The healthcare industry has seen tremendous change and growth in the recent past. With healthcare reforms implemented, the dynamics of the industry has seen volcanic change that drives the need of custom automated solutions for healthcare companies.
Health insurance exchange platform is something that everybody related or concerned about healthcare industry is excited about. How it is going to be created; how it is going to function; how it would be effective in bringing down the costs; how it would come true to the promises it holds; how it would ease the purchase of affordable health insurance—all these questions make an exciting conglomeration in the minds of consumers,
healthcare companies, state authorities and, of course, the companies who would facilitate the creation of these marketplaces.
The obligation lies on every state to create a marketplace that could facilitate purchase of health insurance plans at an affordable price. The marketplace itself holds multiple objectives that intend to operate in the favor of consumers. Overall, healthcare companies have to reduce their administrative costs significantly and compensate for the loss in premium of health insurance plans.
What hangs on the Health Insurance Exchange Platform?
Every state must launch health insurance exchange to comply with the requirements of the Patient Protection and Affordable Care Act. This exchange should allow eligible state residents to search for, choose and buy health insurance, and small businesses to pool together to reduce their insurance costs.
There are two deadlines that need to be met by the states obligated by the Department of Health and Human Services:
1. “Readiness determination” deadline of January 1, 2013
2. Exchange “Go live” deadline of January 1, 2014
Surely, these deadlines throw a heavy burden on the state authorities who might feel the pressure due to lack of resources, proper infrastructure to carry out the plans, perhaps the lack of knowledge/understanding as how to execute what is required.
Let’s talk about some features that a health insurance exchange needs and state authorities should focus on to create:
1. The health insurance exchange should help state residents find an affordable health plan that meets their specific needs with ease. This should be the core functionality for the exchange eliminating or significantly decreasing the need of face-to-face interaction with agents or brokers.
2. The health insurance exchange should help small businesses find affordable health plans that meet the needs of their employees in accordance with the Small Business Health Options Program (SHOP). Without doubt, this feature adds tremendous value to the functionality of health insurance exchange platform as the number of small businesses in the country is significantly large.
3. The health insurance exchange should offer or facilitate a simple, easy-to-understand experience designed for individuals who possess little or no knowledge of health insurance. This is where software or automation intelligence will come into play. Software companies will have to develop potent logic for creating such automation.
4. Ideally, the health insurance exchange should be able to operates cost-effectively and eliminate administrative complexity. In every department, administrative complexity and bottlenecks are bound to happen. However, the exchanges should work hard to eliminate them ab initio.
5. At the end, the health insurance exchange should comply and meet all Federal and State regulations and timetables without fail.
With these features in mind, states can call on private and non-profit collaboration for the development of health insurance exchanges. The online setup of this marketplace should be able to give some real-time control at the back-end and facilitate ease at the front-end. Some necessary features could include:
1. Admin control panel allowing addition and editing of health plans, rates, etc.
2. Eligibility check for the plans and consumers.
3. Quoting engine with broker-like intelligence.
4. Enrolment facility for consumers, health plans, etc.
5. Integrated agent portal for agent management and functionality.
6. Payment options through credit cards, debit cards, and HRA and employer collection facilities.
7. Reports of metrics for agents and consumers.
8. E-apps like e-sign, printing of application forms, etc.
Without doubt, health insurance exchanges are not a one-day task that states could complete. There is whole lot of planning and thinking that needs to be put in to create a blueprint for the creation of health exchanges. State authorities will have to put in the best efforts to create these health insurance exchange platforms.
