Healthcare Technology Featured Article

April 01, 2016

Top 3 Takeaways from Open Enrollment 2016


With the insurance market in flux, an analysis of major industry events like open enrollment can yield valuable clues about the state of the marketplace, and the 2016 open enrollment period was no exception. One obvious lesson is that the Affordable Care Act’s (ACA) health insurance marketplaces aren’t going away. With well over 12 million people using federal and state marketplaces to enroll for 2016, seven in 10 enrollees returning to HealthCare.gov and a 42 percent increase in new enrollees, the ACA marketplace demonstrated both need and value.

It wasn’t just the ACA, though: Exchanges successfully connected consumers to health coverage across the public and private marketplace continuum. But what else does open enrollment 2016 reveal? Here are three top takeaways:

1. More mature technology solutions enable greater focus on other priorities. Once widely derided as a barrier to enrollment, the technology that enables public marketplaces has matured considerably, in part because states are now more willing to use proven off-the-shelf solutions rather than expensive, custom-built platforms that are prone to errors. With better decision-making tools like provider and prescription drug lookups that reflect innovations achieved by private exchange platforms, state-run exchanges are more user friendly. And with less time spent putting out technology-related fires, administrators have shifted their attention to improving the overall enrollment experience, adding new products like dental coverage, reducing the uninsured rate, and eliminating fraud and abuse.

2. More states are looking at private sector alternatives. While HealthCare.gov, the Federally Facilitated Marketplace (FFM), handled millions of enrollments, some states are actively seeking private sector options. FFM use fees will have to increase at some point, and even the handful of federally supported states that use HealthCare.gov will likely find themselves liable for higher technology fees soon. The other 34 states that use HealthCare.gov might also eventually come under pressure to help the federal government close the $600 million-plus budgetary shortfalls on HealthCare.gov administration. States that are exploring options are looking to mature and proven private sector solutions that require minimal customization “out of the box”, cost less, and are fiscally sustainable.

3. Private health insurance exchanges are growing quickly: Private exchanges enrolled approximately six million people in 2015 (source: Accenture). Employers are attracted to private exchanges due to the potential for better cost management, benefits choice and user experience delivery. But the market for private exchanges is broader than that: Subsidy-eligible consumers can rely on insurance brokers using the same private exchange platforms to directly and efficiently enroll them on HealthCare.gov, with more support. Small and mid-size employers are looking to private exchanges for more robust solutions that provide better cost transparency and choice of health insurance and other benefits. After trying “freemium” offerings that failed to fully meet employer needs, brokers are starting to pay more attention to benefits technology platforms that can help efficiently serve this growing but underserved market.

The widespread technical glitches that plagued the initial ACA rollout at the federal level are increasingly a distant memory, and thanks to the ingenuity of private sector solutions, both public and private exchanges have improved immeasurably over the past few years. In 2017 and beyond, look for technology to drive the innovation delivery of a continuously improving customer experience and marketplace expansion.

VJ is responsible for building the hCentive brand, commercializing products and solutions, developing new markets, and expanding partnerships to drive business growth.

VJ has 22 years of experience in global marketing, strategy, product development and management consulting in the technology, software products, professional services and manufacturing sectors.

Prior to joining hCentive, VJ was Associate Vice President and Head of Marketing & Alliances for Infosys Public Services, Inc. Prior to that, VJ held marketing leadership positions with various business divisions at Infosys and IBM, led corporate marketing initiatives and consulting engagements at IBM, and implemented technology initiatives at Johnson Controls.

VJ earned an MBA from the University of Michigan (Ross), MS from the Ohio State University, and BTech from the Indian Institute of Technology.




Edited by Stefania Viscusi




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