Supreme Court Gives Green Light On Health Exchanges, Now What?
Introduction of a private and government exchange will allow 50 million Americans, currently uninsured, to access healthcare coverage they were previously ineligible for or could not afford. Many opine that new exchanges will result in increase in both preventative care and visits to providers earlier in the etiology of illness or injury, decreasing treatment length and costs.
While there is still some uncertainty related to Medicaid exchanges, I believe, the private exchanges will continue to develop, irrespective of ACA's final shape due to legislative drivers. The private exchange market will offer a new revenue stream to health plans while offering affordable insurance options to individuals - market potential for private exchanges is vast with over 50 million Americans uninsured. Obviously, the next twelve months will be critical. A three pronged approach of roadmaps, dedicated portal and regional extension centers are needed to ensure individuals, families, states, vendors and health plans are able to participate in the exchange. In the past, Centers for Medicare & Medicaid Services (CMS) have provided clear roadmap to the public, outlining processes and timelines that, if followed correctly, would result in successful participation.
Roadmaps, information and support would be available through a CMS portal dedicated solely to new exchanges. For entities requiring support beyond the portal, Regional Extension Centers (REC) should be available in each state. These centers provided crucial support during early stages of Meaningful Use - program that incentivizes providers for utilizing Electronic Medical Records correctly. While no one can predict what will happen in the future with public exchanges, we can be sure there will be a market for the private exchange. CMS' approach of road mapping, dedicated portal and Regional Extension Centers has proved successful in the past and should be utilized again to ensure families, individuals, health plans, vendors, state governments and providers have all the pieces they need to enroll and participate in new healthcare exchanges. Lastly, there are a number of entities both private and public that are developing exchange platforms and interfaces to facilitate the enrollment and payment processes. These platforms will be an integral piece of a successful exchange between individuals, families, health plans, employers and governments.