Premium Reports
Health Insurance Enrollment Solutions 2017

Health Insurance Enrollment Solutions 2017

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This first-time KLAS report takes an early look at the vendor solutions used for health insurance exchanges and insurance enrollment in the ACA market. Faced with the uncertainty, political instability, and complex regulation that characterize the ACA market today, healthcare payers are searching for vendors who can help them successfully weather the storm. Based on interviews with healthcare payer executives, this KLAS report gives initial but important insight into how well—or poorly—some of the key solution vendors are meeting needs.

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Key Industry Challenge

The process of understanding and selecting health insurance is widely regarded as confusing and cumbersome for both consumers and businesses, and it is further exacerbated by complex and ever-changing healthcare regulations.

Market Drivers

Regulation
The Affordable Care Act (ACA) has changed the requirements for health insurance; notably, (1) coverage must be made available regardless of preexisting conditions, and (2) individuals who don’t carry health insurance must pay a financial penalty.

Employers
Instead of offering health insurance plans directly, employers may direct employees to choose an insurance plan from the Federally Facilitated Marketplace (FFM).

Consumers
Demand from consumers is growing for better health plan coverage options and for a simple, user-friendly enrollment experience.

Health Insurance Exchanges

Health insurance exchanges (HIXs) are state- and/or federally-facilitated marketplaces where individuals and businesses can shop for health insurance. Individual states can run their own exchange or participate in a federally run marketplace. Most individuals and businesses can use an exchange to shop for health insurance plans, though only certain people qualify for subsidies or cost assistance.

Key Topics

  1. ACA/Exchange Market Creates Icy Roads in Overall Low-Performing Market
  2. Connecture Seen as Market Anchor, but Not without Misses
  3. Early Data Indicates Softheon’s Vision Overshadowed by Currently Missing Fundamentals
  4. Small Vendor Online insight Seen as Compelling for CO-OPs, Small Payers
  5. Some Health Plans Use Core Claims Vendors Cognizant (TriZetto), HealthPlan Services, and MedHOK for Enrollment
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2019 KLAS Enterprises, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.