A few weeks ago you may have seen the article I posted entitled Health Insurance Exchange 101, which provided early details on what the exchanges will provide effective in January 2014. Now you may be wondering about the details surrounding the construction of the health insurance exchanges.
According to its federal “Early Innovator” federal grant application Wisconsin is positioning itself to become a leader in the development of health insurance exchange technology. According to Inside Health Reform.com the state is positioning itself to be a leader in health insurance exchange development and has already garnered support from several other states.
Health Insurance Exchanges are the mechanism through which individuals and small group plans will access health insurance beginning in 2014. In its grant application, Wisconsin envisions a one-stop shop type portal through which residents can access subsidized and non-subsidized health care and other programs.
Wisconsin has already created a prototype model and is encouraging feedback on the design. In total, Inside Health Reform reports that, “the state expects the cost of its health insurance exchange, through implementation, will be about $49.6 million, with $42 million supporting the exchange exclusively (which the grant refers to as "OCIIO funding") and the remaining $6.788 million (non-OCIIO) for the health exchange, Medicaid and other state programs.” According to data in the grant submittal, Wisconsin currently spends $16 to 18 million on its existing IT systems.
According to Wisconsin’s health insurance exchange website, “the exchange is anticipated to drive improvements in care delivery for up to 160,000 people in the non-group market, 1 million small business employees and 770,000 enrollees in the state's BadgerCare Plus and Medicaid programs.”
Wisconsin has yet to iron out details on the Exchange’s governance structure, duties, and powers but the grant application does state the following, “there is strong support for an independent public agency that is modeled after the existing Wisconsin high-risk pool insurance authority (HRISP).”
Structure of the Exchange
According to the Wisconsin Office of Health Care Reform (WOHCR) which is driving the Exchange development and grant application, “the state will use an "iterative" and agile development methodology and a phased-in approached that will allow other states to quickly leverage their own implementation.” The application also notes that Wisconsin currently manages health plan data for several of its state-based programs and intends to incorporate all data into the system to meet the requirements of the exchange as a way to keep administrative costs low.
Once operational, the WOHCR states that the Exchange will also aide the state in managing at a minimum: marketing information/web links, medical benefit (state and federally mandated essential benefits), ancillary product data (e.g. dental, vision), data to actuarial values, pricing data (e.g. by benefit/product/geography), provider network data (e.g. by service area), data (e.g. HEDIS scores), membership/enrollment data, premium payments, premium rebates, premium tax credit information, cost share information, data required for reinsurance payments, and state and federal reporting (e.g. tax credit, cost-sharing, and participation reports)."
The Wisconsin Exchange application has wide support among its health plan systems across the state including ThedaCare, Gunderson Lutheran and the Marshfield Clinic -- who all have written support letters backing the state's effort.
