Most insurers are taking what Bertolini described as a "prudent approach" to the products they offer and the HIX markets where they participate. Cigna, for example, has HIX offerings in only five states (Arizona, Colorado, Florida, Tennessee, and Texas). Any expansions will be carefully considered.
Insurers say they are seeing a marketplace shift to private HIX as employers convert their self-funded plan memberships to defined contribution models and become fully insured plans. The upside for employers is that private HIX can be used by employers to transition to a defined contribution strategy where the employer puts a cap on how much to spend on employee healthcare benefits.
The upside for insurers is that fully insured membership typically generates four to five times the profit contribution of self-insured membership. In addition, large group employers are moving their retirees and Medicare-eligible employees into private exchanges for their Medicare benefits.
UnitedHealth expects to offer products on a private HIX, but also sees opportunities through its Optum subsidiary in providing a platform (myCustom Health) that can be used by payers, providers, state governments, employers, and other businesses developing exchanges.