August 6, 2012

Health Insurance Exchange in 50-yard sprint

HBJ  Photo/Greg Bordonaro
HBJ Photo/Greg Bordonaro
Jason Madrak and Kevin Counihan are two of the newest hires to help run Connecticut’s health insurance exchange. Madrak, left, is the communications and marketing director, while Counihan, right, is the CEO of the exchange. Both men will play leading roles in helping develop the exchange and getting consumers to actually understand and use it.

While a health insurance exchange may still be relatively new concept in Connecticut, Kevin Counihan predicts it will become mainstream in the years ahead.

Counihan, the recently named CEO of the Connecticut Health Insurance Exchange, said he envisions exchanges becoming a primary way for people to obtain health insurance in the state.

And he predicts that there may eventually be several exchanges that compete for business in Connecticut, especially as the way people purchase insurance continues to change.

"Health insurance is going to become more of an individual type of selection product like pensions have become," said Counihan, who is a former senior level executive of the Massachusetts health insurance exchange under then Gov. Mitt Romney. "Defined benefit plans used to be common, but now its defined contribution plans. I think we are going to see that in the health insurance business, where people are more responsible for choosing their own health plans."

As part of that evolution, Counihan said there will likely be a state exchange operating alongside private exchanges as the market adjusts. For almost two decades now, the Connecticut Business & Industry Association has been the only exchange in town, offering coverage options to about 78,000 members.

"There will be more than one exchange in this state and there will be more than one private exchange in this state," Counihan said. "It's just the nature of the business. I think state and private exchanges are going to be serving complementary but distinct markets."

Counihan is about a month into his new role as head of the state's efforts to create health insurance exchange that will allow individuals and small businesses to shop for insurance coverage through an online portal.

The exchanges are being mandated as part of the federal health care reform law, and are seen as a key way to expand access to insurance coverage.

Connecticut has already been aggressively pursuing the creation of its exchange over the past few years as it faces a 2014 deadline to get it up and running.

The process has been drawn out as many important policy decisions have to be made in determining how the exchange will operate. Even the search for a new CEO was a challenge, forcing the state to hire a headhunting service as it had difficulty finding the right candidate.

With dozens of other state's also pursuing efforts to set up a health insurance exchange, there was aggressive competition for talent.

Counihan eventually got the job from a pool of 75 other candidates. He has deep experience in dealing with exchanges. Most recently, he was president of Choice Administrators Exchange Solutions in Orange, Calif., which helps states create exchanges under the federal Patient Protection and Affordable Care Act.

From 2006 to 2011 he was chief marketing officer for the Massachusetts Health Insurance Connector Authority, which administers that state's health insurance exchange. Counihan was also a sales and marketing executive for Tufts Health Plan of Massachusetts from 1993 to 2005, and was a regional vice president for Cigna from 1990 to 1993.

In his short time on his new job, Counihan said he has spent most of his time getting to know staff members and key stakeholders, including the health exchange board, which has been making most of the policy decisions for the exchange over the past two years.

He has also met with key business leaders, including giving a speech at a recent MetroHartford Alliance breakfast.

With tight deadlines for action approaching, Counihan said he has no time to waste. By November, the state has to deliver for approval a blueprint of its exchange to the Centers for Medicare & Medicaid Services. And in January the state must obtain certification for its exchange.

"We are really on a 50-yard sprint to October 2013, which is open enrollment," Counihan said. "There are a lot of milestones we have to meet along the way."

Counihan said his top priority early on will be centered on getting the technology for the exchange in place. He said the state is in the process of finalizing a deal with an integrated eligibility vendor. That deal that is going to help create the most important component of the exchange that will link together various state and federal government agencies.

The idea is to allow people to input demographic, financial and family size information and have a system that interfaces with both state and federal agencies to determine what benefits someone might be eligible for, Counihan said. Some of the options include Medicaid, subsidized insurance, small business tax credits or regular commercial insurance.

Jim Wadleigh, formerly of Cigna, recently took over as the chief information officer of the exchange and will oversee that effort.

Creating a system that is easy to use will also be crucial in getting the 200,000 or so uninsured people who are expected to be eligible to buy subsidized insurance through the exchange, Counihan said.

Another key decision the insurance exchange board will vote on in August is the essential health benefits, or the minimum levels of coverage that insurance plans offered in the exchange must provide.

A working group from the exchange board has already recommended that the state base its essential health benefits on ConnectiCare's HMO plan, whose coverage offerings include 90 days of skilled nursing services and inpatient rehabilitation services per year and comprehensive services for autism patients.

Deciding which benefits will be required is significant because it will determine the cost of insurance plans offered in the exchange.

"The challenge for any state is to balance coverage adequacy with affordability," Counihan said. "It's a challenge because health insurance is so expensive."

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