HealthPlan Services’ signature sales and call center support is always there as a back-up—to answer questions, provided guidance and help close the sale.

Private Exchanges offer inherent advantages to agents who desire to stay competitive, and the complexities of getting one off the ground should not be a deterrent for maintaining future viability. Agents who leverage the inherent advantages of MyConsumerLink℠ offering can expect to improve their business outlook and lay a foundation for future success in the market.

Learn how MyConsumerLink can give you a competitive private medical insurance exchange solution.
Click or call 877-506-2164.

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Posted in healthcare reform, insurance exchange, ObamaCare, Private Exchange | Leave a comment

With less than 221 Days to Go, Procrastination over Exchanges Must End

Posted on February 21, 2013 by Dennis Prysner

Dennis Prysner

With open enrollment in state and federal insurance exchanges slated to begin Oct. 1, carriers that remained mired in the strategic planning stage are headed into dangerous territory. Unless they move quickly into the execution phase, it is highly unlikely that they will meet the timelines for Qualified Health Plan (QHP) submission and approval and interface testing for each exchange they have targeted for participation.

After two years of wrangling and uncertainty culminating in a Supreme Court decision and presidential election, the clock has run down to less than 221 days. It’s not going to stop until the exchanges open. Whether or not a carrier is ready depends entirely on how quickly they can get their technologies, plans and processes in place.

The best option now for carriers that do not want to stand by and let the first open enrollment period go by without their plans in the mix is to outsource execution of exchange readiness plans to a qualified partner—one that didn’t wait for the dust to settle before putting solutions in place that will accelerate entry into state and federal exchanges.

Going it alone means carriers have a very short window of time to build out their technical infrastructures, secure QHP approval, and deploy the processes required to connect, recruit, manage and retain customers acquired through state and federal exchanges. On the other hand, an experienced outsourcing partner can speed deployment and reduce costs by eliminating the barriers to entry with “plug-and-play” solutions that address the comprehensive administrative and technical requirements of multiple exchanges.

Carriers need a partner with a scalable, powerful platform that integrates seamlessly with state and federal exchanges. It should be an end-to-end solution that combines well-established technology and business processes with industry best practices and advanced web-based technologies. Prospective partners should also have in place relationships that ensure its services can scale appropriately in response to expected demand fluctuations in the early days of open enrollment.

The time for planning has passed. Carriers that aren’t yet executing their exchange strategies risk losing the substantial investments they’ve already, made as well as future profits from what is expected to be a very lucrative market. Teaming up with the right outsourcing partner ensures that exchange programs are done right the first time, even at this late date.

Contact us today to leverage the expertise of HealthPlan Services’ Go-To-Exchange solution, or to find out more about how we can help ramp up and administer a profitable exchange for your business.

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Posted in health insurance, healthcare reform, insurance, insurance exchange, ObamaCare, Private Exchange, state exchange, state insurance exchange | Leave a comment

Post-Election, State Insurance Exchange Planning Must Accelerate

Posted on November 15, 2012 by Jeff Bak

Jeff Bak

The outcome of the 2012 presidential election eliminated many of the immediate uncertainties surrounding implementation of the Patient Protection and Affordable Care Act (ACA)– and the state health insurance exchanges that are integral to expanding access to coverage under the law. For HealthPlan Services (HPS), President Obama’s victory and the Democrat’s retention of Senate control means the gamble we took pushing forward with an exchange solution, despite nagging industry uncertainty, will ultimately pay off for our clients.

Exchange deadlines are rapidly approaching. Carriers are under enormous pressure to build the technical infrastructures and put in place the administrative processes necessary connect, recruit, manage and retain customers acquired through state exchanges.

While other organizations waited in the wings, HPS focused on eliminating barriers to entry into the potentially lucrative exchange market. We deployed our IT resources and industry expertise to create a toolset and playbook that allows carriers to quickly ramp up state exchange operations. The end result is our Go-To-Exchange™ strategy, an innovative platform that provides comprehensive management of the administrative and technical needs of health plans participating in state exchanges, speeding deployment and reducing costs.

