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Plans Confident They Can Handle Exchanges

Plans Confident They Can Handle Exchanges

Frank Diamond

Stories about underdogs (David and Goliath, Rocky, the 1969 Mets, the 2008 Barack Obama) are as much about overconfidence as they are about confidence. Yes, the challenger is scrappy. The favorite, on the other hand, needs just enough hubris to make his or her downfall ensure that the lesson resonates with every would-be David and Goliath — and in its entirety because we all have a little of each in us.

Many insurers want to participate in health benefit exchanges, one of the bedrocks of the Affordable Care Act. We’ve been following this at Managed Care. See, for example, here (http://tinyurl.com/Carroll-Exchanges), here (http://tinyurl.com/gov-exchanges), and here (http://tinyurl.com/vision-exchanges).

Of course, in the exchanges, insurers won’t face just one antagonist but a whole marketplace full. It might be enough to give them pause and, in fact, it may have. They’re still confident, though, according to a recent survey by KPMG, the audit, tax, and consulting company. Take a look:

Assuming your organization’s participation, how confident are you in your management’s ability to successfully participate in an exchange?

Option Number of organizations Percent
Not at all confident 3 3%
Somewhat confident 20 22%
Confident 39 42%
Very confident 15 16%
Not applicable 16 17%

I suppose that’s the attitude an organization needs when it’s about to step into the unknown. Perhaps it’s because they feel they have implementation under control.

By when do you expect your organization to start marketing and delivering products that are consumer-focused?

We are doing this now 37%
Within 6 to 12 months 33%
Over 1 year from now 0
Don’t know 10%
Not applicable 21%

As KPMG notes, success will mean “transforming their marketing efforts from a business-to-business focus to a business-to-customer focus.” That’s not the only concern and while insurers — and about two thirds of KPMG respondents are commercial health plans — may be confident, they’re not blind to the challenges.

What is the biggest challenge in building out a customer-centric organization?

Culture 10%
People/skill set 7%
Technology 17%
Senior level buy-in 2%
Budget 3%
All of the above 58%
None of the above 3%

That 58 percent say “all of the above” to this question might signal, again, the level of effort and focus being displayed. Or, to a more skeptical viewer, it might — just might — suggest that organizations are scurrying about in a bit of a panic. Please, weigh in.

Frank Diamond, Managing Editor