Much uncertainty surrounds the creation of health insurance exchanges (HIEs) and the changes they portend for stakeholders. AF4Q National Advisory Committee member Reed Tuckson, MD, moderated a session that strove to explain what is coming from the exchanges and answer questions the audience might have about how the changes might affect them.
Tuckson acknowledged that no one knows exactly how HIEs will play out, including who’s in and who’s not? Who will be eligible? Will the process be simple enough for people to understand?
Panelist Richard Onizuka, CEO of the Washington State Health Benefit Exchange, related how they’re handling HIEs in Washington State. The exchanges are state based (as opposed to federally based or a combination of federal and state based), and the state exchange system interfaces with the federal data services hub. All pieces interface, and the goal is real-time eligibility and then enrollment processing. The state is building a massive IT infrastructure—in fact, most of the setup money is being devoted to building IT. A challenge will be interacting with the public, determining eligibility, and helping people understand and apply for
health insurance under the exchange, and the state plans to employ in-person assistors and call centers to address this issue.
Of course, what works for Washington might not be replicable elsewhere. "When you've seen one state, you've seen one state,” he said. The HIEs will have to find people where they eat, work, pray and play.
Adela Flores-Brennan from the Colorado Health Benefit Exchange described a similar state-based exchange in Colorado that will use in-person assistors in the community to help guide people through the enrollment process. One challenge they face will be to bring existing Medicaid enrollment processes from paper to online.
The audience then heard the employers’ perspective from health care consultant Steve Wetzell, who pointed out that there will be unintended consequences to the employer-based system that are creating anxiety among employers. Many fear they wont’ be able to afford the new system and are balancing the math with maintaining their reputations. The biggest problem they face, he said, is the possibility of a destabilized employer-based system, which currently serves as the linchpin of the U.S. insurance marketplace.
David McGuire of Partners HealthCare System, Inc., took up the issue of cost, saying that health care hasn’t worked well as a marketplace for controlling costs and improving quality and that health care costs are the biggest problem for government at every level.
“We need to align quality improvement with cost reduction,” said Tuckson. “Cost is the crux."
Dr. Tuckson is managing director of Tuckson Health Connections. A graduate of Howard University, Georgetown University School of Medicine, and the Hospital of the University of Pennsylvania’s General Internal Medicine Residency and Fellowship Programs, Dr. Tuckson was most recently executive vice president and chief of medical affairs at UnitedHealth Group
Steve Wetzell has more than 30 years’ experience working with national and regional purchaser and consumer organizations to improve access, quality, and efficiency in the US health care system.
Adela Flores-Brennan joined the Colorado Health 
