As Colorado runs its own exchange, and has had what most consider a successful rollout, we’ll discuss what is next and how the exchange works to improve the long-term health of the people of Colorado. In this chat we discuss choice architectures and how to build an exchange that is really, truly consumer-centric – a great vision for health in any state, and I’m glad to see it emerging here in Colorado.
LK: Have you looked into behavioral economics and what are called choice architectures like what they describe in Nudge? Nudge has a pretty long section on creating a framework for effective decisions based on the goals of the user.
PD: Absolutely. Our marketplace solution is a good traditional transactional system, but it’s not been designed as a true engagement platform, utilizing choice/behavioral best practices, so we’ll likely need to append our architecture with some niche solutions. These could come from the startup community and non-traditional sources of innovation in the local community, and that’s very exciting.
LK: You and I have talked the opportunity for the exchange to be more of a platform, presumably with APIs that would allow outside developers to come in and build new solutions and applications using data supplied via the API combined with other outside sources. What can you share with us about that?
PD: We are implementing an API into various parts of our marketplace, hopefully in the next year or so.
Digital engagement is very important to us. We are going to move forward with a hackathon so that we can engage the local digital health community to bring innovative new ideas that could be leveraged in the long term to create an engaging, transparent experience. As CTO however, there is a balance between being innovative and having an enterprise scalable architecture. Anything that we put into production has to be robust, it has to scale well. We have recently engaged with a startup, CodeBaby, who are based here in Colorado Springs. They helped us go live today with Kyla our avatar who helps people navigate our website. For now this is limited, but we hope to integrate this further into our key, core portal marketplace screens and into our streamlined eligibility application.
LK: That’s great to see, and I can’t wait to see what comes next. I think that this kind of opportunity will be very exciting for entrepreneurs because health care is something that literally everyone has a stake, and it’s great to have these kinds of opportunities in Colorado to get more people involved in improving it, with code.
PD: Denver is a really exciting place to be in the development of new health technologies and new innovations given the work that Mike Biselli is doing (creating Stride, an emerging digital health campus with some big soon-to-be-named digital health tenants) to establish Denver as a hub.
LK: Yes, the Prime Health Collaborative and Stride and Health 2.0 Denver do seem to have started something special in the community here. It seems like a great fit because people do come here to be active, and the active, consumer-centricity has started to show with the startups that have formed here. It’s a great confluence of forces around digital health and consumer-focused solutions.
So let’s talk a little about what makes this environment unique and how we’re going to sustain it. Connect for Health Colorado is a non-profit that will need to be self-sustaining. What are the opportunities for extending the business model?
PD: We do need to be self-sustaining in January of 2015 and we do have a plan to do so based on a broad market assessment and our carrier-fee billing for plans that we offer on the marketplace. In the future however there may also be opportunities for monetizing our (anonymized) information assets and our technologies thereby funneling additional resources back into the exchange to support our ongoing vision and mission. Perhaps to other, newer exchanges.
LK: What improvements are you going looking to roll out in the near future?
PD: In addition to what we’ve already discussed, a key focus area for us will be the utilization of user preferences to identify the important decision-making criteria for individuals.
We’re also putting in an out-of-pocket calculator so people can understand what kind of plan they should choose given their predicted healthcare expenditures for the year.
We do have a provider search tool, so people can see which providers are in-network for individual plans. However there are opportunities to make these searches broader and more inclusive, with real-time information on which providers are taking new patients and the exact services they are providing. For example so someone could find a child ABA (Applied Behavioral Analysis) provider in Denver that also has current openings within their practice. That’s just not possible using the provider search tools in use.
We have recently gone live with a formulary tool to help people find out which medications are covered by individual plans. In the future I would like to see the development of richer decision-support tools around formulary, linking in efficacy and safety information for particular drugs, given the genetic pre-disposition of the individual. Quality ratings for plans, carriers and providers are also areas that exchanges are looking to move into in the future. Amazon-like consumer-driven payer/provider ratings. The ACA has driven a number of initiatives to introduce more transparency in the marketplace. We’ve discussed a little about the All Payer Claims Database, or APCD, here in Colorado, which was driven by the ACA. Transparency and quality metrics is an area (CMS) will be providing guidance on in 2016. The establishment of the health insurance exchanges themselves is, in and of itself, a broad move toward applying more transparency to the marketplace by creating a common benefit package for qualified health plans. So, it’s easier for the consumer to compare plans like they are comparing apples to apples. CMS and ACA are playing a large role in helping to make the healthcare marketplace more transparent.
LK: Despite the hype to the contrary, it really is a free-market approach, and for the free market to work, you need transparency. If we want to fix health care, we need to make all of it more transparent and that creates a lot of opportunity for health IT that can facilitate that transparency.
PD: Reflecting on the success of PatientsLikeMe, that builds communities of patients to share information. There’s no reason we couldn’t explore providing similar communities for people in Colorado.
LK: So more of building a community and helping people connect with others in the state? That sounds great.
PD: In parallel the development of storefronts for the provision of direct to provider services including Telehealth and concierge medicine seem like a natural future evolution for exchanges.
LK: Seems like there are a lot of niches that could be provided and make this more of a communications system between patients, providers, payers and between many different stakeholders in the system, as well as a face to the health care system in Colorado.
One other thing I wanted to ask about is, have you received any interesting demographic trends about who is signing up for insurance on the exchange?
PD: Some interesting facts from our last open enrollment period (2013-14) was that 38% were in 0-34 age range. 35% were in the 35-54 age range. More than 73% of our consumers were under 55. Only about 26% were in the 55-64 age range. The other surprising thing was that 40% of those who enrolled received no financial assistance (tax credits or cost sharing reductions) indicating that people are choosing us as a trusted place to shop for their insurance.
LK: I see a lot of entrepreneurs have been getting their insurance through the exchange, so we’ll look forward to seeing how having this kind of access has improved the labor market, as people no longer need to be tied to a traditional job to qualify for affordable insurance.
PD: And, of course, the other big benefit is that people with pre-existing conditions can no longer be discriminated against, and a lot of people have come to us for that reason.
LK: Well thanks for the interview and all the great work that you’ve done. We are fortunate to live in a pretty progressive state in terms of health care and have some really great people working to improve things in Colorado.