Many experts predicted that the opening of the healthcare exchanges would be rife with technological glitches. As it turns out, they were correct.
But as the story unfolds, consumer enrollment issues may not be the most disruptive bump in the Affordable Care Act's (ACA) rollout. For those who have successfully enrolled, insurers are reporting that their 834 transactions – the technical standard for the transmission of health plan enrollment data – have been transmitting crucial enrollment data inaccurately. In some cases, insurers are finding that consumers' personal data is garbled; in others, information is completely wrong.
Unless the problem is fixed quickly, insurers won't be able to manually verify information that should have been automated. The effects could be far-reaching: Consumers may believe they are insured only to find that they aren't when they try to access care. In another scenario, consumers may be enrolled in coverage for which they aren't eligible, throwing the system into further chaos.
In the case of the ACA's rollout, issues arise from the computerized transaction of enrollment information data between the federal government and health insurance companies.
The 834 standard is not what I'd call up-to-date for transmitting data. The current framework is more transaction-focused and in almost all cases each payer or government entity has its own version. It was a significant step forward for the industry, but it might have advanced us from 1980 to 1995. It isn't taking us forward to 2020.
As the ACA continues its rollout, we will need more advanced data integrity, data validation, and cleaning processes. I suspect while we are currently focused on solving the shopping, selection, and data transmission process, in just a few short months we will be discussing things like eligibility verification to ensure that members pay the right share, or receive the right subsidy, or reside in the right medical home.
While the industry wrestles with repairing the current framework, I want to challenge all of us healthcare leaders to support future migrations by advancing our data transmissions with each other. Some of the primary issues we face are conflict of interest, privacy, security, and lack of trust.
It's as if we all have walls up around our house, and the only way we relate to each other is via a data transmission that essentially gets the data only to our front doors. For a more effective member, patient, and customer experience, we must find ways to allow each of us to relate to each other more intimately -- metaphorically with a nice cup of coffee and a warm fire inside the house.
All of us know there are better ways to solve this problem. How many of us thought 10 years ago we would do one-click holiday shopping on our phones? Let's create momentum around one-click items to leapfrog healthcare forward. I'd like the financial or consumer industry to turn to healthcare one day and say, "Wow, we should develop a framework like healthcare for interacting efficiently with each other for the betterment of our customers."
We'll only get there by advancing beyond the doorway.
Cynthia Nustad is executive vice president and CIO of HMS, a data management company.