The individual health insurance market is at a pivotal moment.
With many carriers losing hundreds of millions of dollars covering the previously uninsured, many insurance companies are making strategic decisions. From the biggest carrier in the country—UnitedHealthcare—to state-focused plans like BlueCross BlueShield of Tennessee, insurers are limiting their participation on the exchanges and in the individual market as a whole.
These decisions don’t just affect consumers. They also affect hospitals, and the gutting of broker commissions for individual enrollment stands to particularly hit hospitals’ bottom lines.
That’s why hospital executives—CEOs, CFOs, and system-wide leaders—cannot rely on brokers to make sure the individuals in your communities are covered.
BlueCross BlueShield of Tennessee recently made headlines for its decision to cut marketplace plans in the state’s three largest regions. In the 30 counties that surround Memphis, Nashville and Knoxville, individual consumers will no longer have access to BlueCross coverage.
But even in the regions where BlueCross exchange coverage will continue, brokers will no longer receive commissions to sign new marketplace enrollees up for coverage. This means that in many communities across the state, brokers cannot afford to spend the time and expend the expertise necessary to help individuals obtain coverage.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
And there is no indication that this is solely a Tennessee problem, either. Could BlueCross BlueShield of Tennessee’s decision be predictive of other Blues plans across the country? In communities with no insurer commissions for individual coverage, what will happen to the hospitals?
Hospitals executives are faced with a choice—risk their facility’s payer mix, or be proactive.
Here are a couple of steps hospital executives might take preemptively.
Reach out to local agencies
The first thing hospital and system executives should do is contact the existing local brokerages and establish whether they plan to continue helping individual clients.
Many of these agencies are going to be tempted to exit the individual line of business. This is where the market is pushing them—most brokerages do not have specific individual segments, and with no revenue to help individuals, many brokers will choose to focus on their employer clients. Hospital leaders should inquire of the brokers in their communities with local healthcare expertise to evaluate the landscape.
Contact the broker for your hospital’s own plan
If the hospital has a group broker, hospital executives should encourage them to support individual clients. Hospitals are often a large client for the broker who serves them, and so that broker will want to try to help in any way his or her agency can do so.
Explore other options
With or without broker buy-in, hospitals can explore insurance advising options internally. There are a few approaches hospital leaders can take.
First, hospital executives can have existing employees become certified application counselors (CACs). CACs can help patients sign up on Healthcare.gov and apply for subsidies, but are not able to recommend plans. Investing in Medicaid eligibility advisors could also be useful, though it ignores the population of potentially commercially-insured patients.
Another option is having employees or third-parties licensed to advise patients on health plans, including coverage comparisons and recommendations.
Hospital executives can work with vendors that provide these enrollment services to patients or individuals in the community.
Regardless of which path hospital executives decide to take, leaders should move quickly–open enrollment is almost here.
Photo: liuzishan, Getty Images
