In the wake of the Affordable Care Act, brokers have been seeking new strategies to meet the complicated challenges of reform. The good news is that, for now, the U.S. government has pushed back the deadline for the employer mandate to 2015, and will not penalize businesses that fail to provide health insurance next year. This gives brokers more time to hone their expertise.
In the case of private exchanges, brokers should expect to take on a more consultative role. The way exchanges work, employers give employees money to purchase coverage, and the employee then picks a coverage level and insurance network based on health needs, employer contribution, provider network participation and risk tolerance.
As navigators, expertly guiding clients in purchasing a plan that is right for them, brokers should consider offering private exchange solutions that can meet consumer demand for convenient, streamlined information and access. Specifically, they should look for a technology solution that offers these five critical features:
1.) A Single Platform
A single technology platform should have the power to accommodate various technology applications and products, integrating data from the sponsoring health plan, pharmacy benefit manager (PBM), or other source into a single member-centric data set that is accessible to multiple software solution sets.
It should include ETL services, analytics, embedded security, scalability and configurability. It should also support national health insurance plans, as well as regional providers and payers, pharmacy claim data from every major PBM, daily processing of every plan member, and all major drug compendia.
2.) Mobile Technology
Mobile technology enables health plans and PBMs to interact with members and providers anywhere they have their mobile phones – whether it’s at the point-of-care, pharmacy or home — and at any time of the day. The best mobile application suite offers a completely configurable approach to placing mobile decision-support tools in the hands of members and patients:
- Medication history and drug look-up
- Drug savings calculations
- Plan benefit options
- Symptom checkers
- Provider and pharmacy network locators
- Personalized messages
- Biometric trackers
- Physician office visit preparation application
Furthermore, a mobile platform can enable employers to offer more insurance options, simplify the enrollment process, engage health plan members, improve compliance and help employees gain the greatest possible benefit from their healthcare services. New mobile technology tools that offer user-friendly enrollment systems allow individuals to learn the details of their health coverage, submit reimbursement forms and find insurance information.
With access to health data, health plans can empower members to make better, more well informed choices that can increase prescription drug adherence, reduce costs associated with emergency care, and improve the overall quality of healthcare. Apps can also serve as decision-support tools for healthcare providers and PBMs, allowing them to quickly suggest additional prescription drug purchasing channels, such as mail order and retail discount options.
Latest posts by Robert Oscar (see all)
- Five Key Technologies for Leveraging Private Exchanges - July 15, 2016