Exchanges would need local participation

November 1, 2009

State-level insurance exchanges are more likely to thrive in the market by taking advantage of integration

In concept, health insurance exchanges would create a new marketplace through which consumers could buy quality health insurance coverage at an affordable price. One major bill in Congress would establish a national exchange, and other bills would create state or regional exchanges (or "gateways," as one bill calls it). Health plans would compete to offer consumers health insurance coverage at the best value.

Details matter a lot. If done well, these insurance exchanges could effectively pool risk and provide good options for consumers, but the devil is in the details. The structure and the rules governing the insurance exchanges will determine whether they flourish or fail. Here are some questions we should be asking:

KNOW THE MARKET

I continue to believe that all healthcare is local. Care is best delivered on a local level by providers and insurers who are part of the community, know the patients they serve, and know the market in which they live.

As we prepare for what is likely to be significant change resulting from health reform, integrated delivery systems like Summa Health System are well positioned to compete in the new insurance exchanges-assuming the rules allow for a level playing field for private, local insurers. At SummaCare, we work closely with Summa Health System's physicians and hospitals to create value for our members and for the community through collaboration.

While a national exchange could offer some economies of scale, state-level exchanges are more likely to recognize the advantages of close integration with local delivery systems.

The challenge for the government will be to design the insurance exchanges in a way that encourages a thriving marketplace and does not tilt the playing field in favor of one set of players over another. The exchanges should focus on fostering fair and robust competition to deliver affordable health plan options, while ensuring effective risk adjustment to facilitate national, regional, and local plans' participation and serving to protect consumers by providing a variety of high quality choices.

Martin P. Hauser is president of SummaCare, which provides commercial and Medicare plans in Ohio.