The latest draft of regulations released by the Obama administration proposes administering a ‘user fee’ on the insurers that plan to market their products through the Federally Facilitated Exchanges (FFEs). The twenty-one U.S. states that refused to set up a State-based Exchange and the five others that are currently electing for a State-Federal Partnership Exchange would be playing host to federal exchanges.

Starting in 2014, the ‘assessment’ or ‘user fee’ fee will be charged monthly at 3.5 percent of the monthly premium amount levied by the insurer for a particular plan. Therefore, the final monthly amount will vary from one insurer to another, depending on the number of consumers that enroll in a specific health policy through the marketplace. Still, this cut into each insurer’s pockets may leave insurers wanting to raise premiums to make up the difference.

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The success of healthcare reform hinges largely on reducing healthcare costs and improving access to healthcare for millions of uninsured Americans. Payers hoping to sell their insurance products through health insurance exchanges are likely to witness severe competition from other exchange-hopeful payers and those operating in the outside-exchange markets. Payers will be required to moderate their premium rates and keep a close watch on their administrative costs to successfully balance their product pricing while ensuring profitable enrollments through an exchange.

Most U.S. payers retain large volumes of patients’ data that is judiciously analyzed to keep up to speed on important trends in consumer behavior. Such information, when gathered and merged with data from other healthcare stakeholders such as hospitals and physician coalitions, can be used to reduce administrative complexities and improve process efficiencies to ultimately improve the quality of healthcare delivery. In the same vein, devising strategies to reduce duplication in administrative processes such as health benefit maintenance through a payer’s local and exchange systems, can aid in controlling excessive waste in healthcare costs.

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In July 2012, the Crider Group conducted a survey to assess the status of Navigator program developments in various states in order to recommend suggestions and solutions for the development of a navigator program for the District of Columbia Health Benefit Exchange. This survey was unique since the concept of “navigators” continues to remain elusive for most U.S. states, with only a few U.S. states that have gone ahead and drafted recommendations and proposals on how their exchange navigator program will work.

The ACA mandates that every state health insurance exchange must incorporate an area for “navigators”. Navigators are responsible for ensuring that the exchange consumers are aware of the latest health options available to them through an exchange and to show consumers how they can easily enroll in health plans and wellness services of their choice. Only a few states, including Connecticut and Nevada, have drafted plans for navigators into their local state-based exchanges.

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President Obama’s re-election has finally cleared the air on health care reforms. From yesterday’s election results, it can be safely surmised that the enactment of the Affordable Car Act will proceed with tight defined timelines already in place. The focus of the reforms is once again come to rest on the states, whose legislators may be pressed for time to draw up strategies for executing the reform’s recommendations, such as setting up subsidized insurance exchanges or expanding Medicaid managed care among other rulings.

Many U.S. states with a Republican majority have staunchly opposed the healthcare reform and the health insurance exchanges’ implementation, since the exchanges were first proposed under the aegis of PPACA enacted in 2010. The reform efforts also took a severe beating on account of Governor Romney’s pledge to repeal the ACA if elected, which resulted in visible slowing down of implementation efforts over the past few months.

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25.2 million. That is the number of U.S. citizens with Limited English Proficiency (LEP), as reported by the Migration Policy Institute in a 2010 data brief. In order to capitalize on emerging healthcare reforms, states and insurers, in the midst of implementing their health exchanges, need to ensure that their systems possess the capabilities to accurately communicate health insurance related data to culturally diverse audiences, such as people with LEP.

In February 2012, California Pan-Ethnic Health Network (CPEHN), UC Berkeley Center for Labor Research and Education, and the UCLA Center for Health Policy Research published a policy brief using UCLA’s California Simulation of Insurance Markets (CalSIM) model. This briefing established that although California’s 6.7 million people with LEP stood to benefit greatly from the PPACA implementation, over 110,000 of them would not be able to enroll in the exchange, unless proper multilingual outreach efforts were introduced. The briefing identified that if language does not pose a barrier for exchange enrollment, 53% of the 1.06 million LEP individuals are likely to enroll in the exchange by 2019. However, in the absence of any sufficient multilingual exchange support and outreach efforts, the enrollment percentage is expected to drop to 42%.

