In the second installment of a three-part series on successful models of health insurance exchange deployments, we took a closer look at a thriving example of a State Health Insurance Exchange (HIX) in action, implemented by Microsoft partner bswift
, a software and services provider for employee benefits administration.
While many states are beginning to address the initial planning stages of HIX implementation following the Supreme Court’s ruling on the Affordable Care Act, the Utah Health Exchange
is an example of a working solution that is already providing access to healthcare for 6,000 individuals, 29% of which were previously uninsured. For Utah, the initial focus has been on the 54,000 small businesses that comprise the majority of the uninsured in the state, although working to expand their services to large employer groups as well. To help small businesses overcome the restrictions facing them in the traditional market, the Utah Health Exchange allows small businesses to provide their employees with health insurance options, while also providing a flexible setup to employees that enable them to take better control of their health and make informed healthcare decisions.
We connected with Patty Conner, director of the Utah Health Exchange, for more details on their state HIX solution.
Microsoft: Can you explain how this solution is tailored to your small business target audience?
Patty: Our exchange is more than a buying portal for accessing insurance, it creates a new and unique marketplace for small employers built around the concept of defined contribution. The idea is that the employer offers each employee a benefit allowance which the employee applies toward the cost of any one of a large variety of insurance products offered by multiple insurers under a group insurance arrangement. No employees are denied coverage or discriminated against based on health conditions since the products are under small group insurance rules.
Employees have a real choice about the amount of risk they want to take in their benefit design, and about provider choice or access. The Utah Health Exchange eliminates the old challenge of having the small business owner decide which doctors or hospitals would be available to the employees in the network. Now, the employees can search the system by provider and find a health plan that includes the providers they want.
The employer enjoys the convenience of consolidated billing so they don’t have to worry about dealing with multiple bills from each insurer every month, and the employees and the corporation both retain tax advantages that apply to group insurance. Also, the corporation feels less pressure at renewal time to match the premium increases of any given plan since the marketplace offers many plans.
Microsoft: What did it take to implement this HIX solution from a technology perspective?
Patty: We didn’t have any guidelines from the federal government or a roadmap to follow from other states, so we encountered a number of policy issues we had to grapple with before diving into the administrative issues. Over the course of the first year, we conducted a beta version of our exchange with a select, small group of participants, giving us the opportunity to work through any administrative questions and to think through how we could enhance processes from a technology standpoint. This centered on coordinating and providing automated, cost-effective functionality around communication, enrollment, eligibility, and data exchange – including shopping tools to allow consumers to effectively evaluate plans.
Also, for the broker community that navigates through the application and enrollment process for the employees, we created different broker portals and built functionality that allows them to segment processes so they can see what’s been completed, what the next steps are, and the final results once their group is successfully enrolled. Once we worked out these questions in the beta version, we re-launched the exchange and opened it up to new groups.
Patty: We were able to leverage the experience and expertise bswift has with enrollment and eligibility in the HIX space, so we didn’t have to build from scratch. Moreover, Microsoft's State Health Insurance Exchange solutions, specifically, using Microsoft SQL Server and the Microsoft .NET Framework, provided us with a solid basis to build off of and interact with other vendors and technologies. We are looking at utilizing various private sector and state technologies, so having a platform that enables us to interact with these technologies is a critical consideration.
Microsoft: What are your next steps or goals for the solution?
Patty: We are always working to fine tune the process, particularly to enhance the user interface and streamline the user experience. Furthermore, we are also preparing to make systems and processes compliant with requirements outlined by the Affordable Care Act – which means we intend to expand beyond the small business market to individual and Medicaid markets, so these will be components of our exchange in the near future.
The implementation of the Utah Health Exchange and their continued efforts to fine tune and expand their program is a successful example of how states are working to provide viable coverage options to the uninsured and drive better health outcomes. Next week, stay tuned as we explore a different approach taken by the state of Nevada and changes in the HIX market with our partner ExtendHealth.