Community First Expands into TX Affordable Care Act Marketplace

Community First Health Plans (Community First) is joining the Affordable Care Act (ACA) marketplace with the help of a member engagement technology company.

The payer’s move to join the Affordable Care Act marketplace will extend its health plan coverage to more individuals and families in South Texas.

Community First has served over 700,000 members in the San Antonio, Texas area for more than 26 years. The payer provides coverage largely through local healthcare providers and collaborates with community-based organizations to assist in member outreach and provide other health plan resources.

Using providers in local networks also helps members easily access affordable care and coverage. By working at the local level, Community First focuses on direct interaction with members to ensure positive health outcomes, according to the press release.

“We are in a unique position where we can blend the latest technology with local experience to offer high quality health and wellness services for our members,” Theresa Scepanski, president and chief executive officer of Community First, said in the press release.

The cloud-based technology company will help Community First manage new enrollees and billing procedures as the payer’s plans attract more members in the marketplace. The technology will also aim to improve user experience and help the payer stay on top of marketplace changes.

Leveraging these strategies, the payer intends to reduce spending on administrative processes and lower the administrative burden, the press release noted. Softheon, the technology company, will also relieve Community First of completing regulatory and operational tasks, allowing the payer to focus solely on delivering quality care to its members.

Community First’s partnership with a technology company also is intended to improve member engagement for current and future enrollees. Other payers have partnered with tech companies to achieve this goal as well.

For example, Humana partnered with IBM Watson Health to help improve member engagement through the use of artificial intelligence. This strategy employed a virtual assistant to provide employers and plan members with benefits, costs, and provider information.

Similar to the technology company with which Community First is partnering, Humana’s partner used cloud-based technology to store healthcare data. This kind of technology can help health plans in a number of ways. In Community First’s case, it will assist the payer in transitioning to the Affordable Care Act marketplace.

The Affordable Care Act marketplace continues to expand, making it an increasingly desirable market for many healthcare payers.

There has been a substantial influx of payers compared to 2018 when the marketplace was considered unstable and many payers were leaving it. In 2019, the Robert Wood Johnson Foundation noted that payers such as Cigna, Bright Health, and Centene would expand their plans to the marketplace.

In the past year, Aetna has rejoined the Affordable Care Act’s individual health insurance marketplace. The major payer withdrew from the market in 2017, nearly four years prior to this announcement and before joining CVS Health. Aetna’s leadership cited market stabilization and resolved structural problems as the reasons for its return to the market.

Community First and Aetna are entering into a marketplace largely dominated by Blue Cross Blue Shield companies, according to a past Urban Institute report. However, in recent years, payers on the Affordable Care Act marketplace have encountered growing competition from Medicaid managed care organizations in the marketplace.

Nevertheless, smaller disruptors, namely Bright Health and Oscar Health, have posed some competitive threat in the regions where they offer Affordable Care Act health plans.

Community First’s members stand to benefit from the payer’s move to join the marketplace. Members’ healthcare premiums and deductibles have declined since the American Rescue Plan Act went into effect for Affordable Care Act marketplace plans. With more affordable plan options, individuals are expected to have better access to healthcare.