The implementation of Health Care Exchanges has begun as part of the ramp up to the large changes in health care scheduled for 2014. The benefits of these websites will be selection and transparency of pricing for the individual and small business market. A couple of early sites are already available, including the one in New York City. This is a trend we will keep you updated on.
Wall Street Journal 11/16/2010 – By AVERY JOHNSON
Health-technology companies are hoping that the new state insurance “exchanges” required by the federal health-care overhaul will offer them big new growth opportunities.
EHealth Inc., an online insurance broker, has won two new government contracts for insurance websites, and has established a separate unit to go after a share of the exchange business. Benefitfocus Inc., which makes software designed for enrolling employees and others in health plans, says it is in talks with nearly 20 states to run their exchanges. Xerox Corp.’s ACS unit is circulating a white paper to states to make its case for integrating exchanges into Medicaid systems the company already runs.
At stake is some $4 billion a year in revenue, according to an estimate by HealthConnect Systems, a tech company that aims to compete for the new business. The Department of Health and Human Services raised the stakes in September when it awarded roughly $1 million each to 48 states and Washington, D.C., to help build exchanges. Last month the agency announced it would award additional grants to help develop the necessary information-technology systems.
Health-insurance exchanges are online marketplaces mandated by the law to promote competition and offer a way for the uninsured to find coverage. Many low-income consumers will be eligible for tax credits to help pay the premiums.
The exchanges must be up and running by 2014, but many states hope to beat that deadline. Utah and Massachusetts have exchanges that predate the overhaul law, but the exchanges are in the early planning stages in most states. That means it may be months, or even years, before major contracts go up for bid.
Setting up the exchanges may prove to be too complex for any one company. The 50 states could decide on as many different ways to run them.
Companies say that some of the challenges they may face include working with insurers to get plan and price information. The exchanges will likely need to be able to verify consumers’ eligibility for federal tax credits and for Medicaid, the program for the poor, which will be expanded by the health law. They may also need safeguards to protect personal-health data and payment information, the companies say, and they will need consumer-friendly interfaces.
Some of the potential competitors for the exchanges specialize in the consumer end of the business, while others are experienced in back-office functions, such as eligibility verification.
EHealth, of Mountain View, Calif., operates ehealthinsurance.com, a site the company says is the largest online vendor of health insurance. It sells plans from major insurers in each state, much the way Amazon.com sells books or music.
Last month, Florida picked EHealth and human-resources and benefits consultant Ceridian Corp. to set up Florida Health Choices, a website where small businesses can shop for coverage.
HHS tapped EHealth this summer to collect pricing and benefits data for healthcare.gov, a federal site where consumers can compare, but not yet buy, individual health plans.
EHealth recently established a separate government-services business focused on courting the states. “This could be a really, really good business,” says Gary Lauer, the company’s chief executive. “We are a tested solution that could work well for state governments.”
EHealth faces some tensions in leaping into the business. For starters, the exchanges will be competing with its existing website. Mr. Lauer says the exchanges might lure consumers online, but not all of them will want to buy there. It isn’t clear how much customer support the state exchanges might have. EHealth said it offers round-the-clock support and expects to sell subsidized health plans to people who qualify.
Insurance brokers like EHealth have little choice but to find new sources of revenue. Broker commissions are likely to be pinched by new rules which take effect next year, that require health plans to spend less on profits and overhead, including commissions. EHealth on its current system earns commissions averaging 10% to 11% on each sale —and more in the first year of a contract, says Mr. Lauer.
The new exchanges offer a way for the company to keep growing amid the expected upheaval Mr. Lauer says each state could approach payment differently.Earlier this year, Benefitfocus, of Charleston, S.C., won a contract from Maryland to set up a website that helps small businesses compare, but not buy, health plans. The site should go live by early next year, the company said.
“There’s nobody that does everything,” says Peter Everett, CEO of HealthConnect Systems, of Norwalk, Conn., which helps power a website for New York City where employers can compare health insurance, and is pitching its services to several states. “We’ll see a variety of companies team up,” he says.
Some of those companies are likely to be technology specialists. International Business Machines Corp. could be interested in getting in on the action, said a spokeswoman. Computer Sciences Corp. already has a contract to host Massachusetts’ exchange and is hungry for more, said a spokesman. And Xerox’s ACS unit, which works with 38 states’ Medicaid programs on such services as verifying eligibility and paying claims, also thinks it could have a role.
“It is the No. 1 or 2 priority of insurance commissioners to figure out how they are going to deal with [the exchanges],” said Will Saunders, chief operating officer of ACS’s government-healthcare business.
