It is essential for Americans to have a streamlined and cost-effective path to obtain and retain healthcare coverage.
Recent events, including the COVID-19 pandemic and the devastation it brought to our healthcare and economic systems, continue to underscore the catastrophic impacts of not providing such an option – and this has been upheld by the Supreme Court in their recent decision to uphold the Affordable Care Act (ACA).
It’s an exciting time for us as Health IT professionals as we play a key role in making healthcare coverage more accessible to residents nationwide.
The evolving face of healthcare IT – it’s about more than just healthcare coverage
It’s no secret that the pandemic has magnified the public’s awareness and perception of the healthcare system, their rights, and their expectations of the government to provide coverage and access to coverage for American citizens. Moving to a State-based Exchange (SBE) over Federally-facilitated Exchanges has seen renewed advantages and benefits as a key way to respond to this need – and it’s not just about the healthcare coverage itself. For us as health technologists, we have the opportunity to play a critical role in the evolution of the system while realizing the promise in achieving broader coverage for residents.
Local SBEs have stepped up their efforts to broaden healthcare coverage for residents and small business employees leveraging various approaches, including extended enrollment periods, new subsidies, and related policy changes.
New methods to drive value and achieve coverage goals
As outside factors continue to evolve the health insurance landscape, SBEs and States considering becoming one have a special opportunity to play a central role in advancing health insurance programs for their constituents. And exchanges that are able to build and adapt their technology to quickly respond to emergency declarations, legislative and policy changes are well-positioned for success.
SBEs continue to play a central role in the leadership and adaptive nature of the healthcare industry. As such, it is critical that they are on top of the leading issues facing the industry to keep access available to state residents and position infrastructures to continue to adapt in the pandemic era and beyond.
State residents are able to register and compare plans through the SBE framework, to make finding and securing the right healthcare coverage option easy and direct.
It’s never been easier to make the switch
In today’s healthcare environment more than ever, SBEs are integral in helping the public get access to affordable healthcare as an alternative to the federal marketplace. Exchange systems vary state-to-state and have taken different forms since the passage of the Affordable Care Act (ACA). Over time the exchange space has evolved to move increasingly away from large corporate players to now be led by a few small and mid-sized groups who can deliver healthcare coverage options at more attractive prices.
The dynamism that small and mid-sized exchange entities bring to the healthcare system has been a leading priority in recent years, however, the execution has evolved over time. Launching a State-based Marketplace is much different today than in 2013. The risk and cost are dramatically lower than those early days.
States today are in a great position to offer their residents a truly competitive insurance marketplace. Public awareness and support for healthcare exchanges are higher than ever before. Today a State may procure a proven, built-to-purpose State-based Exchange technology solution at a fraction of the cost. These same benefits and savings are available to many states looking to migrate from 2013-era systems.
Best practices for state exchanges to maximize outcomes
Agile development methodology continues to be a leading best practice and a key way to develop innovative technologies. From a client perspective, the result is working technology solutions delivered on budget and on a timely basis.
This competency comes into play both under the rollout of general system improvements and custom development projects. For example, HBX was the first State-based exchange to introduce changes in late March introduced by ARPA.
I advise state exchanges to ask potential vendors and their clients about their processes related to technology development and solution maintenance. What is the vendor’s track record for introducing system improvements and extensions?
Methods to develop transferable solutions and the future of the state-based exchange
As state-based systems continue to grow in popularity and demand, so does the importance of developing exchange structures that are transferable state-to-state. The most important element of developing solutions for wider applications is to determine the specific exchange’s mission.
At the risk of over-simplifying, this means answering the question: is the primary mission to maximize premium reduction, or is the exchange an instrument of a larger policy? The first scenario replaces the federal marketplace with goals of a better customer experience and pass cost efficiencies along to the public in the form of discounted premium rates. The second scenario not only brings the marketplace locally, but its mission includes system extensions and customizations that achieve broader state-level policy objectives. Neither is right nor wrong. Both scenarios offer other benefits and can reduce rates of uninsured for the state.
The future of healthcare is state-based
Going forward, the industry is continuing to be propelled by technological advances that drive internal innovation. One specific area of focus is creating systems to help agencies better track and manage data quality between distributed systems.
The bottom line is that SBEs are blazing the trail for the future of healthcare coverage in the United States. The affordability and access they deliver is an unmatched value-add from federal systems, with the added benefits and peace of mind to achieve long-term coverage. Broader healthcare solutions benefit all state residents, and the development of transferable IT solutions to conduct these initiatives is a critical component for the next future of the healthcare industry.
About Dan Thomas
Dan Thomas is the CEO of IdeaCrew, Inc., based in Washington, DC. Dan advises clients on technology strategy, designs business-driven solutions, and leads hyper-productive teams as they implement and operate industry-leading, category-defining enterprise and core mission systems.