WHAT IS A HEALTHCARE INSURANCE EXCHANGE AND HOW DOES IT FIT IN U.S. HEALTHCARE REFORM? By Kathy Darling Kathleen Sebelius, the new Secretary of Health and Human Services, told the House Ways and Means Committee in testimony presented on May 6, 2009 that a health insurance Exchange ("Exchange"), if constructed correctly, could provide the basic format for providing health care to all Americans. So what is an Exchange, how does it work, and could it really transform health care in America? Foremost, an Exchange is not just one thing. Think of a huge outdoor marketplace—sort of like the Pike Place Fish Market in Seattle--in which each of the vendors sells its wares to the public. The market (or Exchange) will have all of its own rules and the vendors (providers of health insurance) decide whether or not to set up shop there. In addition, the market may develop a shop of its own on site at which it sells its own products. The market can decide which vendors will be included in the market, the types of products sold by the vendors, the size and content of the vendors’ stands, the times the market is open, and the market can regulate methods used by the vendors to sell their products. In broad terms, that is the same structure a federal health insurance Exchange could take. The health insurance Exchange could potentially offer all of the health insurance products an American would need at that one location. The array of forms the Exchange can take, the products it can offer, and the level of federal regulation which may be applied are really awe-inspiring. As a starting point, the goals to be addressed by an Exchange may include the following: 1. Transparency. Provide transparency to purchasers of health insurance so that individuals or employers may make informed decisions regarding coverage and cost. 2. Universal Enrollment or Access. Ensure coverage for everyone. There should be no uninsured care after health care reform is implemented. 3. Affordability. Subsidize the cost of health insurance for low- and modest-income Americans so that everyone can afford health insurance. 4. Risk Spreading. Spread the risk so that even the sickest patients can be covered. 5. Cost Containment. Reduce health care costs through value based purchasing and reduced administrative costs. 6. Portability. Maintain health coverage through job changes, periods of unemployment, retirement. 7. Data Collection and Patient Interaction through Health Insurance IT. The Exchange could coordinate health care IT relative to electronic health records (EHR), data collection and data sharing, uniform interoperability formats and formulae, web based portals for patient connectivity.
Publications & Presentations
- "The Changing Dynamics of Healthcare Finance and Delivery" Presentation to Texas Association of Health Plans, Bastrop, TX, October 18, 2011
- "Choosing Partners in a Complex Medical World – ACO’s and Other Practice Models” Presentation to Texas Medical Association, San Antonio, TX, July 12, 2011
- "Choosing Partners in a Complex Medical World – ACO’s and Other Practice Models” Presentation to Texas Medical Association, Houston, TX, June 30, 2011
- “Choosing Partners in a Complex Medical World – ACO’s and Other Practice Models” Presentation to Texas Medical Association, Dallas, TX, June 29, 2011
- “Choosing Partners in a Complex Medical World – ACO’s and Other Practice Models” Presentation to Texas Medical Association, Fort Worth, TX, June 28, 2011
- “Choosing Partners in a Complex Medical World – ACO’s and Other Practice Models” Presentation to Texas Medical Association, Lubbock, TX, June 8, 2011
- “Choosing Partners in a Complex Medical World – ACO’s and Other Practice Models” Presentation to Texas Medical Association, Austin, TX, June 7, 2011
- “Choose Your Partners Wisely – Accountable Care Organizations – Friend or PHO?” Presentation to Metroplex Hospital, Killeen, TX, May 23, 2011
- "CMS Value-Based Purchasing Strategies for Success" Presentation to Healthcare Quality (CIHQ), Phoenix, AZ, Pointe Hilton Squaw Peak Resort, May 12, 2011
- "Choose Your Partners Wisely, ACOs and Other Practice Models" TexMed 2011, Houston, Texas, Texas Medical Society, May 13, 2011
- Nelson, Bryn (May 2011) cited in "Value-Based Purchasing Raises the Stakes" The Hospitalist Magazine (Internet)
- "Accountable Care Organizations: Washington Update" Presentation to the Auburn Post Graduate Program , Washington D.C., March 22, 2011
- "Accountable Care Organizations and State Medical Associations" Presentation to American Association of Medical Society Executives, Washington D.C., Omni Hotel, January 18, 2011
- "Accountable Care Organizations" Presentation to the Houston Bar Association, Houston, TX, January 12, 2011
- "Accountable Care Organizations: Opportunity or Threat" Presentation to Texas Medical Association, Dallas, TX, December 14, 2010
- "Accountable Care Organizations: Opportunity or Threat" Presentation to Texas Medical Association, Houston, TX, December 9, 2010
- ”Accountable Care Organizations: Opportunity or Threat" Presentation to Texas Medical Association, Fort Worth, TX, November 18, 2010
- "Accountable Care Organizations: Opportunity or Threat" Presentation to Texas Medical Association, San Antonio, TX, November 11, 2010
- "Accountable Care Organizations: Opportunity or Threat" Presentation to Texas Medical Association, Austin TX, November 4, 2010
- "Accountable Care Organizations-Friend or PHO?" Texas Medical Association - Fall Meeting, Austin, TX, October 16, 2010
- "How Healthcare Reform will Affect Your Business - The Opportunities and Hazzards, Panel Discussion." 2010 Tax Symposium, Dallas, TX, August 23, 2010 and Houston, TX, August 25, 2010
- Hospitals Should Plan Now for Value-Based Purchasing, Which May Be Game-Changer, AIS's Health Reform Week; Volume 1, Number 8 (July 19, 2010)
- “How I Quit Worrying and Learned to Love Health Reform” HFMA Gulf Coast Chapter 2010 Annual Meeting (May 13-14, 2010)
- Quality Based Reimbursement: How Hospitals and Physicians Can Work Together to Affect Quality Care, Southern Medical Association in Conjunction with Auburn University's Physician Executive MBA program, Washington, D.C. (March 24, 2010)
Categories
- Agency for Healthcare Quality & Research
- Anti-Kickback Statute
- Anti-kickback, Stark and Other Regulatory Impediments
- Architecture of a VBP Network
- Business Case for Value Based Purchasing
- Centers for Medicare & Medicaid (CMS)
- Department of Health & Human Services
- Development of a VBP Program
- Federal Trade Commission/Antitrust
- Future of Value Based Purchasing
- Health Care Exchange
- Health Information Technology
- Insurance Regulation
- Legislative Updates
- Litigation
- Malpractice Risks
- Medicaid
- Medicare
- National Committee for Quality Assurance (NCQA)
- Patient Protection and Affordable Care Act (PPACA)
- Pending Legislation
- Physician Quality Reporting Intiative/PQRS
- Recovery Audit Contractor Program
- Stark Law
- Tax Exempt Hospitals
- Value Based Purchasing
- What is Value-Based Purchasing?
Disclaimer:
External links to other websites on the internet for convenience and informational purposes only. The VBPB does not endorse, sponsor or control the operation or content of any external site. Any link to an external site from the VBPB in no way suggests or implies that the external site promotes or otherwise endorses, sponsors or is affiliated with any products, business relationships, services, causes, campaigns, Web sites, content, or information contained on the VBPB.
The authors and editors of the VBPB, in their sole discretion, reserve the right to edit or remove any comments or other content submitted or posted to the VBPB for any reason.
« January 2009 | Main | June 2009 »
