Thinking Strategically About Private Exchanges

As corporate health exchanges evolve, there are more factors to weigh

By Joanne Sammer December 8, 2014

updated 12/15/2014

Private health exchanges were first introduced to help employers outsource the administration of retiree health benefits. Then, spurred on by passage of the Affordable Care Act (ACA), leading-edge companies turned to a growing number of private exchanges to provide ACA-compliant group policies to their employees, using a defined contribution model.

“Private exchanges have become a new buzzword, but they are really a new take on an old idea,” said Jody Dietel, chief compliance officer at Wageworks. “First-generation private exchanges offered only medical benefits. Now, second-generation or maturing exchanges offer a variety of benefits,” including dental, vision and various kinds of supplemental health coverage.

The evolution of private exchanges means more options for employers and their employees, but more confusion as well. For employers considering whether a private exchange can help them achieve their employee health benefit goals, there are several important factors to keep in mind.

Cost Savings Not Guaranteed

Employers holding out hope that using a private exchange to provide health care benefits will lead to cost savings, or at least to better cost control, need to temper their expectations. “Private exchanges can help to offset costs in the first or second year, but there’s nothing about private exchange design that has been proven effective at ending the cost trend curve for health care costs,” said Rob Harkins, practice leader for private exchanges at Willis Group, a risk advisory and insurance brokerage firm. Shifting to a private exchange model “will not stop people from utilizing and accessing health care and, thereby, increasing cost.”

Instead, Harkins suggested that moving health benefits to a private exchange is just the beginning of a more involved effort to control costs. “You need to integrate other types of tools that can impact health care costs and mitigate the trend,” he said.

For the most part, it seems that employers understand that. The National Business Group on Health's 2014 Plan Design Survey of large U.S. employers found that only 11 percent were confident that moving health benefits to a private exchange would help control health care costs. Instead, these employers expect private exchanges to offer greater plan choice (77 percent), to help with regulatory compliance (51 percent) and to support a defined contribution approach to health benefits (49 percent). (For more on this survey, see the SHRM Online article Employers Adjust Health Benefits for 2015.)

Strategy First

At its most basic, a private health insurance exchange is a tool to help employers achieve their health benefits strategy. So the question of whether and how to use a private exchange depends on what that strategy is. “The starting point is where they are today with regard to benefits and where they want to go into the future,” said Harkins. “From there, they can determine what products and services they need and identify the best private exchange for their needs.”

“The biggest opportunities for private exchanges are where employers want to redesign their contribution strategy,” said Dietel. In fact, a key reason why employers are considering a move to private exchanges is to increase plan choice to facilitate a defined contribution approach to health benefits. Under this approach, an employer provides employees with a set dollar amount for health benefits that they can then use to purchase coverage on the exchange.

The biggest opportunities are where
employers want to redesign their
contribution strategy.


“Private exchanges are very valuable tools for an employer looking to manage its health care costs differently,” said Harkins. In this case, a defined contribution approach provides a level of predictability to health care costs, a key concern for senior management, particularly CFOs.

Because exchanges can offer more options than one employer would be able to manage on its own, employees in a defined contribution model stand a better chance of finding a health plan that meets their needs. These choices can include a mix of deductibles and levels of out-of-pocket costs, as well as plans with different types of provider networks. For instance, some employees may choose a high-deductible plan with lower premiums and a narrow provider network, while others might prefer to pay a bit more for a plan with a lower deductible and a wider choice of providers. This level of choice and flexibility, in turn, can increase employees’ satisfaction with their benefits—or at least minimize dissatisfaction for those who dislike any sort of changes to benefit plans.

Consider the Market

Among the 200-plus private exchanges in the marketplace, some specialize in retiree health benefits while others focus primarily on active employees. Some exchanges work only with large employers or fully insured employers, while others provide coverage tailored for self-insured employers. Some may only offer health plan choices from certain insurance carriers, while others may cast a wider net for plan options. And some are owned by insurance carriers themselves.

Evaluating exchanges begins with an understanding of the employer’s demographics and requirements. For example, an employer with a centralized workforce can include regional exchanges in its search, while a national employer with far-flung locations needs to work with one or more exchanges that can meet the needs of all locations.

Another key issue is pricing. An exchange that offers all of the bells and whistles can be tempting, but those bells and whistles probably mean added costs. Whether such an exchange should be on an employer’s list to consider would depend on how important those features are to the employer’s benefit strategy. For example, robust decision-making tools and technology that can help employees to navigate through the enrollment process will be more or less important to different employers, based on the sophistication of their workforce.

(For more critical factors to evaluate when selecting a private exchange, see the sidebar below.)

