The ‘Oklahoma Health Insurance Exchange’ will begin serving as an online marketplace for individual and small group consumers to buy private insurance in 2014. Online insurance exchanges – which we discussed in this recent blog post – are one of the primary requirements of the Affordable Care Act passed by Congress last year. News from the governor’s office that the state has accepted a $54 million dollar ‘early innovator’ grant from the federal government means that Oklahoma is now poised to build the most advanced insurance exchange in the country.
Why was Oklahoma one of only six states selected for this grant? There are two programs that uniquely position Oklahoma as an innovator of health care information technology: Insure Oklahoma (IO) and SoonerCare online enrollment (OE). Online enrollment for SoonerCare, the state’s Medicaid program, went live in September 2010 and has already dramatically improved the efficiency of the application process. Applicants input required information on family members, income, etc. into a web-based interface, and their eligibility is determined in real-time (subject to verification). Three months after online enrollment launched, only 7 percent of SoonerCare applications were paper. OK Policy blogged about the launch of online enrollment and the resulting national accolades this past December.
In 2005, Insure Oklahoma (IO) became the state’s first premium assistance program. IO currently offers coverage to employees of small businesses through employer sponsored coverage, and directly to individuals who are unemployed, self-employed, or working for an Oklahoma business that doesn’t offer insurance. The IO program is the first step to establishing a state-wide exchange, when coupled with advances in online enrollment automation, Oklahoma is years ahead of other states in readiness to launch an insurance exchange.
One of the first tasks for the Early Innovator grant will be a ‘gap analysis’, an assessment of the capacity of the state’s current technology infrastructure. Once current capacity is mapped, it will be measured against what the state needs to build and operate an effective Exchange. For instance, OHCA already operates a call center to handle inquiries for IO and SoonerCare, but the capacity of the call center will need to be expanded to handle the call volume of a new insurance Exchange that will serve hundreds of thousands of additional consumers.
The goal is for the Exchange to serve as a one-stop shop for all of a household’s health care needs. A single web-based portal for citizens to access affordable private insurance and determine their eligibility for public assistance like breast and cervical cancer screening, services for persons with disabilities, or dental care for children. Currently, those programs listed are provided by three different state agencies. When the insurance Exchange goes online in 2014, they will be accessible through one internet site, alongside an insurance marketplace where private plans can be bought and sold.
Building this single portal is no easy task, especially when you consider the constantly changing needs of each household. As citizens move from job to job, get married, have children, and age, their health care needs and eligibility for public assistance changes too. The Exchange IT system must be interoperable and integrated so consumers can easily make changes, i.e. switch from Medicaid to private insurance or vice-versa.
In addition, the Exchange will be built with the security needed to protect consumer information, obstruct fraud, and comply with the Health Insurance Portability and Accountability Act (HIPAA). The online provider directory used by IO and SoonerCare will be upgraded to a universal provider directory, a state-wide database of doctors searchable by location, gender, and specialty. For the full Early Innovator grant proposal including all the proposed system upgrades, click here.
Once the basic infrastructure upgrades are made, there are innumerable and creative ways that businesses, consumers, providers and state agencies can use these tools to improve care. For example, North Carolina has used upgrades to their Medicaid information system to help doctors make wiser patient treatment decisions. As doctors and hospitals submit claims information to the state, they receive periodic reports back from the system that reveal how their treatment and prescription choices compare to other doctors treating the same kinds of patients right down the street and in other parts of the state. Providers can use that information to make sure they are not falling behind, or getting ahead, of the standard of and cost of care in their specialty area and geographic location.
Improving the quality of health care, and reducing long-term costs for the consumer, require large up-front investments in infrastructure. This money represents an opportunity for Oklahoma not just to be a leader and example for other states, but to facilitate relationships between consumers and private sector providers that will guarantee the long term health of its citizens and the profitability of its businesses.
For more information, check out our ongoing series examining the Affordable Care Act, including previous posts on long term care and consumer protections for preexisting conditions. You can also visit the health care reform page on our website for more resources and information. If you have thoughts on health care reform, we encourage you to comment below or contribute a guest blog.