Health Insurance Marketplaces: the Nevada Solution

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The Supreme Court’s decision in June 2012 to uphold the Affordable Care Act (ACA), followed by President Barack Obama’s re-election in November, put states on the clock when it comes to developing Health Insurance Marketplaces (HIXs) – and consumers in the driver’s seat when it comes to health insurance decisions.

States are more focused than ever on meeting the deadlines that outline HIX implementation progress – determining a strategy, selecting vendors, making design plans and having discussions with participants to ensure they will be able to enroll. There is little margin for error in getting a marketplace ready for open enrollment by October 2013, providing coverage by January 2014 and self-sustainable by 2015.

On top of deadline pressure, many states are prioritizing the development of a marketplace that is simple for healthcare consumers to navigate. The expected benefits  also translate into potential challenges for states that have chosen to set up their own HIXs. These states will need to work through a number of steps to ensure they are creating a consumer-friendly experience, addressing the underlying technical issues, connecting all necessary parties (from healthcare consumers to insurance carriers to banking partners) and complying with associated regulations.

Nevada is addressing these challenges with a strategic plan that places strong emphasis on engaging consumers. The Nevada plan has five goals, each of which are comprised of very detailed objectives:

  • Increase the number of insured people
  • Facilitate the purchase and sale of health insurance
  • Assist qualified employers in the enrollment and purchase of health coverage and the application for subsidies for enrollees
  • Provide consumer education on matters relating to enrollment in, and effective use of, health insurance
  • Assist residents with access to programs, premium assistance tax credits and cost-sharing reductions.

Nevada Health Link (Nevada’s marketplace) also acts as a bridge between public and private healthcare programs. Nevada’s eligibility system is its main location for Medicaid and CHIP systems information, sitting on one side of the “bridge.” On the other side is the Qualified Health Plan enrollment-related business operations system.

Nevada Health Link will provide a single point of entry for the state’s existing Medicaid and CHIP programs, as well as its new health insurance marketplace. The Nevada marketplace will connect the eligibility and healthcare systems,  allowing them to communicate with each other at several interfaces. In this way, all public and commercial program application, eligibility and enrollment will come through Nevada Health Link, making it the central hub for all the state’s health insurance programs. This makes it easy to see how HIXs, like Nevada’s marketplace, can serve as bridges between systems and important facilitators for streamlining and speeding health plan purchasing and other state eligibility processes.

Efficiency and savings are also driving forces behind the Web portal and online selection tool that the state will deploy, developed and operated by Xerox in conjunction with Choice Administrators. Xerox also will manage the customer contact center for Nevada Health Link. Consumers can call to speak to a person and get additional information about the price and quality of health insurance products.

Nevada Health Link will create a simplified experience for consumers and a flexible one for the state, which can maintain control over the HIX and its insurance market, while building in customizations without sacrificing timeliness.

Nevada’s marketplace received conditional approval from the Center for Medicare & Medicaid Services and the Center for Consumer Information and Insurance Oversight in January for the operation of a state-based exchange and will open for business in October 2013.

Kevin Walsh is senior vice president and managing director, Healthcare Eligibility & Exchange Services, at Xerox.

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