In the KPMG poll of more than 80 executives from the healthcare payer community, conducted in the weeks leading up to implementation, 32 percent said “No” when asked if the exchanges would be ready on October 1st, while 33 percent responded “Maybe, but I have my doubts.” 35 percent were confident that the exchanges would be fully functional on October 1st.
“Despite their trepidation, nearly 80 percent of respondents felt that their companies are or are close to being ready to process healthcare benefit exchange transactions on day one,” said Ed Giniat, national sector leader of KPMG’s Healthcare and Life Sciences practice. “Payers largely view the inception of the health benefits exchange as a necessary change in our business landscape and believe it can be a way to improve their business and increase their membership.”
Evidence of this mindset was displayed in a separate question, where 35 percent of respondents characterize healthcare benefit exchanges as necessary change for America’s healthcare system. Twenty-six percent viewed healthcare benefit exchanges as a risk management issue that needed to be carefully managed, while 12 percent thought it provided a way to improve their business. Twenty-seven percent were still unsure of the impact of healthcare benefit exchanges.
Expected Short Term Challenges
More than half (51 percent) of payers cited a mix of issues surrounding eligibility, customer service, enrollment and payment processing, and potential financial impact as the greatest operational challenge to their businesses once the exchanges go online. Of those choices, one quarter singled out new patient eligibility as the biggest operational obstacle.
“With the potential of more than 30 million Americans being added to our healthcare infrastructure, determining who is eligible and what they are eligible for presents a significant short term burden to the new system,” said Joseph Parente, principal and management consulting leader for KPMG’s Healthcare and Life Sciences practice. “Companies must get the set up right or make quick adjustments in order to prevent future bottlenecks in the system when enrollment and payment processing starts to take shape.”
When it comes to their customer service preparation, payers for the most part are ready to tackle the incoming wave of interactions through a mix of methods. The majority of payers (42 percent) stated that they will be ready for enrollment by 2014. Those that source their customer service outside their walls indicated that their service partners are ready for open enrollment and will continue to work with them on a “going forward” basis (26 percent). One quarter of respondents shared that they are not as prepared as they would like to be.
Uncertainty Over Long Term
31 percent of respondents were uncertain of how the exchanges would perform over the next 12 months. Payers that expressed confidence believed that exchanges would lead to more efficient and effective cost structures, the creation of more standardized products and services, greater data integration, and the addition of more customers and upselling possibilities (23 percent selected all of the above, those that selected one of those sentiments ranged between 10 and 14 percent).
“The next 12 months will present significant challenges for healthcare payers; not only will they need to react to the changing landscape, they will also have to develop strategies that get them closer to their customers and take advantage of the new tools that can help separate themselves from competitors,” concluded Giniat.
About the study
KPMG LLP commissioned DistilNFO, a publication house that operates seven industry vertical focused publications that reaches healthcare, retail and IT executives worldwide, to gauge the opinions of healthcare payer executives on the coming implementation of healthcare benefit exchanges. The survey was conducted online from August 20th to September 19th, 2013. For more information on DistilNFO, please visit http://www.distilnfo.com.
About KPMG Healthcare and Life Sciences
KPMG LLP is a leader in healthcare convergence, assisting organizations across the Healthcare and Life Science ecosystem to work together in new ways to transform the business of healthcare. With more than 1,500 U.S. partners and professionals supported by a global network of in 150 countries, we offer a market leading portfolio of tools and services focused on helping our clients adapt to regulatory change; design and implement new business models, and leverage technology, data and analytics to guide them on their path to convergence. Click here for more information on KPMG’s thought leadership in healthcare and life sciences.
About KPMG LLP
KPMG LLP, the audit, tax and advisory firm (www.kpmg.com/us), is the U.S. member firm of KPMG International Cooperative (“KPMG International.”) KPMG International’s member firms have 145,000 people, including more than 8,000 partners, in 152 countries.