Offer More Than Choices
The California Health Benefit Exchange has to be more than a health insurance marketplace. There are already some excellent broker operated, web-based portals, like eHealthinsurance.com and HealthcareShopper.com, that present plans and rates to individuals and small businesses. The private sector is more than able to adapt to the new Affordable Care Act (ACA) rules and develop dynamic choice portals. If the private market can deliver choices, the Exchange has to deliver more than choices.
Insure “No Wrong Door” Functionality
The health insurance exchange in California must become a proactive force of change in the market. It can be a model that educates individuals and small business and efficiently delivers them to carrier partners. It must organize these two disorganized market segments - individual health insurance and small business health insurance - by offering a better way for sellers to sell and buyers to buy. The Exchange needs to reduce the confusion involved in qualifying and enrolling in health insurance products. It must assist consumers with understanding and selection of appropriate plans, but also lead qualified individuals to existing government programs like Medi-Cal and Healthy Families. The Exchange must deliver on the concept of “no wrong door” envisioned in the ACA.
Consistently Provide a First-Class User Experience
Those Individuals who are getting subsidies toward their health insurance premiums may put up with long forms and endless questions, but other consumers will not. Web-based enrollment technology has the ability to request information from consumers only if it is needed. The Exchange platform must be able to ask a handful of initial qualifying questions and make a preliminary determination if an applicant may be eligible for Medi-Cal, Healthy Families, or a subsidy through the Exchange. Those that are not will be presented only with the standard online enrollment form, just like they would fill out at a carrier or broker or website. Only those who seem to be eligible will be asked additional questions in the event of an Exchange subsidy and likewise forMedi-Cal and/or Healthy Families. Medi-Cal integration cannot become the common denominator through which everyone must pass.
Provide Value for Partners
Finally, the Exchange must provide real value for its partners. That means it must make life easier, not more complicated for carriers, agents and brokers, employers, individuals and providers. It must remove some of the inefficiencies involved in serving these market segments by providing centralized education, quality ratings, online enrollment, participant eligibility maintenance, automated billing and collection, carrier EDI, electronic disbursements and reconciliation.