In our last SHOP exchange blog, we covered various functional and structural aspects that states need to consider while designing SHOP exchanges. In the following blog, we talk about various issues that states might face while designing SHOP exchanges.

States and exchange implementers are aware that the SHOP exchanges need to be tailored specifically to small businesses needs and requirements. To achieve this objective, it is imperative that small businesses remain actively involved and engaged in the exchange design process.

Listed below are things that states and designers will need to do to ensure the success of SHOP Exchanges:

1) Engaging the target customers while designing SHOP exchanges

Exchange administrators and supervisors can establish a proper conduit through which regular inputs from the beneficiaries’ can be received. For example, the exchange website can be designed to allow visitors to leave feedback and exchange related suggestions. Navigators’ network or customer service desks can also prove helpful.

Advisory boards and focus groups can be set up for consumers, insurers, brokers, medical providers etc. to solicit exchange design related suggestions.

Brokers often have strong relationships with small businesses, which coupled with their insurance expertise can help them gauge and understand the common issues and concerns that small businesses face.

2) Extending coverage to other state employees

Several U.S. states have urban areas that span two or more neighboring states and consequently employ residents from all the neighboring states. Buying insurance coverage for employees from multiple state exchanges can increase the administrative complexity for small employers.

Also the insurance premiums regulations vary from one state to the other. Every state forming multi-state exchange may need to review and standardize the insurance regulations of all the neighboring states and discuss them with participating health plans.

3) Shopping platform options for self-employed individuals

States have the jurisdiction to allow self-employed individuals to purchase their insurance from either individual or SHOP exchange, or both. It may be further beneficial to self-employed members, if an online cost calculator or decision matrix can be made available on the website as it would help them take an educated decision.

4) Designing an exhaustive and effective website design

A simple and user-friendly interface is integral to a smart website design that attracts enrollees and presents complex information in an easy-to-understand manner. Shopping for health insurance needs to be as easy and familiar for users as shopping from any other popular e-commerce website. However, there are few details that may be critical to the success of the exchange:

a)    Comparison tool – The tool needs to allow easy comparison of plans and present reliable information about the quality of participating health plans.

b)    Cost of plans – Accurate and detailed information about the cost of plans need to be displayed so that employers can make an educated decision.

c)    Tax credits & member services – Through SHOP exchanges, small employers will be eligible for both state and federal tax credits. Employers should be able to easily check eligibility and have the ability to calculate final costs after deductions. Employers need to be well-informed about all the member services they can avail of while shopping at an exchange.

d)    Customer support – Smart website designs can offer one-click customer support facilities to employers. Direct contact details of navigators or exchange personnel can be also made readily available.

There are several other concerns that SHOP exchange policymakers need to evaluate while drawing the structural and operational blueprint of the SHOP exchanges. We will continue this discussion in the next post of this SHOP Exchange series.

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