Show Coverage: Exchanges require ambitious infrastructure

June 15, 2011

Heads up, health plans. If you want to compete in a health insurance exchange, the time to prepare is now, said Sarah Rodehorst, director, government health programs for Atlanta-based Connecture, a Web-based administration solutions company. She co-presented a session on Wednesday on building an infrastructure to meet exchange requirements.

Heads up, health plans. If you want to compete in a health insurance exchange, the time to prepare is now, said Sarah Rodehorst, director, government health programs for Atlanta-based Connecture, a Web-based administration solutions company. She co-presented a session on Wednesday on building an infrastructure to meet exchange requirements.

To serve the new distribution channel presented by exchanges, health plans must build an efficient infrastructure to interface with the exchange, share their benefit features and premiums and support decision tools offered by the exchange, she said.

In short, she added, invest in your product, rating and network systems-such as storing an updated list of providers in the network, current deductibles and out-of-pocket costs–-to position yourself in the online marketplace. In that way, the exchange can filter your specific plan information to potential customers.

Implementing systems to enroll members online is another competitive advantage. “Build your online enrollment applications so you can utilize them now, and the exchange can interface with them in real time in the future,” Rodehorst said.

Exchanges will provide three models for enrollment and premium collection:

  • Consumers select a health plan on the exchange that shares the new member information with the insurer, who then manages the application process, initial payment, policy maintenance and ongoing billing.


  • The exchange is responsible for plan selection, application and the initial payment, after which the health plan maintains policies and performs ongoing billing.


  • The exchange performs all enrollment functions, while interfacing with the plan.

Rodehorst anticipates that no one model will overshadow another; preference will depend on how much responsibility the insurer is willing to assume. “While administration by an exchange has the potential to save money through economies of scale, plans that assume responsibility can leverage their already-existing business systems,” she said.

Her final advice is matching analytics with technology, such as rate modeling, real-time integration and online communication.