In a new brief, Accenture estimates that 3 million persons enrolled through private health insurance exchanges in 2014. (Accenture Report) While there is some variability in what is meant by a private health insurance exchange, the common features tend to be a choice of benefit designs for the enrollee, tools to help with enrollment and other decisions, and a set dollar contribution by the employer toward the cost of whichever plan is selected by the employee. Some exchanges offer plans only from one health insurance carrier and others from multiple insurers. The plans may also be self-insured. The large benefit consultants, AonHewitt, Towers Watson and Mercer, all offer their own platforms to facilitate private exchanges, as do a number of other vendors. These benefit consultants have a very strong influence on large employer health benefit offerings and what large employers do tends to filter down to medium and even smaller sized firms.
Accenture says that employees are looking for a retail-like shopping experience, increased choice and flexibility across diverse products and decisions support tools; while employers are seeking cost control and predictability, reduced administrative burdens and standardized products. Given the rapid growth, the firm appropriately suggests that it is important to review whether these needs are being adequately met by the exchange experience to date. The size and complexity of the offering company’s workforce may require some customization and the administrative needs growth with the complexity of the private exchange. The online interface that most employees use is a critical piece that must be simple to us but also provide good support for the complex array of information that exists in health care. Selecting a plan and the accompanying health care providers can be a daunting task for many individuals. At the end of the day, we suspect what will most drive the private exchanges is employers perceptions that they will limit health spending growth; and that consumers will not only end up eating more of the total health cost but being disappointed in the ongoing complexity of their health benefits.