Payors Rushing to Size Up HIE Enrollees

According to an article published in the Wall Street Journal (WSJ), payors are clamoring to get the data on the four million people who federal regulators say have signed up so far for coverage in the health insurance exchanges (HIEs). Despite the prediction that a majority of the new patient population will be young and relatively healthy, payors suspect that details released so far aren’t enough to determine a full risk evaluation. New enrollees don’t have to disclose pre-existing conditions under the Patient Protection and Affordable Care Act (ACA), and this may skew the risk assessment for payors. The young people who sign up may be those more likely to have serious medical needs, insurance-industry officials say.

So payors aren’t wasting any time. Unlike health care providers, who are left to wait for the demographic data to be reported by CMS, insurers are reaching out—calling, emailing and writing letters to HIE enrollees, to encourage them to divulge their medical histories, prescription medication usage and even personal habits.

“Day one, we’re starting to take a look at these individuals,” said Betsy LaForge, an executive at Blue Cross & Blue Shield of North Carolina, reported the WSJ. They are even offering new enrollees $50 gift cards if they fill out the assessments. The information gathered from new patients will help insurance companies determine pricing for the coming year, help them assess the possibility of profiting from the new health care law, and ultimately, help them decide whether or not they will continue participating as providers in the health insurance exchanges.

The new health law does offer financial assistance to those insurers who take on the nation’s less than healthy patient populations, but there are requirements for payors to make accurate assessments of the patients and keep accurate documentation of their diagnoses. The onus is on the payor at that point, to take that information and get us to the next level in reducing health care costs—to use that patient’s diagnostic information proactively to contact patients and get them on the right path to wellness.

For example, Florida Blue, according to the article, will identify patients with chronic diseases that require long-term treatment, such as Diabetes, and encourage them to see a physician regularly and/ or offer them incentives or discounts on diet plans. Florida Blue will also track those patients, and if they are not getting the tests and using the medications indicated to treat their chronic conditions, it might call the patient directly.