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I was listening to a story about Nevada quietly starting their implementation of health insurance exchanges, as part of what everyone loves to call Obamacare. I’m not even going to get involved in the politics and merit of making sure everyone is insured--I want to focus on the execution of it.

Immediately I think: Where is the state health insurance exchange platform API?

According to healthcare.gov an exchange is:

A mechanism for organizing the health insurance marketplace to help consumers and small businesses shop for coverage in a way that permits easy comparison of available plan options based on price, benefits and services, and quality. By pooling people together, reducing transaction costs, and increasing transparency, Exchanges create more efficient and competitive markets for individuals and small employers.

And the principles and priorities of state health insurance exchanges are:

  • Establishing a State-based Exchange - Establishment of an Exchange is a critical step that States must take to be on track for achieving certification of an Exchange by January 1, 2013 under Section 1321.
  • Promoting Efficiency - Exchanges must be mindful of costs for consumers, employers, and the federal government.
  • Avoiding Adverse Selection - Successful Exchanges will avoid adverse selection by ensuring that those who buy through the Exchange are a broad mix of the healthy and the less healthy.
  • Streamlined Access and Continuity of Care. Section 1311(d)(4)(F) requires Exchanges to evaluate and determine eligibility for applicants in Medicaid, the Children’s Health Insurance Program (CHIP), and other health programs - Exchanges must also comply with all applicable federal statutes relating to nondiscrimination. The federal government will provide critical building blocks and financial support for achieving an efficient enrollment process including verification of eligibility for tax credits.
  • Public Outreach and Stakeholder Involvement - Section 1311(d)(6) requires Exchanges to consult with a broad range of stakeholders in carrying out their activities.
  • Public Accountability and Transparency - Accountability requires transparency. Section 1311(d)(7) requires public reports on Exchange activities, and Section 1311(e)(3) requires additional reporting, which should include standardized data reporting on price, quality, benefits, consumer choice and other factors that will help measure and evaluate performance.
  • Financial Accountability - Section 1313 provides for the efficient and non-discriminatory administration of Exchanges, and seeks to prevent fraud and abuse.

If you are going to successfully implement 50 state health insurance exchanges that meet the definition, principles and priorities of the federal government objectives, you will need an open source platform, complete with a robust API strategy. Maybe it exists, and I’m unaware of it.

If you know more about current initiatives in this area, please let me know.




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