As Aetna and UnitedHealth Group retreat next year from most public exchanges under the Affordable Care Act in the face of losses they say they can’t handle, a model is emerging in Florida that may be the answer to caring for patients and turning a profit.
Florida Blue, a Blue Cross and Blue Shield plan, is offering a diverse mix of products statewide on public exchanges. That is in sharp contrast to UnitedHealth and Aetna, two of the nation’s largest health insurers, which will leave public exchanges in most states–including Florida beginning in 2017.
“ Florida Blue offers every metal level ACA product in every county in the state , and we offer four different product networks to satisfy a full range of consumer needs, so the makeup of the plans our members have chosen is very mixed,” Florida Blue spokesman Paul Kluding said in an interview.
Florida Blue said it began to prepare for Obamacare patients and their expensive medical claims three years ago when the rollout of coverage was dogged by technical issues of the Healthcare.gov web site. Back then, Florida Blue opened 20 retail centers across the state to sign up residents and the investment paid off.
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New Obamacare patients were assigned a care manager, generally a nurse who screens patients making sure they are getting outpatient care upfront before more expensive claims emerged down the road. In the first three years that Obamacare has been available, Florida Blue said more than 400,000 Florida residents have visited a retail center.
“They continue to serve as significant hubs of information for marketplace plans, offering direct customer service and access to a variety of healthcare plans,” Kluding said of the retail centers. “We also provide a number of free health screenings, such as blood glucose, cholesterol and blood pressure, so individuals can get personal health assessments while they are shopping for healthcare plans.”
Contrast the Florida Blue retail center strategy to efforts to sign up Obamacare patients by national insurers. Humana, for example, last year lost more than 100,000 Obamacare enrollees that were terminated because they lacked “proper immigration documentation and/or income status,” the insurer has said.
“The Florida Blue retail centers have been invaluable during marketplace open enrollment, particularly the first year when there were significant issues with online enrollment, so potential members enjoyed the in-person consultative option,” Kluding said.
In a CNBC interview last week following Aetna’s decision to scale back from 15 states this year to just four states next year on public exchanges, Florida Blue’s CEO said the insurer anticipated that its customers would be sick and have a pent up demand for healthcare services.
But Florida Blue is also limiting patient choice of providers through narrow networks, particularly for Americans buying the lower-tier silver and bronze plans that get the largest federal subsidies under the health law. Last year, Florida Blue launched a new product called “myBlue” in 10 counties for residents eligible for subsidies through the exchange.
“It does provide a more narrow network; however, the silver-level products have affordable low copays or no cost for the most commonly used services,” Kluding said, referring to routine doctor visits and access to specialists for less than $5 as well as checkups and lab work at no cost.
Florida wouldn’t comment on the decisions by Aetna and UnitedHealth to leave Florida or other markets. But it’s clear from the numbers built up so far that Florida Blue won’t mind taking on the patients Aetna and UnitedHealth leave behind.
“Through the first three years of the ACA we were the only insurer to offer plans in every Florida county, and as a result we have insured more than 700,000 individuals in the state,” Kluding said. “As a company dedicated to the state for more than 70 years, we understand the diverse health needs of Floridians, and are able to build and price products that best suit their unique healthcare needs. We look forward to offering Floridians access to quality and affordable healthcare options through the marketplace in 2017 and beyond.”
Date:Aug 23, 2016