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Improving Individual Insurance

April 11, 2017

Financial analysis released last Friday revealed improving individual insurance markets compared to what was previously thought.

The focus of the S&P Report was on Blue Cross plans in roughly three dozen states since implementation of the Affordable Care Act.

Improving individual insurance shows markets have rebounded; many are stemming their losses last year, breaking even this year, and are planning to start to make money next year.

In total, more than five million people are in the individual market with Chicago-headquartered Health Care Services Corporation (HCSC) the national leader in part due to its pseudo-government position, as well as its mission to provide care to those who are left behind. The improving individual insurance markets potentially creates an opportunity for HCSC’s continued dominance.

“The market is not a ‘death spiral,’” the analysts from Standard & Poor’s said in a recent New York Times article.

Many people who did not have insurance for years were extremely expensive initially.

These individuals would require initial testing, diagnostics, and treating any lingering issues that were untreated for years.

This only reemphasizes the importance of preventative health that can provide ongoing analysis of an individuals’ health ensuring that low-cost solutions are provided on-demand before care becomes costlier.

“Things (insurance markets) are getting better,” explained a vice president at the Kaiser Family Foundation, Gary Claxton, in the NYT article.

Some Blue Cross plans are already profitable, including Florida Blue. This is all welcome news to the insurers who have been fearful of the individual markets with some of the for-profit insurers such as UnitedHealthcare and Aetna, among others, pulling out of the individual markets in states around the country.

The S&P report projects that in five years there will be stability in these markets with 2017 already year four. The chart below shows the falling Medical Loss Ratios of the individual plans. Even with the falling Medical Loss Ratio, many of the plans still can make additional efforts to drive profitability by seizing the immediate opportunity of improving individual insurance markets.

On-demand solutions could be used to identify those who are experiencing higher acuity cases that need to be routed to more traditional care such as a doctor face-to-face or other community health resources provided. This provides valuable help to improve care coordination.

Most people can receive the care that they need through a military-proven behavioral health technology, which has a few of salient benefits:

  1. Ability to further integrate behavioral health with medical care, according to Health Affairs
  2. There aren’t enough behavioral health doctors in America; the shortage is estimated at over 20,000 with over half of American counties lacking a licensed clinician
  3. A low-cost solution of peer-to-peer support provides immediate care before issues escalate to insurmountable levels

Individuals are taking on a larger share of the costs related to healthcare through consumer-centric healthcare with some estimates of Americans spending nearly half of their paycheck on healthcare by 2030, according to the Council for Affordable Health Coverage.individual insurance costs

Harnessing the power of technology also allows insurers the opportunity to improve the all-important net promoter score (NPS), which measures how well they are delivering a consumer experience and how loyal a customer is. Often the question asked to measure this is “how likely are you to recommend the product/service to a friend?”

Independent review by the Agency for Healthcare Research and Quality showed that 94 percent of Users would recommend Prevail to a friend.

Politics is the art of the possible. With existing technological solutions for pressing problems, it is up to innovative leaders at insurers to ensure individual Americans can live a happier, healthier life.

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