The seemingly millions of tasks for payers to be ready for the roll out of health insurance exchanges should be steadily shrinking as October swiftly approaches, but there is still much to do, including looking to the future.
Testing of the federally-facilitated exchange (FFE) and plan processes started during the summer, said Jeanette Thornton, vice president, health IT strategies at America's Health Insurance Plans (AHIP) at the organization's annual conference held in June.
AHIP has been working with the Health and Human Services Department on operational issues, she said.
In July, state review of plans were due to be completed, and health plans were expected to be able to see how their data would be presented to consumers in the exchange.
In late August or later, transaction testing with the FFE will be conducted on enrollment and payment integration. It will be at this point, she said the data can be sent to real plans to see if those plans can accept the data and process it within their systems.
But for the time being, by now health plans should have fully under way or have recently jump-started processes for enrollment, premium billing and funds flow, and perhaps outreach and support tools, said Patrick Holland, managing director of the Boston office of healthcare consulting firm, the Wakely Consulting Group.
Payers should have completed what they needed for areas including provider contracting, qualified health plans, risk adjustment and rate filings.
As health plans scramble to get the basics in place, Holland said there are particular things that should receive attention.
Enrollment will be "the guts of the process," Holland said. It will feed the billing system, so it's important for health plans to nail down processes, especially for electronically-transmitted
enrollment and dis-enrollment information.
Many have put d
ecision support tools on hold until the phase of the exchanges, but "it's an opportunity where the carriers could step up and use their expertise to fill the information gap, with information and materials on their website and working with employers and other stakeholders," Holland said.
Analytics may also have been pushed to the side, he noted, but plans need to know how and where they will have these data points performed, most of which will be done on the backend.
And plans really need to look ahead, he said, by
• Learning from early missteps. High-performing organizations will learn, fix and move ahead.
• Not getting discouraged. There's a lot trying to be done in a short period of time, he said, but it can be done.
• Creating flexibility where possible in business and process flows.
• Evaluating competitiveness of provider contracts for 2015 rate development.
• Developing organizational discipline to stay on top of year-end reconciliations.