Changes Ahead

With so many private exchange options available, it is inevitable that there will be some level of consolidation through mergers and acquisitions even as new players continue to enter the market, industry watchers say.

Changes can also happen behind the scenes. For example, Aetna recently acquired bswift, which provides technology platforms to both private exchanges and employers. How this will impact the private exchange marketplace as a whole and private exchange costs in particular remains to be seen. However, this move follows on the heels of Aetna’s announcement that it will be launching its own private exchange in partnership with Sam’s Club, the member warehouse arm of Wal-Mart Stores. This is only one example, but clearly a major player like Aetna can have a significant impact on the private exchange marketplace.

For employers navigating this terrain, having clear objectives, carefully considered criteria for choosing an exchange and the willingness to conduct due diligence on exchange partners will be crucial to building a successful partnership.

Sidebar: Private Exchange Factors

Interest in private exchanges is increasing among U.S. employers as a strategy for full-time active and retirees, but the potential transition must address a number of critical considerations according to findings from the second annual survey sponsored by the Private Exchange Evaluation Collaborative (PEEC). The national survey was conducted in November 2014, with respondents from a variety of industries representing self-insured and fully insured employers.

While a small percentage of employers had implemented private exchanges for 2015 (6.4 percent for actives), interest in private exchanges as an option for their full-time active employees over the next several years remained high and one out of five respondents (20 percent) indicated they were considering private exchanges as an option for 2016, and 41 percent by 2018.

Critical Considerations

The increasing interest in private exchanges was not without a number of perceived hurdles, the highest of which were:

  • Employee readiness (cited by 84 percent of respondents).
  • Stability of carrier relationships (84 percent).
  • Loss of flexibility in plan design (78 percent).
  • Loss of control or stewardship (72 percent).
When asked to consider the importance of key elements of private exchanges for active employees, employers identified as “somewhat” or “very important”:

  • Delivery and reporting capabilities such as implementation assistance (93 percent).
  • Spending account program administration (89 percent).
  • Member advocacy (85 percent).
  • Enrollment and eligibility maintenance (85 percent).
  • Employer specific reporting (91 percent).

In an era of increasing administrative burden on benefits staff, employers also rate highly the importance of a private exchange to reduce the administrative burden on internal resources (85 percent).

Transparency and Choice

Employers placed high value on the following attributes of private exchanges for active employees:

  • Experience and track record (96 percent).
  • Transparency of fees and rate setting (92 percent).
  • Carrier/network options (89 percent).
  • Plan design choices (87 percent).

Among other survey findings:

  • Cost, cost and cost. In considering a private exchange for active employees, 98 percent of respondents said that the cost of plan options was “somewhat” or “very” important (up 5 points from the previous year). The “level of fees” was only 1 point behind at 97 percent (up 3 points from prior year).

  • Saving money and consumer choice were the top two reasons cited by employers who had already shifted to providing health benefits through a private exchange.

  • The importance employers place on the shopping experience saw sizeable increases: 85 percent said “tools that aid in plan selection” were “very important” (vs. 70 percent in 2013) and 35 percent rated “mobile device compatibility” as “very important” (vs. 26 percent in 2013).

Employers also reported less interest in public exchanges as options for key workforce segments with 67 percent say they are not considering such an approach for part-time employees and 84 percent not considering for their full-time active employees.

Assessing Early Results

“A number of the private exchanges have begun to share the results of early adopters for their enrolled active employee populations and the survey underscores the importance employers place on the experience and track record of an exchange” said Larry Boress, president and CEO of the Midwest Business Group on Health, a member of the collaborative.

Emma Hoo, director at the Pacific Business Group on Health, another collaborative member, noted, “Employers have taken a step back to assess the early implementation results and are seeking greater transparency in administrative, and consulting or broker fees to assure that employers and employees get better value. Many are not yet ready to relinquish control of key stewardship roles such as funding, carrier, plan design, provider network choice and even their benefits consultant.”

Joanne Sammer is a New Jersey-based freelance writer.

Related External Article:​

What Do Employers and Employees Really Think About Private Exchanges?, The Institute for Healthcare Consumerism, December 2014

Related SHRM Articles:

Private Exchanges Spur Health Coverage Shift, SHRM Online Benefits, September 2014

How to Evaluate Private-Exchange Options, SHRM Online Benefits, January 2014

Dental Benefits Evolve in an Exchange-Driven World, SHRM Online Benefits, October 2013

Time for Defined Contribution Health Benefits?, SHRM Online Benefits, September 2013

On Private Health Exchange, Choice Drives Satisfaction, SHRM Online Benefits, updated September 2013

As Employers Drop Coverage, Retirees Turn to Private Exchanges, SHRM Online Benefits, September 2013

How to Choose Health Insurance Exchanges, HR Magazine, October 2012



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