HIEs Struggle to Catch On (Part 2)

by webadmin on February 18, 2013

On Friday, we looked at how a total of 32 states missed the Feb. 15 deadline to set up their own, state-run health-insurance exchanges (HIEs).

Now that the deadline has past, the government must become intricately involved in state healthcare, essentially running the show as they set up exchanges in these 32 states (the only exceptions being seven states that have agreed to partner with the feds on exchanges).

Setting up over two dozen HIEs before the launch date in October 2013 may seem impossible, but Doug Desjardins at HealthLeaders Media reports the feds are optimistic about meeting the deadline. Nothing is set in stone yet, but speculation holds that the government will establish a single portal through which consumers can access the insurers and health plans in their state and area.

As you can probably imagine, it’s not easy for the state or federal government to set up an HIE. Tech firms have stepped up to the plate, though, and embraced the challenge with fervor.

Take for instance California, who was one of the early adopters of HIE and began to make plans for it soon after the 2010 PPACA legislative victory. The California HealthCare Foundation (CHCF) and Palo-Alta technology firm IDEO, along with non-profit groups such as the Robert Wood Johnson Foundation and the New York State Health Foundation, united to develop the $3-million Enroll UX 2014, “a template,” Desjardins writes, “that state and federal officials are using to create their own exchanges.”

Enroll UX 2014 developers consulted with 11 states, the Office of the National Coordinator for Health Information Technology, and the Centers for Medicare and Medicaid Services (CMS), an effort that CHCF vice president of programs Sam Karp called “bi-partisan” and “included states like Alabama and Tennessee, which have decided not to set up their own exchanges but will leverage some of the design elements of Enroll UX to improve their online Medicaid websites. And that’s the goal of the program; to provide states with a starting point and some ideas about how an exchange can work.”

According to Desjardins, Enroll UX 2014 is a “roadmap” of sorts, “designed to provide consumers with a website that’s user-friendly and intuitive, with simple, direct questions posed in chronological order.”

As Karp describes it, Enroll UX 2014 sounds exceedingly simple. He said the first question consumers will be asked is, “Who is your current doctor?” The program will then provide a list of insurance plans accepted by that doctor from most affordable to least affordable.

Enroll UX 2014 is but one of the HIE templates being developed by such renowned technology firms as IBM, CGI Technologies and Solutions, and Accenture. Desjardins observes, “Since all health-insurance exchanges are required to follow the same guidelines outlined by the PPACA, most will share a similar infrastructure.”

While the infrastructure is being established, the states are detaching their health officials to recruit insurers “to sell their products on the exchange” and craft “plans to set rates,” Desjardins writes, with the rates being “based on economies of scale.” “In California, which will operate the largest exchange in the nation, state health officials have received bids from 33 different health plans interested in selling insurance plans on its Covered California exchange.”

Ease of use is the goal that all involved are pursuing. To that end, many states, such as Maryland, will incorporate “their Medicaid enrollment plans into the exchange to create a single destination for all enrollees.”

What are your thoughts on HIEs? How will HIEs (negatively or positively) affect the functions of your organization?

-by Pete Fernbaugh

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