Difference between revisions of "HIX (Health Insurance Exchange"
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== Introduction HIX == | == Introduction HIX == | ||
| + | [[image:HIX_2.png]] | ||
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| + | There is no single right answer to this question. Certain states, specifically Delaware, Illinois, Arkansas(Kaiser Family Foundation, September 14, 2012), have recognized that having their own exchange operation in 2013 is unrealistic and reliance on the FFE for some functionality on an interim basis is required. Their experience provides some guidance to states that are in a similar situation. The division of exchange functions between the State and the FFE will vary. In general, responsibilities break down as follows: | ||
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| + | '''FFE''' - individual/navigator, SHOP, payer portal (presentation layer) with integrated eligibility verification, subsidy and credit calculations, and plan selection. | ||
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| + | '''State''' - plan management, premium illing and financial reconciliation | ||
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| + | The Divions of labor around many other functions like member outreach, call center, etc. need to be defined as wel. Assuming that a hybrid model is the likely defauls strategy for many States, what are the implementation steps? Whether a state is an early innovator or tabled a decision until after the election, no single vendor is able to provide a sole source end to end solution. As October 2013 approaches, states should be looking at a modular solution with as many pre-built components as possible. The specific modules required will depend on the functions assumed by the State Exchange vs. the FFE. In any case a system integrator with established partner relationships for critical niche functions is needed to assure that all the parts work together and connect appropriately with the FFE. | ||
Revision as of 16:38, 5 November 2013
Introduction HIX
There is no single right answer to this question. Certain states, specifically Delaware, Illinois, Arkansas(Kaiser Family Foundation, September 14, 2012), have recognized that having their own exchange operation in 2013 is unrealistic and reliance on the FFE for some functionality on an interim basis is required. Their experience provides some guidance to states that are in a similar situation. The division of exchange functions between the State and the FFE will vary. In general, responsibilities break down as follows:
FFE - individual/navigator, SHOP, payer portal (presentation layer) with integrated eligibility verification, subsidy and credit calculations, and plan selection.
State - plan management, premium illing and financial reconciliation
The Divions of labor around many other functions like member outreach, call center, etc. need to be defined as wel. Assuming that a hybrid model is the likely defauls strategy for many States, what are the implementation steps? Whether a state is an early innovator or tabled a decision until after the election, no single vendor is able to provide a sole source end to end solution. As October 2013 approaches, states should be looking at a modular solution with as many pre-built components as possible. The specific modules required will depend on the functions assumed by the State Exchange vs. the FFE. In any case a system integrator with established partner relationships for critical niche functions is needed to assure that all the parts work together and connect appropriately with the FFE.
Principal Components of HIX