The Go-To-Exchange technology framework provides carriers with an end-to-end solution that combines proven technology and business processes. It leverages industry best practices and advanced web-based technologies to deliver a scalable, powerful platform that integrates seamlessly with state exchanges and provides comprehensive management of health plans’ administrative and technical needs.

But we didn’t stop there. We also have established relationships with other strategic partners that, if needed, will help ensure rapid ramp-up and response to the sharp volume fluctuations many anticipate when exchanges open on October 1, 2013.

By working with a qualified partner like HPS, even those carriers that have delayed exchange planning won’t be left on the sidelines. Our Go-To-Exchange strategy lets them launch quickly, effectively and compliantly—regardless of how many states they have targeted for exchange participation.

Posted in health insurance, Healthcare, healthcare reform, insurance exchange, ObamaCare, Reform Rebate, state exchange | Leave a comment

The Private Exchange Myth: They’re Not Just for Insurance Companies

Posted on October 30, 2012 by David Holton

David Holton - Vice President Consumer Sales

It’s time to bust a myth: Insurance companies aren’t the only ones that can benefit from private insurance exchanges and the growth in consumerism.

Large firms, employers, professional associations and affinity groups can all stake a claim in the private exchange market by “private labeling” online portals to sell off-exchange health plans containing the new Essential Health Benefits (EHBs), as well as Medicare and ancillary products.

The secret to success is teaming up with a partner that offers a truly turnkey solution focused on providing an exceptional customer experience.

Designed to engage consumers in coverage decisions, private exchanges are the ideal channel for increasing loyalty as a leading-edge retention strategy. They are essentially online retail outlets that have outgrown the sterile confines of the insurance industry. Private exchanges allow shoppers to browse, seek guidance, compare costs and benefits and ultimately purchase medical, Medicare, dental and vision plans, as well as ancillary options and advanced benefits, online from organizations with which they have established trusted relationships.

The challenges have always been the high cost of establishing private exchanges, as well as the requisite carrier relationships, technical infrastructure and deep administrative capabilities to manage education, enrollment and underwriting and ongoing customer support. Today, those barriers are being eliminated by a small but growing number of existing insurance portals that can be “re-skinned” and marketed under the employer’s, association’s or firm’s brand.

One example is benefit crossroads, a turnkey private exchange solution built upon HealthPlan Services’ proven technologies, data-driven customer acquisition and retention programs and robust “e-tail” style analytics.

For example, using the benefit crossroads Roadmap the employer, association or firm directs its employees or customers to a link on the organization’s website which takes them to the rebranded exchange site. Here, they can access a variety of plan types and styles as well as education and research tools for personalized guidance. The experience appears seamless to the user, who is connected to a powerful technical infrastructure, licensed and highly experienced agents and always-on customer support before, during and after enrollment.

It’s a level of service that would not otherwise be financially feasible for employers and associations.

The upfront costs of a private label exchange are minimal. The typical arrangement provides a landing page explaining the site and available coverage, various pages to provide independent lines of coverage options, quote engine, results page and enrollment application. In the case of benefit crossroads, it includes guided-selling features that provide examples of what peers have purchased and a comprehensive array of education, research and consulting tools to ensure a positive customer experience.

Partnering with benefit crossroads lets employers, associations and firms leverage the strength of their own brand to efficiently and affordably tap into the private exchange market while increasing revenues through strengthening employee/member loyalty.

Find out more about private exchanges with benefit crossroads!

Posted in health insurance, insurance, insurance exchange | Leave a comment

Reaching Seniors Aging into Medicare Coverage

Posted on August 6, 2012 by Anne Marie

Anne Maria Faria - Chief Marketing and Sales Officer

According to the U.S. Census Bureau, 35,000 baby boomers turn 65 every month —a number that is sending daily Medicare applications skyrocketing. Indeed, baby boomers and seniors are not only part of the fastest-growing population, they are also the most affluent consumer group, controlling more than 48% of all discretionary purchases.

Carriers have a unique opportunity to reach this growing and lucrative demographic – one that spends nearly $2 trillion on goods and services each year – as they age into Medicare. However, to do so effectively, they must update their marketing strategies and product lines to better serve seniors seeking Medicare coverage.

