Should Carriers Run Away from Exchanges?

According to recent research by The Commonwealth Fund, and reported in the article “Amid financial losses, insurers see promise in marketplace plans” at FierceHealthPayer:

Through the first quarter of 2016, earnings among the country’s five largest health insurers have varied, with some companies seeing year-over-year losses as high as 46 percent. Financial losses linked to Affordable Care Act plans prompted UnitedHealthcare to pull out of all but a few state exchanges.

Our take?

The varied reactions of carriers in different ACA-related exchanges shows only one thing.

There is no single playbook that every carrier can use, now that exchanges have opened up more competition, and when it comes down to it, carriers need to make sure they’ve taken a look at their risks through any given channel, and are adjusting accordingly.

Participating in ACA-exchanges themselves doesn’t cause carriers to be more or less profitable, it’s the approach that each carrier takes, and the profit/cost ratio that they have in all of their channels that dictates whether they win or lose in ACA-exchanges.

For carriers that want to sell direct, on public exchanges, private exchanges, or all of the above, there is no reason why they can’t do that – with proven solutions that work for any way they want to be compete in the market.

If they’re looking to de-risk participating in exchanges this late in the game, it almost certainly doesn’t make sense to build their own billing or integration into an exchange.

With our success in HealthSource RI and HealthSource RI for Employers (the first and most successful SHOP program in all of the current public exchanges), in rapidly standing up MinutemanHealth (one of the few remaining CO-OPs) and the Washington DC Health Insurance Marketplace, and through the largest private exchange in the NorthEast,, we know both by working with public exchanges and in running our own exchange 24/7/365 that exchanges, ACA or otherwise are NOT the problem.

For carriers using technology and service providers that are adding more cost and risk to your business than your bottom line can tolerate, contact us to setup a demo of the NFP Health Marketplace Manager – the only solution in the marketplace backed by a company that owns and operates it’s own private multi-carrier exchange.

Contact Us to Setup a No Obligation Demo