Exchanges Represent Immense Opportunity And Potential Risk
Coming on the heels of last week’s deadline for states to inform the federal government of whether they intend to leverage a partnership health insurance exchange (HIX) or participate on the federally facilitated exchange, a study released today by
Healthcare industry experts view HIXs as central to the effectiveness of the Affordable Care Act (ACA) because they provide an online marketplace where consumers can shop for, compare and purchase health insurance. The
The potential upside for a health insurer participating in an HIX is significant. According to a
The special report, “HIX Insights from the 2013 Healthcare Mandate Summit,” includes survey results from more than 125 senior healthcare professionals attending the 2013 Healthcare Mandate Summit that took place
Key findings from the 2013 Healthcare Mandate Summit special report on HIX include:
• Health insurers recognize the HIX opportunity and are taking preparations very seriously. When asked about their plans for participating in an HIX, 80 percent reported they plan to participate on an exchange in 2014—the first year HIXs will offer coverage and expected to be one of the largest open enrollments in history. When asked about meeting the
• There is an urgent, immediate need for more information sharing and collaboration among health insurers and the HIXs they plan to join. Like any major business or technology project, transparency with stakeholders is imperative. However, most of the survey respondents reported a lack of good information coming from the state exchanges they are targeting for participation. Sixty-nine percent rate the quality of information as “poor” or “very poor.” In addition, an overwhelming 93 percent expressed a strong desire for exchanges to solicit input from them on how to define and operate their enrollment processes.
• Health insurers are far more concerned about the ongoing challenges of operating on an exchange than the process of actually joining one. Each state has considerable leeway in determining how it will run its exchange, which means health insurers operating on multiple state exchanges face the daunting task of supporting multiple exchange formats and added levels of complexity. Just over 31 percent of those surveyed indicated they plan to participate on three to five exchanges, with another 15 percent planning to participate on more than eight.
“The message we heard from Summit attendees is that while compliance with mandates such as Health Insurance Exchanges is no easy feat, there are considerable benefits to be gained, including increasing member enrollment,” said
To download the report, visit http://www.edifecs.com/downloads/2013SummitSpecialReport_HIXs.pdf .
About the Report: “HIX Insights from the 2013 Healthcare Mandate Summit”
The survey was conducted among health insurers and healthcare provider attendees of the 2013 Healthcare Mandate Summit, an industry conference hosted by Edifecs that took place
The survey is not based on a probability sample, and therefore, no estimate of theoretical sampling error can be calculated. All decimals in this report are rounded to the nearest percentage point. This may result in certain numerical totals adding up to slightly more or slightly less than 100 percent.
The estimates and opinions expressed in this report are based on the survey results only, and the results do not purport to represent all entities or professionals in the healthcare industry.
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.
Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.
Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of
1 CBO, “Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the
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