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Health Care Insurance Prepares for Online Marketplace

July 6, 2013
online healthcare, insurance

July 6--Fall enrollment dates are anticipated for the new online insurance marketplace -- known as health insurances exchanges -- and the health care industry is gearing up to take on the quickly approaching overhauls brought on by the Affordable Care Act. Mike Koehler, Cigna president and general manager for South Texas and Louisiana, has been in the health care insurance business for more than 20 years. He spoke with the Houston Chronicle about how the industry has changed, the impact of health care reform on the country and Cigna's participation in these new exchanges.

Q: You've seen a lot changes in the health care industry. What are some of the biggest differences from when you first started?

A: When I started back in the mid '80s, that's when HMOs (health maintenance organizations) were starting to be prevalent. Back then health insurance or this industry was really a financing vehicle for companies.

Costs have gone up substantially. It's just too big to ignore. So now the industry has evolved to where we are having conversations about which doctors should you be going to and how do you implement programs that get people healthier.

Those were conversations that never even occurred 15 years ago because it wasn't that big of a cost.

The biggest evolution is the whole concept of moving from a financing vehicle to being an active partner in improving health.

Q: What kind of impact do you think health care reform is going to have on the industry and the country?

I kind of look at in three buckets. I'll start with access to care. Absolutely, I 1,000 percent agree that it's just not right that a lot of people don't have access to care. Everybody should really be in the system. So it's great. This country really needed it for a long time.

The next part is the financing vehicle component of health care reform. There are lots of questions, lots of concerns.

The simplest way I can describe it is that health insurance is all about patterns and consistency. Health care reform is going to throw those patterns out the window and that's the piece where nobody really knows what's going to happen.

The third part is the delivery of care. We're going to have 30 percent of the people in the health care delivery system that weren't in there before, depending on the state. We already have a physician shortage and it's going to get worse. Most conversations are about the financing piece. As I kind of sit with my years of experience looking at what's around the corner, I'm actually more concerned about this.

Q: Have you put in an application to participate in the new federally run insurance exchange in Texas?

A: We have. There are five statesthat we are actively participating in and Texas is one of them.

Q: Why did you chose to participate in the exchanges in those states?

A: It was a combination of a number of things. One is that we look at a market that we have a good footprint in, one with a good delivery system in, one where we can offer products at high quality and low costs. These are markets we can do that in.

Q: Will you be doing anything on your company's end to helpwith outreach efforts to help educate the public about the exchanges?

A: Absolutely.That's going to be, in our view, one of the key things moving everything forward to make it easy for the patient.

Q: Is there anything else, from a health insurance provider's standpoint, that you think is important for people to know about health care reform and insurance exchanges?

A:What I advise is that there is going to be all kinds of options to consider. But if it looks to good to be true, it probably is too good to be true. Read the fine print, look on the second page. Just be really careful.

When you are drowning in all these options to consider, and it's going to be confusing, go with people you know and trust.

Talk to your physicians and get their advice.

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