A key component of the Affordable Care Act (ACA) is the Health Insurance Exchanges or marketplaces where consumers will be able to purchase affordable health care plans in their respective states. The implementation of the ACA has resulted in many challenges, and the exchanges are no exception. This session discussed the various issues in implementation, including barriers to enrollment, cost containment and consumer choice. The session included speakers from the federal government, state health departments, and independent consulting firms.
Rogelyn McLean, from the U.S. Department of Health and Human Services Office of General Counsel discussed the importance of protecting consumer information. She emphasized that while there may have been some setbacks in the implementation of the Health Exchanges; there were some milestones that should be recognized. Before the ACA, there were no standards for privacy and security of health information amongst the various stakeholders. The Department of Health and Human Services created the first set of standards to mitigate the potential risks associated with safety and privacy of health information submitted to the Health Exchanges. She also recognized that the importance of safety and security of consumer health information has led to new partnerships between parties that have not traditionally worked together.
McLean discussed the clauses of the law that discuss information sharing as well as the requirements that must be followed if using consumer information from the Health Exchanges. She noted that any infrastructure as complex as the Health Exchanges is difficult and will take time. Ensuring privacy and security will be a major challenge. For example, when a navigator such as a community health center is assisting a consumer in choosing a health plan, they too will have to follow the information sharing procedures and robust security controls. The current proposals that the Department of Health and Human Services has created provide some flexibility in these situations; however, any flexibility should ensure that the protections afforded under the ACA will still be in place.
While McLean discussed the federal perspective, Richard Onizuka, from the Washington Health Benefit Exchange, provided the state level view on the implementation of Health Exchanges. Washington State’s Health Exchange is a state based exchange with a public-private partnership. The Exchange went live on October 1, 2013. Some of the successes that Washington State reported included high enrollment numbers, effective marketing campaigns, strong support from stakeholders, and stable system performance. Onizuka noted that three days after the Exchange opened; the website had few problems in enrollment. However, there were challenges such as long call center wait times, issues with renewals for Medicaid, and providing the best user experience. The state did not anticipate consumers using the website as a “calculator” for Medicaid, or the heavy volume of callers.
In order to succeed in rolling-out the Health Exchange in Washington State, Onizuka noted that bi-partisan support was key. He also highlighted the importance of effective governance, balancing system fixes with stabilization, understanding the importance of a call center, and recognizing that the Exchanges will continue to be a work in progress.
In contrast, Erica Pham, from the Kaiser Foundation Health Plans discussed the challenges of the Health Exchanges from an insurance company’s perspective. Kaiser Permanente is involved with Washington State, Oregon, California, Colorado, Hawaii, Maryland, DC, Virginia, and Georgia’s state Health Exchanges. As a result, Kaiser Permanente has had to create 8 different ways to handle billing and administrative infrastructures to meet the needs of the different states; this has been an incredible challenge. There have been lag times in processing enrollments, sometimes up to two months, which has been confusing for consumers. She noted that Kaiser did not expect the process to be perfect in year one, and would like to see the process improve by 2016, after the small business Health Exchanges have opened.
The last speaker, Daniel Schutyler from Leavitt Partners, LLC discussed his experiences with the health information technology department with Utah’s Health Exchange. Utah’s Exchange is a small-business exchange; employers provide employees a set amount of money to put towards the available plans. Schutyler noted that Health Exchanges are one of the most complex IT projects ever initiated by the federal government, and challenges would be inevitable. He highlighted the various aspects from the IT end that were expected to work flawlessly when the Health Exchange was rolled out; it was simply not possible for all of the components to work in a short time period. As a result, on October 1, 2013, there were some system failures. Enrollees in Utah had trouble registering and the sites could not handle the volume of visitors. He also recognized that a common IT issue across states has been processing Medicaid enrollments. Schutyler has a lot of confidence that Health Exchanges will eventually be an easy and effective process. He expects to see significant improvement in the next year and a dramatic increase in enrollment.
The question and answer session provided the speakers an opportunity to further share their experiences with the Health Insurance Exchanges. Participants were especially interested in hearing about the type of data that will be generated from enrollments and how they can help other states that have not yet decided to run their own exchanges. There was also a discussion about the need to reconcile enrollment files and payment files, which have caused massive delays for both consumers and insurance providers.