health care

Visions of how to ‘shop’ for health insurance

Posted 1/16/12

PROVIDENCE – The design of the new Rhode Island Health Benefits Exchange is moving ahead apace, according to discussions at the Executive Committee meeting of the R.I. Healthcare Reform Commission on Jan. 9.

Responses are due on Jan. 17 to the state’s Request for Information from interested vendors in respect operations, software, IT infrastructure and implementation of the “Small Business Health Options Program,” or SHOP Exchange, a significant part of the overall Exchange.

At the same time, there is ongoing work at a very “granular” level to craft a consensus vision for the Exchange, involving many of the key players in the Rhode Island health services delivery sector, including health insurers.

In the public comment section at the meeting, a representative of Blue Cross & Blue Shield of Rhode Island asked why the health insurer had not had input into the wording of the vision articulated within the RFI, at the same time that Blue Cross had been intimately involved over the last month in detailed, granular conversations regarding an overall vision of the Health Benefits Exchange.

In response, Lt. Gov. Elizabeth H. Roberts indicated that the vision in the RFI reflected a sense of the how the Exchange would work from a customer perspective, done within a very short time period. Richard Licht, director of the Department of Administration, responded by saying that there were important distinctions between an RFI and a Request For Proposals, and how such a vision should be interpreted.

Within the RFI, the vision statement read as follows: “We envision one integrated (end-to-end) business process for employers and employees serving existing Medicaid (e.g. RiteShare) and new Affordable Care Act programs (e.g., SHOP) and potentially state and municipal employee health insurance programs.”

For employers, the program would cover eligibility guidance and determination, payment level selection, purchase decision, premium billing and collection, marketing/outreach, employer relations (post enrollment), and legal notifications.

For employees, the program would cover plan selection, enrollment/disenrollment, and legal notifications.

“The process will run on multiple channels, support both self-service and agent-mediated interactions, with tiers of support available, and will be configured for delivery by both direct and indirect service delivery partners, and sensitive to the full range of qualifying events,” the vision statement continued. “Where affordability is an issue for an employee, a pathway to the individual process will be supported.”

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