Is The CMS a Unifying Force?

CMS regulated plan materials are a big set of steps in the right direction for online commerce and digital process transformation for healthcare payers.

For payers, the Internet promises direct consumer interaction and a plethora of live, traceable, and relevant data, streaming 24/7.

The HHS counts 11.7 million Americans enrolled in marketplace coverage (as of the end of 2016 open enrollment), presenting a surplus of data for plan development teams.

This data is easy to access; the HHS and CMS publish weekly and monthly reports and host copious data collections on their own websites.

Exchanges provide a single point of contact where those seeking insurance can determine which insurance programs they qualify for (Medicaid, CHIP, Exchange-based coverage), learn about plans available to them, and both sign up to get coverage through the Exchange and to choose a particular health plan.

In an ideal future, health exchanges function as a single source of truth (rationalized data) about consumer healthcare plan and benefit selection.

The common denominator is the healthcare plan itself.  This works out well,  because the SBC (and other CMS regulated plan materials) function as a shared language to map healthcare plan coverage and benefits to real life use cases for (in order for consumers to compare and select plans in the marketplace) via the SBC table fields, and other CMS regulated plan documents.

The clearest illustration of the CMS as an agent of digital transformation is the SBC.  The SBC is designed to work for consumers shopping for plans online, without the help of agents or brokers to guide them through the morass of legalese and healthcare payer lingo.

The SBC works in several ways when it comes to online business.

First, choices and interactions are data points that enable consumers to shop directly for their own plans online.  Because of the CMS regulations, consumers use standardized comparison (SBC) and plan documents to decide the relative value of healthcare plans; competition tends to become focused directly on the actual fields of the table on the first page of the SBC (and variously, on other CMS-regulated marketing documents).

Next, the standardization that CMS regulations afford to plans sold on exchanges makes direct data point analyses an obvious tactic.  Payers will find that their competitors’ plan and benefit offerings are easily accessible as well (the SBC table, for example); plus, demographic correlates are just another click away.

Payers will bridge gaps in strategic plan development by bringing CMS compliance documents online, where they can realize their potential to facilitate understanding of the relative performance of individual benefits and plans.

Finally, data analysis will ensure that payers eventually achieve member-centric plan and benefit offerings that are based on a multitude of continuously updated data points that directly reflect real time selective pressures from the marketplace.

Payers will deduce exactly what consumers want.

Forward thinking payers will take advantage of the CMS standardization of plan materials to collect and interpret massive amounts of readily available exogenous and federated data.  They will use what they learn to differentiate with strategic precision predicated on lightning-fast data analysis.

As far as consumers are concerned, competition and choice have turned out to be a good thing, in many a marketplace.  Competition acts to increase quality and lower prices.  Since the efficacy of product strategies and marketing efforts unfolds in real time on exchanges, payers will rush to develop new plans that meet consumer demands and preferences.

The cost of plan premiums is offset by the federal tax credit for consumers covered by plans on the marketplace.  The cost is further offset by the tax penalty levied on the uninsured.

This enrollment season, almost 8 million individuals residing in states where they could (and did) buy their plans using qualify for an average tax credit of $263 per month.  Over half of them (55%) will pay just $100 (or less) per month, with the tax credit.

Finally, consumers who are underinsured will pay and owe medical bills and will often forfeit the right to bequeath their own property to their descendants.  Even people enrolled in high deductible (often employer sponsored group) plans will pay more, often long before their health insurance ever kicks in.

Perhaps the answer does lie in the (highly regulated) online marketplace.newsletter-2_graphic_e0e60812

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