By Gary Palgon, VP Healthcare Solutions, Liaison Healthcare Informatics
With the recent Supreme Court ruling on the Affordable Care Act comes an even greater need for healthcare IT tools and systems, as providers and payers alike will experience a substantial increase in the number of patients they serve.
A recent report from information technology analyst group Gartner discussed the emergence of health insurance exchanges (HIXs) in light of the expected increase in the number of insured patients. HIXs offer patients an online forum for choosing health plans that then transfers the patients’ eligibility information to the selected payers. According to the report, each state is required to submit its HIX blueprint to the Centers for Medicare & Medicaid Services (CMS) by November 16, 2012 in order to launch its own state-based exchange and participate in federal-state exchange.
Just like prior exchange models before it, HIXs will surely see integration as their first challenge to overcome. Connecting with many different payers, using many different methods and receiving data in many different formats is not simple. Then, they will have to manage the large volumes of complex data in order to make decisions from it. And the same applies on the payer side of the equation – they will begin receiving more and more information from disparate HIXs and will be faced with data management challenges.
Together, HIXs and payers will have to work together to maintain control over large volumes of data so that they can offer targeted health insurance services to individuals and companies throughout the United States. Hopefully, both can learn from prior mistakes and look to innovative ways to solve these problems by taking advantage of cloud-based integration and data management platforms that already exist. They will then be able to expediently address these issues rather than re-inventing the wheel and suffering the hardship consequences we’ve seen before.
How do you think HIXs will impact payers under the Affordable Care Act? And how will the new law affect healthcare IT as a whole? Do you think HIXs and payers can learn from HIE issues to overcome integration issues?
Until next time,