According to a recent study conducted by LIMRA, “Advisor Perspectives on Retirement Planning,” many advisors have already begun adjusting their approach to seniors entering retirement. Among the most common changes are introducing new products or services (44%), obtaining special training (32%), adding professional staff (21%), changing platform or practice models (15%) and launching new websites or making major additions to existing web pages (15%).

For carriers intent on reaching the Medicare market, the most impactful marketing strategy will be providing seniors with a single resource dedicated to helping them make the right insurance decisions for themselves and their families.

Medicare can be a complex and confusing process, particularly for seniors sorting through multiple options for the first time. Carriers seeking to reach this lucrative market should leverage the power of the eTail model by launching a web-based, direct-to-consumer sales channel that provides aging-in seniors with convenient access to the information, research tools and personalized guidance they need to select the right plan or plan combinations for their individual needs.

A prime example of this model is benefit crossroads. Its success lies in its ability to provide seniors with an easy way to educate themselves on Medicare. They can tap into the expertise of licensed and Medicare-certified experts who can help them identify specific plans to meet their exact needs and even enroll online.

In addition to robust, retail-style analytics, research, education and purchasing tools, benefit crossroads is backed by a team of licensed insurance agents who are available to consult with consumers, prepare customized packages and provide ongoing member support services. Agents are specially trained and AHIP-certified in Medicare and senior marketing to ensure customers receive the support they need in the manner they are comfortable receiving it. This consultative approach has been proven to increase customer satisfaction while resulting in a higher issue rate than market average.

But benefit crossroads goes beyond the technical requirements. It also provides its sales agents with “senior-specific” training to help all generations come together to achieve the common goal of meeting the customer’s needs.

Notes David Holton, vice president of customer sales for benefit crossroads: “For twenty- and thirty-something agents, it’s not always easy to relate to the needs of our senior customers. Therefore, we provide specialized training to help them better connect with the customer, understand what they are experiencing and offer them the best solutions possible.”

A unique branded-partnership opportunity, benefit crossroads is a turnkey, cost-effective solution for carriers seeking to launch a direct-to-consumer sales channel and maximize the revenue potential of the lucrative and growing senior market.

Visit benefit crossroads for further information.

Posted in Healthcare | 2 Comments

Supreme Court Ruling Creates New Urgency for Carrier Exchange Planning

Posted on July 5, 2012 by Jeff Bak

Jeff Bak

If you hoped that the Supreme Court would send ObamaCare packing, your dreams were dashed last week with its 5-4 ruling upholding the Patient Protection and Affordable Care Act (ACA). Now, that ticking sound you hear is the clock running down to the Oct. 1, 2013 launch of the state insurance exchanges created under the ACA—and the date by which carriers must have their exchange strategies in place and be compliant with the new QHP mandate.

For carriers that waited to begin preparations, all is not lost despite the fast-approaching deadline. HealthPlan Services took a chance on the fate of the ACA and dedicated our IT resources and expertise to creating a toolset and playbook that lets carriers quickly ramp up state exchange operations—taking the guesswork out of both planning and participation.

That gives our carrier clients a considerable advantage over the competition, because while the Supreme Court ruling lay to rest any uncertainty over the future of state insurance exchanges, it did not eliminate the challenges to participation. As we’ve noted in previous posts, there are four main issues confronting carriers in terms of exchange strategies: 1) varying operational models, 2) inconsistent technical interface capabilities, 3) management of multiple data interfaces, and 4) management of multiple entities.

The clock is ticking. Much work must be done if carriers are to have the QHPs (qualified health plans) and technical infrastructures in place when open enrollment launches in a mere 16 months.

A smart strategy…one that promises to simplify processes, speed deployment and reduce upfront and ongoing costs…is partnering with an outsourced service provider capable of streamlining the interfacing and information sharing. The best partner is one that can offer a “plug and play” solution to connecting with exchanges, and provide access to systems and processes designed to ease the burden of managing and complying with multiple reporting, billing and plan management requirements.

