While many states are still trying to establish the core services of their health insurance marketplace, some exchanges are already setting a blueprint for business opportunities beyond a platform that enables shopping for and purchasing health coverage.
Connecticut's Access Health CT views exchanges as well positioned for a role in formal consumer education on how to buy insurance, get the most value from it, understand provider networks, and how to speak with a provider.
"We think we're witnessing the 401K of health insurance, although not necessarily overnight," said Kevin Counihan, CEO of Access Health CT, at a recent conference sponsored by America's Health Insurance Plans (AHIP).
In the early 1980s, the pension business began to migrate from a defined benefit to a defined contribution approach. "We think we're witnessing something analogous to that," he said, citing, for example, the announcement by Time Warner and IBM during the summer to move their early retirees into an exchange.
He noted that, whether they are public and private, exchanges enable something that company CFOs have wanted to do for decades – to manage health insurance cost increases.
Employees are not any better educated to make health insurance decisions than they were for their 401K plans, Counihan said. So education will be critical "to prepare employees for this world of taking more responsibility for not just their healthcare but purchasing health insurance," he said.
Connecticut is also implementing its all payer claims database. Access HealthCT is setting up a separate company, AccessHealth Analytics, to use that data, with the first reports anticipated in December 2014. The data will be a tool to help educate consumers. "It may also provide a consulting opportunity that we might be able to have with other states," Counihan said.
Its solid early exchange performance offers the opportunity to create another business division – Access Health Exchange Solutions – to deliver "an exchange in a box." Many states would like to have the flexibility to respond to their own state needs but may not want to go through building an exchange on their own. "We've been contacted by a couple of states in different parts of the country asking if they can franchise or lease our platform," he said.
Exchanges scale well. "We can bring a fairly turnkey type of exchange, which means a governance model, an operations model, marketing, access to a stable platform," Counihan said.
The District of Columbia exchange also plans to scale its reach and offer services with a cloud-based platform. Mila Kofman, executive director, DC Health Benefit Exchange Authority, is considering a multi-tenant cloud model.
Once built, a platform is easy to scale in a cloud environment. "In terms of what would work politically and culturally in a particular state, there is not a lot of difference in whether you call something a regional effort or call it a state effort, if you're all sharing a multi-tenant cloud environment on the IT side to support all of this," she said. "You can pretty much label it whatever makes sense in your particular state."
Consumers will see the interface that is particular to their state on the front end, and the portal will feel very local, Kofman said. But all the back office pieces will be essentially done by the state – whether DC or Connecticut – that can handle that kind of scalability.