Aetna, Humana and UnitedHealth are not the only payers shifting their strategy and brand image from claims processor to wellness coach.
Four forces are pushing some states to take their Medicaid programs through a similar transformation.
Mary Scanlon of Xerox’s Government Healthcare Solutions reviews all the RFPs that come in from states planning to launch health insurance exchanges.
She said that Medicaid is becoming the platform for reform.
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“I believe it will be transformational in providing a new market,” she said. “Now that the election is behind us, the states will have to pick a model for their exchanges: state-based or federal or a hybrid, where states are using the federal portal but doing their own consumer outreach and plan recommendations.”
As senior vice president of business development, her customers are the Medicaid directors in all 50 states. She said recent requests from Washington and Kentucky have recently asked for a hybrid model.
Scanlon listed these four forces as the ones pushing officials to take a new approach:
- Medicaid expansion
- Health insurance exchanges
- Emergence of a new health care consumer
- A bigger push on innovation
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Xerox’s development work has been around plan selection tools, member outreach, and the navigator function that helps people pick the right plan.
“From what I’ve seen, some states are looking for simple solutions but others looking for the opportunity to fully modernize their eligibility system,” she said.
She named Nevada as a state focused on delivery and innovation. She also said Xerox has been working with Choice Administrators to learn from that company’s experience in building private exchanges.
Scanlon said that the scale of these projects has prevented most startups from working in this area at least for now.
“Once the first phase of exchanges goes out, we’ll see smaller companies addressing different components of it that have not been considered yet,” she said.