Insurers: Health Care Exchange Customers Using More Medical Services

Sep 23, 2016

Customers on Connecticut’s health care exchange use medical services at a much higher rate than non-exchange customers, according to insurance providers. 

Both Anthem and ConnectiCare, the two insurers who will offer plans next year, offered data on how their members are using services during a meeting of the Access Health Connecticut board. 

Deremius Williams of Anthem said on-exchange customers use healthcare services about 40 percent more than non-exchange members.

"In our third year, we're now getting the opportunity to delve into the data in a way that allows us to evaluate it more specifically," she told the directors. "And in particular [we] see the difference between that on-exchange versus off-exchange experience. And it really is remarkable what that difference is generally across multiple categories of services."

Williams was asked whether this was an effect of people who had previously not had access to care being able to seek services for the first time. But she said the reasons aren't yet clear, and Anthem is still investigating what lies behind the disparity.

Meanwhile, Dr. Wayne Rawlins of ConnectiCare said their data shows several trends.

"We know that preventive care is key," he said. "And we're finding the exchange members have some barriers to getting this preventive care. Cost is obviously an issue with high deductibles and sometimes costs which are hard to predict or unaffordable for some people."

He also believes the novelty of insurance could be a factor. "Many people may not have experience with the health care delivery system and how to use this insurance benefit."

Both insurers have hiked rates for their plans on and off the exchange for next year. A recent analysis by the Urban Institute showed that on-exchange rates in Connecticut are about one percent lower than those off the exchange this year, excluding the government subsidy offered to exchange members.

That's a much smaller difference than in general around the country; on average state exchanges offer rates that are 10 percent lower than general rates.