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A recent Markets and Markets research estimates that the global healthcare cloud computing market is set to exceed the $5 billion mark by 2017. With the launch of its own private healthcare cloud service, hCentive decided to wade deeper into the current Cloud adoption trends and tried to understand the reasons behind this industry wide reticence.

Current adoption of cloud technology in healthcare  

Last year, CDW, an American IT services provider, conducted a nationwide ‘Cloud Computing Tracking Poll’ survey of over 1,200 IT managers. As of May last year, 30% of surveyed healthcare organizations were using cloud computing, but most of the cloud-based applications (39%) were office productivity tools. Public cloud based applications, such as Gmail, Salesforce, Live Meeting etc., were most commonly used by healthcare companies. Gartner in a May 2012 survey report reported that healthcare payers & providers were primarily utilizing cloud technology for processes such as claims processing, medical records, care management etc. Let’s have a look at the various cloud models popular across the industry:

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With the Supreme Court largely upholding President Obama’s Affordable Care Act, the spotlight has once again fallen on the payers and their proposed measures to improve the affordability of health plans and quality of administered care. For a successful implementation of the entire healthcare model, it is imperative that payers possess an in-depth understanding of the health needs and preferences of the beneficiaries, prior to introducing new measures or re-aligning their health plans for consumers.

Despite the mounting uninsured populace being the linchpin of the entire healthcare reforms, little information is available on their health plan preferences and market expectations. In 2007, Harvard Business Review team had conducted a consumer survey in which they analyzed consumers’ medical & financial requirements & their general disposition towards maintaining a healthy lifestyle. Based on the survey results, HBR recommended segmenting consumers based on their health & wealth profiles, considering the diversity of the existing insurance markets. For instance, individuals categorized as healthy worriers, are receptive to new health products but are sensitive to rising healthcare costs and therefore are likely to be best candidates for employer-sponsored insurance. They are receptive to quality service & self-directed analysis tools. On the other hand, unfit and happy segment is mistrustful of doctors and is least responsive to new products. Self-help incentives are likely to work best with such individuals.

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The Supreme Court’s June 28 decision to uphold the Patient Protection and Affordable Care Act (PPACA) has finally put an end to the U.S. healthcare industry’s wait. The epic SCOTUS decision, comprising of 193 pages of opinions & dissensions, has paved the way for U.S. states, insurers, providers and healthcare firms, to get back on course to implement the healthcare law’s numerous decrees over the next couple of years.

On the Affordable Care Act’s most controversial section , the individual mandate clause, the Supreme Court adjudged that the individual health insurance mandate does not pass muster under the Commerce Clause; however, levying a financial penalty as tax, falls within the federal government’s constitutional power to “lay and collect taxes”.

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The US healthcare payers’ arena has been witnessing a lot of private health insurance exchange (private exchange technology New York) related activities over the past year. Last year in August, Walgreens, US largest drugstore chain, declared its plans to set up private health insurance exchange. In September 2011, Wellpoint, in partnership with BCBS Michigan and Health Care Service Corporation, bought controlling stakes in Michigan based Bloomhealth to run its private insurance exchange. In continuance with the growing private health insurance exchange trend, in May this year, TowersWatson a NY-based professional services company, signed a deal with Extend Health to take over its largest private Medicare exchange operations.

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At a high level, US states’ Health Insurance Exchange (HIX) implementation plans appear as an interesting and colorful patchwork. While some US states are hard-at-work drawing and designing HIX plans, many other states are awaiting Supreme Court’s ruling and hoping for health reform implementation to get stalled. Further more, instead of enforcing a ‘one-size-fits-all’ exchange model for states, the federal government has awarded considerable autonomy to states for designing individual exchanges and deciding which facilities to administer via their exchange.

The disparity in states’ HIX endeavors, coupled with the leeway extended to states in designing structurally different exchanges, has complicated matters for payers, especially for those that operate nationally, as national players would need to align their products as per states’ respective exchange requirements.

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