An analysis of early claims data from enrollees in public exchanges suggests that this population has a higher incidence of serious medical conditions than those in either individual plans off the exchange and those in employer-sponsored group plans. This may lead to a rush for health care services due to pent-up demand from high-need enrollees who previously did not have access to care. In employer plans, new employees don't typically use health care benefits immediately because they likely had coverage from a prior employer and are now busy learning about their new company and how to do their job. However, this may not be the case for newly eligible employees in 2015 after the ACA's employer shared responsibility requirements go into effect (and all employees working 30 or more hours per week must be offered coverage). Employers can look to the experience of the public exchange to help anticipate enrollment and demand for care by their own employees who are currently uninsured.
At the same time, the public exchange might benefit from knowing more about how employers manage risk selection -- something the public exchange has invited in these early days. Maintaining choice and managing selection is a tough balancing act that employers have addressed for many years. The public exchange could also learn from the work employers have done to help their plan members maintain or improve their health status by focusing on high-cost claimants and those with one or more chronic conditions. The good news is employers have made progress. See Beth's post on our analysis of how employers use best practices to manage their cost increases to the low single digits. It can be done!
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