This blog entry was written by Triveni Harsh Mohta, senior project manager, insurance healthcare and life sciences practice, at Infosys Technologies.

With health benefit exchanges (HBE) to become operational by 2014, there will be an impact on core broker business, since entire policy sales and enrollment operations will happen online. Although this won’t affect the broker community supporting large employers, it still will be a remarkable impact.

A few years ago a similar challenge was faced by travel agencies after online booking boomed. Although it did impact the business--lots of mergers and line of business changes--but some travel agents transformed themselves into travel consultants that support customers not only by creating complex travel packages, but also in customer profiling, personalization of travel plans and education.

Even though the impact of HBEs on the broker community is significant, those brokers still have a role to play in the marketing and sales of exchange-based plans. Similar to travel agencies, health insurance brokers can also transform themselves into consultants and work with HBEs, since they’re very close to the consumer community and they understand consumer needs/psychology very well, apart from having deep product knowledge. HBEs are burdened with several operational mandates and are going to be bit complex in terms of consumer education and adoption. Brokers can help address these issues since they understand both sides of the coin--consumers as well as benefit designers. A few existing successful benefit exchange implementations have proven that brokers play a vital role in the market-- in fact, the spectrum of responsibility increases.

Brokers can accept and adapt to the online enrollment infrastructure of the HBEs and at the same time expand their role across following key areas:

1.HBE product sales: Brokers can facilitate exchange sales and help capturing enrollments from remote and rural areas for individuals as well as for the family insurance market. The National Association of Health Underwriters (NAHU) has stated it will work toward developing a certification program--the Certified Health Care Access Advisor--for brokers, including those who market through an exchange, to ensure that they are thoroughly trained on all private and government health insurance options.

2. HBE marketing and navigators: HBEs will be successful if they make plan purchase and enrollment easy for the needy. The promotion of exchanges should cater to entire populations including those who don’t have access to the internet. Hence the health reform’s recommendation of a role for “navigators” to provide assistance and education around exchange-based health plans and related enrollment. The law recommends that the navigator role should:

  • Conduct public education activities.
  • Distribute information concerning enrollment in plans and subsidy availability.
  • Facilitate enrollment in plans.
  • Provide referrals to health insurance consumer assistance offices or ombudsmen to enrollees with grievances, complaints or questions.

Since brokers are experts in product domain they are best suited to perform this role. They can take seminars and also set up physical booths for marketing and capturing enrollees.
3.  HBE benefits design support: Brokers can help in comprehensive benefit designing based on the surveys they can conduct through their relationships with consumers. They can even use the online I.T. infrastructure of the exchange. Brokers currently bridge the gaps between consumers and health plans. Through exchange I.T. infrastructure they can also open up chat channels for anytime/anywhere connections with consumer. In terms of exchange operations, brokers can also form call center organizations to provide helpdesk support for online enrollment and related queries using their domain expertise and associated certifications.

Health exchange brokers in Utah have played a role in not only product distribution, but also as exchange product experts for coordinating and complying with federal and state laws related to employer-based health plans. This seems another important area of responsibility for brokers.

Similarly, brokers can also play the intermediary role between exchange governance body and the funding sources that will form the ongoing revenue streams for exchanges. The potential funding organizations will also need to understand the exchange operational details, and brokers can provide that educational as well.

Since brokers can provide impartial and accurate information on suitable products for different consumer communities, and can remain an integral part of the insurance market by adapting to utilize the health benefit exchange I.T. and business infrastructures.


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