One such turnkey solution is HealthPlan Service’s Go-To-Exchange strategy, an innovative technology platform that provides comprehensive management of the administrative and technical needs of health plans participating in state exchanges. A critical technology component is ExchangeLink, which facilitates the technical connections necessary to link carriers to exchanges.

Go-To-Exchange and ExchangeLink leverage HPS’ active ongoing engagement with industry groups and state and federal agencies to stay informed on the technology needs required for exchange connections. They reflect the firm’s thought leadership around the complexities of exchange integration and QHP administration, which have positioned HPS as a leader in reform readiness.

By outsourcing to a qualified partner like HPS, carriers can ramp up exchange activities quickly and effectively, while keeping internal resources focused on core activities to maximize profitability.

Posted in ACA, ObamaCare | Tagged ACA, ObamaCare | Leave a comment

A Better Approach to the Individual & Medicare Markets

Posted on June 8, 2012 by Anne Marie

Anne Maria Faria - Chief Marketing and Sales Officer

Few will argue that healthcare reform has forced carriers to re-examine and restructure nearly every aspect of their business in order to remain profitable. But change isn’t always bad, as evidenced by the new opportunities reform has created in the individual and senior markets.

Private insurance exchanges are a prime example. They are an innovative way for carriers to not only break into the lucrative individual market, but also to compete cost-effectively with public insurance exchanges and reach the rapidly growing Medicare population.

The challenge is dedicating the human, financial and technical resources necessary to effectively and efficiently build, market and manage a private exchange—particularly for those carriers that do not already have a significant track record in the individual and Medicare markets. The solution is a trusted partner with a proven track record of administering every aspect of a direct-to-consumer sales channel.

The solution is benefit crossroads, an innovative turnkey approach to market that leverages HealthPlan Services’ 40-plus years of experience providing customized administration and distribution services to insurers of individual, small group, voluntary and association plans.

The benefit crossroads platform brings together HPS’ proven technologies, data-driven customer acquisition and retention programs and industry-leading customer support in a single online portal where consumers can self-select plan combinations – including a specialized Medicare and supplemental plan option – and complete enrollment online. In addition to robust, retail-style analytics, research, education and purchasing tools, benefit crossroads is backed by a team of licensed insurance agents who are available to consult with consumers, prepare customized packages and provide ongoing member support services.

The benefit crossroads platform offers carriers a unique branded-partnership opportunity to cost-effectively launch a direct-to-consumer sales channel and maximize the revenue potential of the lucrative and growing individual and senior markets. Consumers can research, compare, ask questions and purchase products that suit them personally in an environment best compared to a “retailistic” approach rather than that of an insurance related experience. Consumers find comfort and experience confidence in this approach.

By launching a rebranded benefit crossroads private exchange web solution, carriers are able to leverage HPS’ expertise and their own reputations for excellence to promote and cross-sell single or multiple products. It is a sales model that is particularly effective at reaching those seniors who are exploring Medicare for the first time and therefore require some additional attention to ensure they make the best informed decision based on their individual healthcare needs.

Most importantly, carriers can do all this rapidly and with the confidence that comes from partnering with an industry leader.

Visit benefit crossroads for further information.

Posted in health insurance, Healthcare, healthcare reform, individual insurance, insurance | Leave a comment

Four Main Challenges to Exchange Participation

Posted on May 2, 2012 by Dennis Prysner

Dennis Prysner

Carriers are finalizing their state insurance exchange strategy in preparation for the October 2013 date by which medical plans will be available for purchase through these initiatives. Many are finding themselves confronted with four challenges that are hampering their efforts to roll out programs in multiple states.

One of the most significant is the lack of consistency in the exchange models being deployed by individual states. HHS has suggested two federal-state partnership models. In one, states assume responsibility for managing participating health plans. In the other, states aid consumers in navigating the system. Four additional models have been identified by Deloitte: 1) information aggregator, 2) retail-oriented exchange, 3) guided exchange and 4) market curator.

The model ultimately deployed will dictate the level of responsibility that will fall upon participating carriers’ shoulders and, therefore, the capabilities and technical infrastructure that they must put in place. In fact, variance in exchange models is the underlying source of all the primary challenges carriers face when preparing for exchanges.

