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Created

April 25, 2011

With Liberty and Healthcare for All

Chances are you’ve had at least one or two (or twenty) conversations about Health Reform in the past year.  In my experience, regardless of political affiliation, most people find common ground and agree that the traditional US healthcare system has presented multiple opportunities for improvement, to say the least.  Among daunting issues, including inefficiencies and fraud, one of the most recurring challenges highlighted has been the lack of access to affordable health insurance for many citizens.

Deemed by many as “the great compromise,” Health Insurance Exchanges are central mechanisms created by the Health Reform legislation to help individuals and small businesses purchase health insurance – for up to 32 million newly covered members.

Beginning in 2014, a Health Insurance Exchange (HIX), also called Health Benefit Exchange (HBE), will be established in each US state and territory as an online marketplace to help consumers make valid comparisons between plans that are certified to have met benchmarks for quality and affordability.  The states will manage the exchanges; and the plans offered through these exchanges will be provided by commercial payers, competing for all these new customers who don’t qualify for Medicaid.

Recently, I was invited by the American Public Human Services Association (APHSA) to their annual policy conference in Washington, DC to speak on the topic “Surveying the State of the Art in Health and Human Services Technology Systems.”   APHSA is a bipartisan organization representing appointed state health and human service agency commissioners from all 50 states, the District of Columbia, and the US territories. Their members probably know better than anyone the opportunities and challenges that lie ahead as the states prepare to implement their exchanges throughout the country.

Since Adobe has invested considerable resources in the development of an innovative user-centric solution, I was prepared to share the following top 5 key elements to implementing a successful HIX/HBE as I see it.

1. An engaging, personalized, and secure experience for each of the primary HIX/HBE stakeholders (applicant, state administrator, payer) – regardless of platform or device

2. Ease in handling of eligibility and enrollment in the Exchange as well as premium tax credits and cost-sharing reductions for benefits and services

3. Agile HIX management to easily adapt content or implement policy changes that affect rules, and analytics to measure effectiveness

4. Seamless interoperability with existing federal (HHS, IRS, DHS) and state-based (Medicaid, CHIP, MMIS, etc) programs and systems

5. Prudent measures to help address fraud and streamline payer workflows, even for atypical cases

The audience was engaged as we wrapped up the session with open discussion after a brief overview of Customer Experience Management as a platform, and the critical role it plays in the evolution of our healthcare ecosystem.

As conversations turn into collaboration and the dialogue on Health Reform continues to advance, so too does the collective innovation that will help to deliver on the promise of improved access to health benefits and services for US citizens.

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