Now that the Department of Health and Human Services (HHS) announced the proposed rules for Affordable Insurance Exchanges earlier this month industry experts say, it’s time not to reinvent the wheel, but to borrow on IT infrastructures that health information exchanges (HIEs) have already built or are building. One proponent of leveraging preexisting synergies between insurance and information exchanges is Scott Devonshire, CIO, Massachusetts Health Connector, the state’s health insurance exchange.
On July 11 HHS Secretary Kathleen Sebelius announced proposed legislation that mandates states create marketplaces for consumers to compare and shop for different health insurance plans. Sebelius said that states would have the flexibility to design their own exchanges and there was no “one-size-fits-all solution.”
Massachusetts got an early start on its insurance exchange as a part of its health reform law in 2006. In 2010, about 98 percent of Massachusetts residents had health insurance, including 99.8 percent of the state’s children. Much of its coverage provisions, like subsidized coverage options for people with low and moderate incomes, became the basis of the federal Patient Protection and Affordable Care Act (PPACA), enacted in March 2010.
In February HHS awarded $241 million in “Early Innovator” grants to Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin, and a multi-state consortium led by the University of Massachusetts Medical School to pioneer IT infrastructure around health insurance exchanges. The University of Massachusetts Medical School received $35.6 million on behalf of the New England States Collaborative for Insurance Exchange Systems (NECSIES), of which part will fund an in-depth analysis of what the Health Connector will be able to reuse and what will be additionally necessary to comply with the 2014 PPACA requirements. One of the first items the organization is trying to nail down is the policy and technology requirements of a real-time integrated eligibility system, which as Devonshire says, many states are struggling with.
All-Payer Claims Database
One way Massachusetts’ Division of Health Care Finance and Policy (DHCFP) plans to leverage common HIE ground is to work with health insurance carriers to develop an all-payer claims database. “It’s going to be a pretty robust tool to capture claims data and have some provider directory information,” Devonshire says. “It’s a tremendous undertaking just to get some consensus on how to do this.”
He says that this would create a central hub for all interested parties like public health agencies, health plans, etc., to go to for information to support the insurance exchange. This would also allow for one common transmission method for carriers instead of customizations for each insurer.
At an HIX/HIE panel earlier this month at the eHealth Initiative 2011 National Forum on Health Information Exchange, representatives from states spoke about the synergies can be derived from collaborating resources between state HIEs and HIXs. Both Kim Davis-Allen, statewide HIT coordinator, Alabama Medicaid Agency, and Edward Dolly, deputy commissioner, state health information technology coordinator, West Virginia Bureau for Medical Services, said that their states were leveraging resources and lessons learned from their HIEs to drive planning for their health insurance exchanges. Davis-Allen noted that if an HIE has good population data, this information can be translated to the HIX, so patients can see which health plans are best for them and health plans can additionally use that population data to structure better benefit packages to speak to the populations they serve.
Devonshire hopes that his organization can capitalize on its early success, and go even further by using its information for risk management capabilities and models for the Health Connector. He also says Massachusetts plans to embark on a publicity campaign, partnering with the Boston Red Sox, using radio ads, TV spots, and direct mail to educate the public on changes in the HIX in light of future ONC regulations.
As with HIEs, there is no tried and true path to sustainability, and it has yet to be seen how prescriptive the PPACA regulations with be around financial options. Devonshire says he believes it’s a shared responsibility and collaborative engagement between his state’s private insurers and public interests, along with government support. The Health Connector is currently funded through an administrator fee per plan that is agreed upon with the carriers. Devonshire predicts that future options could entail premium billing services for individuals and small groups purchasing through the exchange and provider contracts.
Devonshire is excited about a few new tools his exchange is launching. One is an integrated search, for consumer to shop for plans by providers and by hospital networks. “It’s something that as far as we know has never been done before,” he says. “It’s going to be a huge boon to consumers, who may not be just shopping by price or benefit, but want to understand which doctor is available for which plan.” The Health Connector recently implemented a wellness program for small businesses, funded by a state-authorized 15 percent subsidy per employee toward employers’ premiums.