Understanding Your Exchange Population: Answering the Questions
According to a recent article in the Wall Street Journal, health plans are now seeking substantial rate boosts and citing higher than expected medical costs incurred by people newly enrolled under the Affordable Care Act, making exchanges a viable part of the healthcare blueprint. To better understand exchange populations, Truven Health Analytics teamed up with a large health plan to investigate the demographics, risks, finances, and utilization patterns of the exchange population in the health plan’s state. As discussed at AHIP Institute last week and covered in a Modern Healthcare article, we found:
- Exchange enrollees are significant consumers – with 64% more emergency room visits and 39% more admissions than non-exchange members
- Exchange enrollees may be older than expected
- Exchange enrollees have a higher prevalence of heart failure and diabetes
- Exchange enrollees specialty drug costs are higher
Although we found a lot of data that contradicted the pre-exchange enrollment forecasts, one conclusion can be drawn from our analysis: It’s more important than ever to understand the details about your unique populations to create appropriate product strategies and plan designs for the future.
In addition to the questions we highlighted in our previous blog, Understanding Your Exchange Population: Are You Asking the Right Questions?, there are also specific actions you can take to ensure your care management programs, member services and outreach are tailored to your exchange members’ unique needs:
- Leverage clinical data from your first-year ACA plan members’ cost, utilization and demographics, and couple it with advanced analytic tools
- Understand your population to determine the behaviors that guide their healthcare consumption
- Risk stratify members to identify opportunities for intervention
- Include accurate coding initiatives to optimize members’ risk scores that will drive risk fund transfers and plan profitability
Taking these actions is vital to the success of your plan, but it’s a task that requires advanced analytic skills and methodologies. With more than 30 years experience, Truven Health can use your exchange data to help you perform the actions necessary for implementing product strategies and plan designs that are tailored for your members.
To learn more, download the research brief and register for our upcoming AHIP webinar, Understanding Your Exchange Population: Lessons from Real-Life Data.
Kimberly Bradbury, Senior Analytic Consultant
Kevin Ruane, Director of Client Services