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 Health Insurance Exchanges

The Nevada solution

Expected benefits also translate into potential challenges for health insurance exchanges.

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   By Kevin Walsh, March 2013

The Supreme Court’s decision in June 2012 to uphold the Affordable Care Act (ACA) put states on the clock when it comes to developing health insurance exchanges (HIXes) and consumers in the driver’s seat when it comes to health insurance decisions.

States are more focused than ever on meeting the deadlines that outline HIX implementation progress – determining a strategy, selecting vendors, making design plans and having discussions with participants to ensure they will be able to enroll. There is little margin for error in getting an exchange ready for open enrollment by October 2013, fully operational by January 2014 and self-sustainable by 2015.

On top of deadline pressure, many states are prioritizing the development of an exchange that is simple for healthcare consumers to navigate. Healthcare.gov states that HIXes are designed to make buying health coverage easier and more affordable. Exchanges allow individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs and enroll in a health plan that meets their needs.

The expected benefits of an exchange also translate into potential challenges for states that have chosen to set up their own HIXes. These states will need to work through a number of steps to ensure they are creating a consumer-friendly experience, addressing the underlying technical issues, connecting all necessary parties and complying with associated regulations.

The Nevada plan has five goals, each of which comprises detailed objectives:

  • Increase the number of insured persons in Nevada;
  • Facilitate the purchase and sale of health insurance;
  • Assist employers in the enrollment and purchase of health coverage and the application for subsidies for enrollees;
  • Provide consumer education on matters relating to enrollment in – and effective use of – health insurance; and
  • Assist residents of Nevada with access to programs, premium assistance tax credits and cost-sharing reductions.

To meet ACA deadlines and work toward strategic goals, Nevada chose Xerox’s cloud-based HIX Solution Suite, which provides a user-friendly online portal where individuals and small businesses can compare and purchase health plans.

The Nevada Exchange acts as a bridge between public and private healthcare and other human services IT systems. Nevada’s eligibility system (run by the state in cooperation with Deloitte) is its main location for welfare and Medicaid systems information, and it sits on one side of the “bridge.” On the other side is the healthcare enrollment-related business operations system (BOS), run by Nevada’s HIX Board and supported by Xerox and Choice Administrators.

Among Xerox’s tasks for Nevada is to create a single point of entry for the state’s existing Medicaid and CHIP programs as well as its new Eligibility Rules Engine. The Nevada Exchange will connect the eligibility and healthcare systems and allow them to communicate with each other through several interfaces. In this way, all public and commercial program application, eligibility and enrollment will come through the exchange, making it the central hub for all the state’s eligibility decisions. This makes it easy to see how HIXes can serve as bridges between systems and important facilitators for streamlining and speeding health plan purchasing.

Efficiency and savings are also driving forces behind the Web portal and online selection tool that Xerox, in conjunction with Choice Administrators, will develop and operate for Nevada. Because these critical elements of an HIX are part of Xerox’s cloud-based software-as-a-service (SaaS) model, states pay only for the services they need, without substantial investment and ongoing maintenance costs for dedicated hardware and infrastructure. Xerox will also manage a customer contact center for the Nevada Exchange.

The Exchange designed for Nevada uses proven solutions from the commercial marketplace and will create a more consumer-friendly experience. It was a priority to implement a service that is easy to use and supports the objective of increasing health coverage. Xerox also gives Nevada the flexibility to maintain control over the exchange and its insurance market, while building in customizations without sacrificing timeliness.

Planning ahead was key for Nevada to have its exchange ready for the October 2013 deadline to initiate enrollment. The Nevada Exchange has received conditional approval from CMS (the Centers for Medicare and Medicaid Services) and CCIIO (Center for Consumer Information and Insurance Oversight) for the operation of a state-based exchange in Nevada. To date, 24 states and the District of Columbia have submitted plans to run state-based exchanges. The Nevada Exchange will be open for business in October 2013; health insurance policies purchased before Dec. 15 will start coverage on Jan. 1, 2014. HMT

About the Author

Kevin Walsh is senior vice president and managing director, healthcare eligibility and exchange services, Xerox. For more on Xerox: www.rsleads.com/303ht-206


Tags:  Health Insurance Exchanges