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February 2013 St@teside

Taking a Strategic Approach to Plan Management

State Network recently released a report and hosted a webinar to help states take a strategic approach to managing relationships with issuers and shaping the characteristics of plans that are sold on the insurance exchanges. While some have made “negotiating” with plans a political issue, leaders from Wakely Consulting argue that building strong relationships and fostering clear communication can help exchanges achieve a range of goals, including:
  • Maximizing carrier participation;
  • Maximizing total enrollment;
  • Focusing on enrolling lower income uninsured;
  • Providing exceptional customer service;
  • Controlling costs and minimizing premium trend;
  • Achieving financial self-sustainability;
  • Reforming payment and delivery systems; and,
  • Attracting targeted issuers (Medicaid MCOs). 

The Wakely report, “A Strategic Approach for Insurance Exchanges to Select and Manage Qualified Health Plans,” outlines a step-by-step process from a preparation stage that includes goal setting and initial communication with plans to procurement to the final contract process.
The State Network webinar also featured Donna Frescatore, the executive director of the New York Health Benefit Exchange, who was able to comment on New York’s process and goals leading to their recently released invitation to issuers. Ms. Frescatore talked about the collaborative process used in New York and discussed how their invitation reflected the following objectives:
  • Ensure adequate plan participation and reasonable level of competition;
  • Ensure exchange coverage is available in all areas of the state;
  • Make it easy for consumers to compare options;
  • Balance health plan innovation with reasonable consumer choice;
  • Ensure consistency with the insurance market outside the Exchange;
  • Ensure reasonableness of QHP premium rates;
  • Ensure QHPs have adequate networks;
  • Monitor QHP quality, utilization and consumer satisfaction;
  • Monitor financial performance of QHPs; and
  • Ensure high quality customer service.