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Vision for health insurance exchange design gets a little clearer

Deltek Analyst Amanda White reports.

The inaugural Health Insurance Exchange Congress conference, hosted by the Institute for International Research (IIR) USA on November 9-11, 2011 offered considerable insight on the roles and functionality insurance exchange systems should provide to consumers. Anita Murcko, MD, and partner with Cambiare, LLC, identified three fundamental components of exchanges: a portal/website, an enrollment interface, and health plans. During her presentation, she also noted the importance of continuing to strive for meaningful use, and said insurance exchanges should be able to swap data with health information exchanges – this is a key reason why there must be an element of standardization with these various health IT systems.
Sarah Thomas, vice president of public policy and communications for NCQA, gave a presentation titled “Create a System for Health Plan Certification,” which described exchanges as opportunities to drive a “value agenda” that includes:
  • Choice architecture – nudging consumers toward best value options by paying attention to how consumers behave
  • Benefit design – fostering value-based designs that steer people to better options by integrating patient-activation tools
  • Network design – seeing quality and cost measures for tiering
  • Market makers – facilitating health plans as change agents supporting (with data) and driving (with payment) improvements in care delivery
According to NCQA, the projected 2019 exchange population is relatively older, less educated, has lower income, and is more racially diverse than the current privately-insured population. For that, Thomas stressed the need for quality measures for the exchanges, what she calls a “national starter set.” She believes that the same quality standards should be used nationwide and that the first set of measures should be feasible and enhanced over time. Moreover, these measures should ultimately align with national health improvement goals, Medicaid, Medicare and commercial strategies. Thomas reiterated the importance of setting quality measures by stating the need for auditing to ensure reliability and validity of results, which may require surveying to gather patient experience. As a result, vendors can count on opportunities such as quality assurance (QA) and independent verification and validation (IV&V) to come down the pipeline of these exchanges. States will be looking for proven results and evidence that the consumer experience with the portals is a positive one.
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