While the nation waits for states to declare whether they will develop their own health insurance exchanges (HIXs) by the January 1, 2014 deadline, or have the federal government do it for them, health insurers are debating their own decisions on how and where to play in this market. PwC estimates these policies could be worth nearly $60 billion in revenue premiums in 2014 and grow to nearly $200 billion in 2019.

Those who participate will need to ramp up quickly and make significant changes to their businesses. This includes selling health insurance to individuals in a retail market and moving away from a reliance on risk selection to a focus on population risk management, since the law requires insurers to accept all eligible members regardless of their health.

The Congressional Budget Office (CBO) estimates that 12 million consumers will buy health insurance in the exchange market in 2014, rising to a population of nearly 28 million consumers in 2019. Despite concerns and unresolved legal and design questions, many insurers feel they cannot afford to opt out of health insurance exchanges. Those who participate, however, will face new business risks, stiff competition and millions of consumers newly armed with the power of choice.

PwC has recently conducted its most extensive research to date on health insurance exchanges. It draws on insight from a nationwide survey, commissioned by PwC, of 1,000 consumers and 153 health insurance executives concerning their expectations around health insurance exchanges. In addition, PwC conducted in-depth interviews with 35 health industry leaders, including those representing state insurance exchanges, health insurers, policy makers, consumer advocacy organizations and independent quality organizations.

This session presents detailed findings and analysis of PwC's new HIX report, Change the channel: Health insurance exchanges expand choice and competition. It outlines the key strategic considerations for insurers as they gear up for participation in health insurance exchanges, including the impact of various exchange models on their business. Each state has flexibility in how to design and operate an exchange, which could mean dozens of variations in exchange models across the country. The differences could make some exchanges profitable for some insurers but not for others, and insurers will need to decide which ones they will enter.

Join PwC's Serena Foong and Shannon Smith as they discuss PwC's HIX report in depth, address strategic considerations for stakeholders, and tackle your specific HIX questions.
 

1. Examine detailed PwC HIX research findings from commissioned nationwide consumer and insurance executive surveys and in-depth stakeholder interviews
2. Explore health plan strategic considerations regarding HIX market entry, preparation, risk management, adverse selection and risk adjustment
3. Identify health insurance needs and preferences of new HIX consumers
4. Understand the dynamics of consumer engagement and touchpoints that will apply to HIXs
5. Consider preparation points for market disruption, redefining the sales process, and prioritizing population management
6. Engage in interactive learning through online question submission, attendee feedback and opportunity for follow up questions, and networking with attendees, faculty and other professionals through dedicated LinkedIn group