President Obama’s re-election will go down in history as a critical marker on the journey of healthcare transformation in the U.S. Since the election, states have become more focused on deadlines for major components outlined in the Affordable Care Act, specifically the standing up of Health Insurance Exchanges, or HIXes. Side note: For more information on Health Insurance Exchanges, please refer to my colleague Jeff Hechemy’s blog post on the topic.
States across the country are at varying stages of adoption when it comes to Health Insurance Exchanges, and in less than a year — when open enrollment starts on Oct. 1, 2013 — exchanges will need to be up and running to take in customers for 2014. Many states have been taking a “wait and see” approach when it comes to submitting their HIX plans – and they’ve recently been given an additional month to consider their options. But some states, like Nevada, have taken action to meet this deadline, and, in doing so, they have set a strong example for other states to follow.
Nevada’s solution is called the Silver State Health Insurance Exchange (SSHIX), and it works like a bridge connecting uninsured Nevadans with health plans. The Exchange enables individuals and even small businesses to compare and buy health insurance plans that meet their needs.
The Exchange is also a bridge between public and private healthcare and other human services IT systems – with eligibility (run by the state of Nevada in cooperation with Deloitte) on one side, and the healthcare enrollment-related business operations system (run by the Exchange Board and supported by Xerox) on the other. These two systems meet at several interfaces to communicate with each other. The state’s eligibility system is the main location for all welfare and Medicaid systems information. Because it communicates with Xerox’s BOS, the SSHIX will become the central hub in Nevada for all eligibility decisions. When put this way, it’s easy to see how HIXes can make the health-plan purchasing and managing process significantly more efficient.
As the BOS partner for the SSHIX, Xerox is tasked with integrating Nevada’s existing Medicaid, CHIP programs and the state’s new Eligibility Rules Engine in order to provide a single point of entry for all public and commercial program application, eligibility and enrollment through the Exchange. The Web portal and online selection tool we’re creating for Nevada are part of our cloud-based SaaS model, which allows states to pay only for the services they need, without substantial investment and ongoing maintenance costs for dedicated hardware and infrastructure. In addition to developing and operating the Web portal and online selection tool, Xerox will also manage a customer contact center to share information with participants about the price and quality of health services.
Planning ahead and bringing Xerox in early were key for Nevada to put itself on schedule to have a HIX up and running in time for open enrollment on Oct. 1, 2013. As a result of that early commitment, the state of Nevada received a Level Two Establishment grant from the federal government worth $50 million. It’s one of only seven states in the nation to receive such a grant.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
