Before the ACA, most health plan leaders had a solid understanding of the demographics, chronic conditions, and health risks of their members. The advent of exchanges has changed the landscape, however, and now more than ever, you need to understand the details about your unique populations to create appropriate product strategies and plan designs for the future.
Truven Health Analytics™ partnered with a large health plan to investigate the demographics, risks, financial patterns, and utilization patterns of its exchange population. Pre-exchange enrollment forecasts suggested that exchanges would attract younger people, offsetting the higher utilization and costs incurred by the older population. But our research of this health plan’s population revealed older exchange enrollees – 46 years old, on average, compared with 44 for the average off-exchange enrollee – and that the exchange enrollees had more hospital admissions and emergency department visits, and were more susceptible to costly chronic conditions, specifically heart failure and diabetes. To learn more, .
This study makes it clear that initial predictions about your exchange populations might not always be accurate, making it even more important to leverage data in your planning. By analyzing your first-year exchange members’ cost, utilization, and demographics data, you’ll be able to answer these questions:
- What are the profitability drivers of my ACA-compliant plans?
- What disease management programs can we implement or expand to control cost and utilization while closing gaps in care and improving our members’ overall health?
- What are the best outreach methods that my ACA membership will respond to based on socio-demographic characteristics?
- Based on the characteristics of my current ACA membership, what populations should I be targeting to grow my membership?
- How can I provide actionable analytics to incentivize and appropriately reimburse my provider community so that they better manage this new membership?
Answering these questions is vital to the success of your plan, but gathering and analyzing exchange member data is task that requires advanced analytic skills and methodologies. Contact us to learn how you can get started.
Kevin Ruane, Director of Client Services
Kimberly Bradbury, Senior Analytic Consultant