States are looking at different models for their Health Insurance Exchanges, or HIXs. Given that each state will adopt its own approach to HIX implementation, we potentially could end up with 50 different models. Some states may join together to provide a regional HIX, but it is still likely there will be many different implementations.

The question is: How will carrier services be incorporated into the various HIX models? For many years, carriers have provided most, if not all, of the services that will be encompassed in a HIX. Access to provider networks, claims processing and online enrollment, as well as health management tools and member services, are all available from carriers.

Although there could be many HIX configurations, there are only three models of carrier integration: the open market approach or aggregator model; the complete consumer-oriented model; and a hybrid of the two. This month, we'll explore these models and their potential effects on consumer utilization.


Aggregator model

The open market or aggregator model is the simplest carrier integration approach. In this implementation, either selected carriers or carriers choosing to participate provide users with direct access to their online services.

The HIX "aggregates" access to the participating carriers. These aggregate HIX websites also must have links to sites that provide side-by-side plan comparisons, since this is one thing that carrier sites don't do. An aggregate HIX makes use of existing technology and online services, wrapping them into a common access point.

The HIX aggregate model is the easiest to implement, so, given the tight timeframes involved in PPACA HIX deployment, this approach may end up being the default. The problem with it, like the Web in general, is that the consumer is responsible for research and navigation through the various sites provided in the HIX.

Unfortunately, the uninsured, as consumers, have little or no experience buying health insurance either online or offline. Moreover, this model doesn't easily lend itself to having brokers or agents assist in the process.


Consumer-oriented model

At the other end of the HIX spectrum is the complete consumer-oriented model. In this approach, the shopping, purchasing and enrollment experience is handled by the HIX. During the shopping experience, the consumer has a view of all carrier services for the participating carriers. Side-by-side plan comparisons, including the Summary of Coverage provided by the HHS in August, are part of the HIX and not provided by third-party tools, as in the aggregate model. Furthermore, enrollment is done online in the HIX. When enrollment is complete, the HIX transmits the enrollee information to the selected carrier.

The interface between the HIX and the carrier is an essential component of the consumer-oriented HIX. If designed properly, all carrier services would be communicated across the interface between HIX and carrier and presented to the consumer. One important facet of this approach is to allow the selected carrier to promote its brand and corresponding services in the HIX after the consumer has enrolled.

Utah and Massachusetts provide examples of these two models. While this is somewhat an over-simplification of these two exchanges, it is fair to put them at different ends of the spectrum. For a review of the experience of these exchanges, refer to "The Massachusetts and Utah Health Insurance Exchanges: Lessons Learned" at prepared by the Georgetown University Health Policy Institute.


Hybrid model

The third approach to a HIX implementation is the hybrid model. This model is where most states will most likely end up, albeit with slight variations. The shopping, purchasing, and in some cases enrollment, will be done online in the HIX. Once someone is enrolled, however, the HIX will provide direct and hopefully seamless access to the carrier site for all subsequent services and processing.

From a user perspective, this means that the enrollee will be going between the HIX website and the carrier's website. This is not an ideal situation, but technology can be used to make the movement between sites smooth and seamless for the user.

Online enrollment provides us with a good example of how "consumer oriented" a HIX might be. Quite simply, if enrollment is done within the HIX, a consumer would have to enter personal and family information only one time. (This would a user's expectation of any online commercial portal). That information subsequently could be used to enroll in other products or when the consumer decides to switch carriers. In the aggregate model and some variants of the hybrid model, the consumer would have to re-enter their information again.

In the end, letting the HIX be the primary interface for consumer and carrier services and the ultimate repository for consumer health insurance-related information would best serve both consumers and the needs of the states. This approach works equally well for private exchanges. However, whether there is enough time to implement a fully consumer-oriented model or if all parties even agree to the approach remain questions to be answered.

Reach Lamb, of Benergy Interworks, at A.D.A.M., Inc. at

Time to bunker

Despite a recent spate of natural disasters such as Hurricane Irene, which caused massive floods, power outages and untold billions in damages, more than half of small businesses (57%) in a recent survey said they did not have a disaster preparedness plan for their business data.

According to a poll conducted by Carbonite, a provider of online backup systems, which surveyed 130 owners, small businesses ranked the permanent loss of data as the No. 1 challenge to maintaining their business in the event of a natural disaster.

Yet 59% responded that they had not created a disaster plan because they "haven't thought about it."

Bill Carlino writes for Accounting Today, a SourceMedia publication.

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