COD E R E D

Four health plans negotiated discounts with providers as a means to keep premiums low.Products that utilized provider discounts coupled with restricted panels experienced more difficultyattracting enrollees than products that used discounts and the usual provider network. One healthplan reimbursed primary care services in full while specialty care services were partiallyreimbursed to provide incentives for preventive care for the uninsured.Program Duration: Several of the initiatives were either time-limited pilot programs orintended to serve as short-term insurance. Among the new, shorter-term programs, enrollmenthas been lower than anticipated, as some pilots with limited availability due to service area,income, or number of potential members experienced marketing difficulties. Long-establishedprograms were better able to meet membership targets. One health plan indicated that pilotsnot supported by senior management may have problems achieving their goals. A pilot launchedin competition with another commercial product could garner less investment and less aggressivemarketing. Short-term pilots provide only temporary coverage for the uninsured since the closingof a program marks the end of health benefits. Also, some employers who have made thecommitment to join a short-term pilot may face a predicament: once the program terminates,they must maintain coverage without plan subsidies, find another affordable product, ordiscontinue health benefits.Nonetheless, under certain circumstances, a pilot may be desirable. Pilot programs allowplans to try new, unproven or otherwise risky approaches to coverage. Plans are able to makechanges on a small scale and refine their products over time, before investing significantresources in major program modifications. To overcome the barriers inherent in pilot programs,one health plan created a product intended for those currently covered as well as the uninsured toreplace its existing programs. By rolling over its current members into new individual and smallgroup products, the plan mitigated the risk that initial enrollment projections would not be met.Over time, however, a health plan has no guarantee that every member will prefer the newproduct over the old or that all members will choose to renew. Moreover, the replacementproducts still face obstacles similar to pilots or other new programs in attracting the uninsured.Transitions: Recognizing that many people become uninsured as a result of transitionissues, some health plans designed products for those who (a) lose status as a dependent onanother’s policy but are unable to secure one’s own coverage; (b) change jobs or becomeunemployed; and (c) lose eligibility for public programs but are unable to secure privatecoverage. Five products addressed these age, income and public/private transitions by: allowingover-aged dependents to remain on their parents’ policies; guaranteeing rate stability for the nearelderly;providing subsidies to pay for a percentage of one’s premiums for a fixed amount of time;and bridging the divide between the public and private sectors through cross-referrals. Some ofthe transition efforts conflict with other plan strategies; for example, seeking relief from communityrating to pursue age banding versus directing products to the uninsured who are near-elderly. Ingeneral, products attempting to address transition issues have generated higher enrollment thanthose that have not.Enrollment and Operations: Innovative health plans acknowledged enrollment andoperational problems as major barriers to obtaining health coverage since applicants must gothrough a multi-step process prior to obtaining coverage. A failure in any step of this process canresult in lack of coverage. Several products examined in this study addressed enrollment issuesby streamlining applications, allowing self-declaration of income, and providing multilingualapplication materials. These products attracted a greater percentage of the uninsured thanothers. Those health plans with less success had problems upstream in the enrollment sequencesuch as in marketing. Because some people are unable to obtain care due to language or culturalD-31