It doesn’t have the inherent drama of a space launch countdown, but in T-minus nine days, America will embark on a voyage into the vast, unexplored regions of the health-insurance marketplace.
Actually, those regions aren’t that unexplored. Insurers have been running consumers through simulated exchanges for the last several years. While insurers may not be completely comfortable with how things unfold after Oct. 1, they do have a pretty good idea about what coverage consumers want and what they will pay for it.
The bottom line: Price is a key consideration, but so are hospital networks, even more so than doctors. And most consumers will decide frighteningly fast.
How do they know this?
“We decided to build a real, live public exchange that looks and feels and breathes like a real, live exchange,” said Marc Pierce, founder of Stonegate Advisors, a health industry consultant that tested 6,000 consumers.
Stonegate and other national consulting firms have been running simulations for clients almost since the day the Affordable Care Act became law in 2010. The distilled data have helped insurers better understand their new customers and, in turn, design their marketplace products.
“What many health plans are doing is creating their own bench simulator,” said Jamie Estupiñán, vice president and partner with Booz & Co. in New York.
A bench simulator gives consumers three health-plan options and asks them to buy one. Consumers can be given as many as 20 different, three-option sets, each time choosing their favorite one.
“Based on that, I am essentially gleaning an understanding of your preferences, what are the things that you value in terms of different dimensions put out there,” said Estupiñán, whose company tested 17,000 consumers in 25 states.
Independence Blue Cross did something similar. In the last two years, Southeastern Pennsylvania’s largest health insurer has performed two rounds of simulations using 1,100 consumers. The latest, which began in January, had 10 or more plans with different benefits. For instance, one choice might have dental and vision coverage, but not prescription. Consumers were asked to pick a plan. Independence used that information to refine its products.
“It was a great exercise because it really allowed us to understand what the different dynamic is when an individual consumer is shopping versus the employer market that traditionally health insurance comes through,” said Brian Lobley, Independence’s senior vice president of marketing and consumer business.
What did all that simulation reveal? For starters, price is important – to an extent.
“In our study on average across 6,000 people, 81 percent chose bronze [the lowest-cost plan] or silver [the next-lowest cost], and 19 percent picked gold or platinum,” the two most costly, Pierce said.
Cost may be an important driver. But, said Booz’s Estupiñán, it is not the only one.
“On average, 40 to 60 percent of what drives somebody’s choice is related to cost,” Estupiñán said. “But there is another 40 percent out there not focused just on cost.”
Which leads us to network coverage, the next biggest consumer consideration. In the Booz simulations, anywhere from 10 percent to 50 percent of consumers selected a plan based on the hospitals included.
“Whether a given hospital system is in the network is actually very important to folks,” Estupiñán said.
Pierce concurs. In fact, Stonegate’s simulations found that a majority of people chose staying in a network over keeping their primary-care doctor.
“What we found is that while they [people] are not as doctor loyal, there still is a level of health-system loyalty,” Pierce said. “So if you took a large health system and that was your system and you suddenly weren’t able to go to that system, people were willing to pay more to still have access to their system.”
The one area of disagreement among the groups was brand identification. Stonegate’s consumers said an insurer’s brand was not that important. But Estupiñán and Lobley found otherwise.
For example, people will pay an extra 10 percent for the Blue Cross brand, Estupiñán said.
Perhaps the most interesting finding came from Stonegate, which found that most people entered the exchange, made a selection, and finished in less than 10 minutes. While Booz did not time its consumers, Estupiñán said he was surprised by how comfortable people were using the exchange.
“People do land on choices fairly quickly,” he said. “I found that people are able to make thoughtful choices, and when we asked them, they are able to articulate pretty coherent reasons why they are making those selections.”
But in a separate consumer survey, Lobley said Independence found that its consumers were still confused and were seeking help. The desire for more information has led to sold-out information events at the YMCA.
“We have had to do two per night,” Lobley said. “We are educating people on what I would say quite frankly is how to use insurance.”