State health insurance exchanges, to be built by 2014 under the Affordable Care Act (ACA), may prove to be good for vendors who provide consulting services on how to make customer service available on health plan websites, experts say.
On July 11, the Department of Health and Human Services (HHS) released the proposed regulations for state health insurance exchanges, a key part of the healthcare overhaul. States have until the end of 2012 to demonstrate that they have a plan in place.
[See also: HHS unveils proposed health insurance exchange regs.]
To date, only a few states have exchanges in place, including Massachusetts. The Commonwealth Connector – the online marketplace for Massachusetts to support state-wide healthcare reform – was created in 2007. When Massachusetts began the process of healthcare reform implementation in April 2006, they were operating in uncharted territory.
Greg DeBor, a partner at Falls Church-Virginia-based CSC Healthcare Group said the health IT industry is still trying to digest the proposed rule to determine whether there's a role in it for them.
In the individual health plan market today, very few health plans have advanced-enough service to offer a consumer the ability to purchase insurance directly online, according to DeBor. This is the capacity that state health insurance exchanges will have to provide under ACA, and this will open up a whole new vendor marketplace for health IT vendors that can help health plans gain this capacity, he said.
DeBor helped to build the Commonwealth Connector, the online marketplace Massachusetts began to use in 2007 as part of its state-wide healthcare reform.
Jordan Battani, a principal with Global Institute for Emerging Healthcare Technologies at CSC said some of the confusion about what the exchanges will do is leaving it unclear to vendors as to what kind of services and products will be needed.
"The simple way to think of it is to compare the exchange to a consumer website like Travelocity," she said. Potential beneficiaries will log on to the exchange and will search for products and find doctors in network. States will be "scrambling around" to build this capacity within the next two years.
[See also: PwC: Insurance exchanges will empower consumers, create $200B market for payers.]
As far as the impact of exchanges on providers, Battani said hospitals will feel the impact in their reimbursement process. Medicaid agencies are going to be spread pretty thin trying to build technology for exchanges. "The agency will be very busy and distracted," Battani predicted.
DeBor said the exchanges will have an impact on physicians as more patients flood the market and compete for the limited physician resources. Physicians and hospitals might see a new demand from their patients to look for ways to deal with the anticipated 10 to 15 percent increase in number of people looking for a primary care physician.
Follow Diana Manos on Twitter @DManos_IT_News