For example, each model will require carriers to provide different interface capabilities. In the first model recommended by HHS, the state assumes responsibility for managing plan selection, collection and analysis of rate and benefit information and for collecting and reporting plan performance data—responsibilities that will likely be transferred to the carrier as part of the state’s price of admission.

These interfaces must also be capable of overcoming another common challenge: meeting the technical and information needs of multiple entities. This requires carriers to establish not only the interfaces but also the internal technical infrastructures and business processes to ensure that required information is properly and compliantly exchanged with all entities. These include federal and state exchanges, state departments of insurance, employers, reinsurers and consumers.

Finally, carriers must be able to step in and fill in any functionality gaps that the state exchange is not equipped to offer. These may include premium and claims administration, document fulfillment and retention and cross-selling activities. These are typically highly specialized processes and programs that are most effective when leveraging advanced technologies and proven business processes.

Over the next few weeks, we will take a closer look at each of these exchange challenges. We’ll break down their underlying causes and offer solid solutions for overcoming them so carriers can successfully tap into this potentially lucrative market—and maximize the return on their investment.

Posted in health insurance, Healthcare, state exchange, state insurance exchange | Leave a comment

Outsourcing as an Insurance Exchange Strategy

Posted on March 20, 2012 by Dennis Prysner

Dennis Prysner

The race is on for carriers planning to participate in state insurance exchanges. Under interim final rules issued by the Department of Health and Human Services (HHS) March 12th, states will be allowed the flexibility on how many key provisions of the law are implemented, and at the same time, if they wish to operate their own exchanges, they must “demonstrate complete readiness” by Jan. 1, 2013.

This means carriers must also be ready to respond and be far enough along in their exchange planning to satisfy any requirements states may set – as well as to meet the October 2013 enrollment launch date—or risk being excluded from the exchange. This includes:

Designing and securing certification of exchange-specific Qualified Health Plans that meet the Actuarial Value and provide all Essential Health Benefit (EHB), the details of which will not be finalized until September of this year
Establishing physical connections to each state exchange to publish plan and rate information and manage enrollment and benefits, which for carriers operating in multiple jurisdictions could mean implementing scores of different technical interfaces
Designing business processes to administer exchange plans, including the ability to calculate subsidy levels and out-of-pocket limits and bill multiple sources for premium payments

Clearly, participating in state exchanges, while potentially advantageous, is resource intensive and requires a fundamentally different approach to administration. That is why outsourcing to experts is gaining favor as one of the best, most cost-effective strategies for accomplishing all the heavy lifting that goes into state exchange programs.

Partnering with an experienced outsourced provider to handle the infrastructure and administration allows carriers to focus internal resources on core competencies. Carriers can focus on plan design and certification while their partner focuses on establishing the technical gateways and administrative business s operations. This includes ensuring the interface with each exchange meets the technical specifications, data collection, reporting and communication requirements of each state.

Outsourcing also enables carriers to tap into a depth of expertise that is often not available internally. It allows them to leverage their partner’s experience administering individual plans, as well as Medicare and Medicaid, to meet the unique needs of exchange participants.

For example, the members purchasing insurance through exchanges will typically be eligible for varying levels of subsidies, which will necessitate flexibility in premium billing, payment processes, and reconciliations. Many of these members will also be new to the individual insurance market and will require a higher level of customer support than most carriers are accustomed to providing.

Experienced outsourcing partners can provide transparent plan administration which enables carriers to reap the rewards of exchange participation without diverting valuable resources away from other profitable business lines. They can also implement strategies designed to maximum the investment into state exchanges, such as analytics-driven marketing, retention and cross-selling programs.

Time is short for carriers to finalize their exchange readiness programs, even for those who recognize the distinct advantages offered by outsourcing some or all of their needs. Resources are limited, and carriers that wait too long to establish key relationships could find themselves standing on the exchange sidelines.

Posted in Healthcare, insurance, insurance exchange | Tagged healthcare, insurance, insurance exchange | 1 Comment

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