Demand and Consolidation
The Federally Facilitated Marketplace has outpaced the state-based exchanges, by stabilizing their technical operations and carrier interfaces leveraging stable Federal funding. It takes money for states to stabilize and as of Jan 1, 2015 state-based exchanges must be fully sustainable. Previously issued federal funding for Planning, Level I, Level II, and Early Innovator grants has come to an end. States could have requested “No-Cost Extensions” to extend an exchange project beyond the first year of operations (Dec 31, 2014) but this doesn’t include costs for on-going maintenance and operations. The affect is state-based and partnership exchanges are consolidating to meet funding restrictions, but not resetting consumer expectations. This expectations realignment needs to take into account the new depressed funding levels, especially as reduced funding impacts call center response times or the resolution for escalated issues like outstanding QHP and Medicaid verifications which are excessively backlogged in many states. The root causes are typically technology problems with operational symptoms that take skilled resources and the associated funding to remedy.
Journey to Customer Bliss
There are five major functions for an exchange to be successful that include: customer service, a seamless shopping experience (eligibility and enrollment), carrier integrations, plan management and financial management. As federal funding for states ended, states must get creative on how they support these essential functions. We have already seen shutdowns as in the case of Hawaii or heavy layoffs as experienced with the Oregon and Illinois exchanges. Effective and efficient exchange capabilities are important to enable consumers to enroll and establish healthcare coverage. When these capabilities are effectively orchestrated, it’s like listening to Pachelbel’s Canon in D, providing a seamless customer experience. When they are not effectively orchestrated, it’s akin to trying to get the attention of the neighbor’s kid, asking for the stereo to be turned down. You call which feels good, but the effort actually produces no results. Consumers need new expectations.
The Good Stuff
The good news is the customer experience on the Federally Facilitated Marketplace has dramatically changed for the better. The single solution for future sustainability is unclear, but what is clear is the need for an evolution towards shared state services, increased adoption of cloud capacity for scalability and cost containment, and creative leadership approaches for managing the increasing administrative requirements.
References
NY Times. (2015). The Health Care Supreme Court Case: Who Would Be Affected? (Online Image). Retrieved July 30, 2015, from http://www.nytimes.com/interactive/2015/03/03/us/potential-impact-of-the-supreme-courts-decision-on-health-care-subsidies.html