Phila. startup aims to help people through Affordable Care Act

The Affordable Care Act is working. More than eight million people - many for the first time - have signed up and are covered by health insurance.

But that doesn't mean that choosing a plan won't be hard and frustrating. It is, especially for first-time buyers.

Plans are divided in bronze, silver, gold, and platinum tiers, and are loaded with unfamiliar and confusing terms - monthly premium, annual deductible, co-pay, coinsurance, out-of-pocket maximum, pharmaceutical formulary, network.

Settling on the right plan - HMO or PPO? - can be difficult, especially when drugs and doctor networks are taken into account. What consumers need is help in narrowing their options to the ones that fit their needs.

Now a company is developing technology to do just that.

Picwell, a Philadelphia-based start-up, has launched its predictive analytics platform that aims to help consumers pick the plan that's right for them. But the company isn't releasing its proprietary online system to the public until February or March 2015.

"It won't be available for this open enrollment," said Jay Silverstein, Picwell's CEO. "We will be rolling the product out into the active state through the course of 2015."

Folks who need help sooner can get it the old-fashioned way: hooking up with a navigator by calling 877-922-2377 in south Jersey or 866-761-0626 in Pennsylvania or by going through the main Affordable Care Act website, healthcare.gov.

Picwell aims to offer another way. Founded just over a year ago by a group of University of Pennsylvania Law and Wharton School professors, the firm has developed software that analyzes 900,000 plan selection variables, including public and private claims and lifestyle data. Combined with its real-time survey information that keeps prices current and machine learning, the technology can narrow plan choices for each person.

"These capabilities are tools being deployed in so many walks of life. Why shouldn't we integrate them all and apply them to one of the biggest purchasing decisions each individual makes every year?" Silverstein says.

During the last year, the team has refined the technology focusing on keeping things simple. Consumers have only a handful of questions to answer, such as name, age, zip code, what medications they take, and whether they want plans sorted by participating doctors and hospitals.

The program continually refines the correlations between tens of millions of claims, both drug and medical, Silverstein says, so that consumer costs are "statistically credible down to a local level, married to behavioral and lifestyle segmentations."

The system ranks the plans: Green is best; yellow, middle of the road; red, not for you. It also gives consumers each plan's real monthly costs while also factoring in things like lifestyle, preference, and risk tolerance.

"So you can sort the plan by fit ranking and by the real cost," Silverstein says. "We are building satisfaction studies into the plan so you will be able to also rank plans by favorability by people like me."

The best plans are those that are one in fit, Picwell ranking, and favorability. "That's kind of like cherry, cherry, cherry - bingo," he says.

Picwell is an independent, free-to-consumer technology company. It doesn't sell health insurance or generate any brokerage fees. The company is currently talking with several state exchanges, insurers, and employers interested in its technology. It also has had "very early" discussion with the Department of Health and Human Services for use on healthcare.gov.

In the meantime, Picwell has signed a partnership agreement to integrate its technology with Aon Hewitt, the global retirement and health solutions company. Clients of Aon's 300,000 member Retiree Health Exchange will use the tool to help narrow their choices of Medicare products.

While Picwell's product won't come online until next year, Independence Blue Cross customers can use a simpler tool on the insurer's IBX4you.com member site. The company's tool, limited to Independence plans, has been on its website since last October.

"Our goal was to say, what is it that you are looking for in a plan," says Paula Sunshine, Independence's vice president of sales and marketing for consumer business. "The first thing you are going to do is answer questions about your plan preferences."

The questions range from premium and deductible amounts to the number and type of prescriptions a consumer expects to fill and whether or not they expect to visit an emergency room or urgent care facility.

"We are able to narrow down their options from 13 plans to the three best matches," Sunshine says.

When healthcare.gov got off to a shaky start last year, Independence decided not to embed its Guided Shopping Experience on the site. Still, nearly 30,000 customers used it to help them select plans. The insurer expects more people to use it this year.

This article was written in partnership with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.