Establishing Successful Healthcare Insurance Exchanges

Healthcare Insurance Exchanges, the online market places scheduled to launch on January 1, 2014 will be designed to provide low-cost health insurance options to millions of uninsured Americans. While the exchanges will give buyers more flexibility and control over choosing their insurance plans, they will also promote more transparency and competition among health plans. The Health Insurance Exchanges once launched, may alter the face of the ailing U.S. healthcare industry.

However the U.S. states need to rise up to the challenge of meeting the federal deadline of setting up fully operative exchanges by January 1, 2014. Not only that, the U.S. states have been mandated to submit a well-structured proposal by January 1, 2013 - outlining the design the state exchanges will operate on.

With both the deadlines slowly edging closer, states need to gear up in their HIX efforts to propose at least a basic plan of how their exchange will operate. While Massachusetts and Utah already have functional state exchanges, their modus operandi is entirely different. States may create their exchanges completely in line with either of these designs or may amalgamate the best features of both to come up with an innovative, unique design. In all scenarios, time is of essence if the states don't want the federal government to step in and run its own exchange.

Establishing an exchange from scratch takes time, more so when there are not many already functioning models available for guidance. Many aspects of setting up a viable exchange will need to be properly attended to - compliance procedures, front end and back end technology set ups, ready to launch software applications or portals etc. All the aspects of a HIX will need to integrate perfectly before an exchange can even take off. Most importantly, the work doesn't stop here. Apart from continuous maintenance and resolving inadvertent technical glitches, the basic model may need to be revamped and redesigned over time, to effectively service consumers' growing requirements and expectations.

There are four vital principles that will need to be kept in mind while designing successful and fully operational health insurance exchanges

1) Flexible and Scalable structure - The exchanges will need to have a flexible architecture to accommodate changing business needs and will need to be scalable to cope well with growing business needs.

2) Smooth exchange of data - The exchanges need to be so designed that they can handle tons of data without losing any data or breaking down. All the exchanges set up in U.S. states should be so designed to ensure smooth integration of applications and efficient exchange of data among various healthcare entities.

3) Simple and easy interface - For all their refined technology and sophisticated processes, the Health Insurance Exchange will not be successful unless what they are selling is understandable to an average American. The exchange will need to break down the complex processes into user friendly applications which are simple to understand and easy to use. The individuals buying insurance off the exchanges should be able to search, compare and take an educated decision before applying for a plan that fits them.

4) Secure - With hundreds of thousands of data being exchanged at any point of time, the HIX model will need to comply with HIPPA, ACA regulations and all other security protocols. Exhaustive measures will need to be employed to prevent any theft of highly sensitive consumer data.

The HIX will need to fulfill a lot of complex design regulations but at the same time will need to be simple enough for every American to understand. The task is indeed daunting, but with collective and dedicated efforts, it will gradually take shape.

Author is a well known authority on health insurance in the US. He is currently looking to expand his expertise in state health exchanges and Health insurance exchange available.