Oracle Platform Helps States Support Health Insurance Exchanges

Oracle's health insurance exchange platform will enable states to meet federal mandates on affordable care and allow consumers to choose and manage health plans.

Oracle has announced a health insurance exchange (HIX) platform that aligns several of its existing applications to allow states to create a marketplace for purchasing health insurance.

Under the 2010 Patient Protection and Affordable Care Act (PPACA), states must establish health insurance exchanges by 2014.

"The impending rollout of health insurance exchanges will require state governments to establish state-regulated and standardized health care plans, from which individuals may purchase health insurance that is eligible for federal subsidies," Mark Johnson, senior vice president for Oracle's public sector, said in a statement.

The HIX will enable citizens and small employers to determine eligibility for health plan subsidies, according to Oracle.

The platform, announced on Sept. 26, conforms to guidelines by the Center for Consumer Information and Insurance Oversight (CCIIO) and the Office of the National Coordinator for Health Information Technology (ONC) on integrated IT systems.

The HIX's rules engine allows states to meet federal rules on eligibility and provide capabilities to accept patient applications, Kevin Curry, Oracle's group vice president, public sector, told eWEEK.

Oracle designed the platform to support multiple programs to allow states to deploy HIXs quickly and cost-efficiently, the company reports. Oracle will phase in additional applications as legislation changes dictate.

"To help address the challenges state governments will face related to these requirements, Oracle offers a robust solution which consists of proven technologies that are architected to work together and include the necessary capabilities needed to deliver a successful program," Johnson said.

The foundation of the HIX platform includes Fusion Middleware, particularly the Oracle SOA Suite. Fusion is a leading application infrastructure platform.

The service-oriented architecture suite features hot-pluggable software and the ability to reuse existing application development tools to reduce development and maintenance costs. The suite provides end-to-end security and unified metadata management.

As state governments roll out the insurance exchange, it will allow for companies to broker insurance plans, manage the details of plans, measure eligibility and automate enrollment. In addition, the platform will allow insurers to collect premiums, provide customer service, and keep track of tax credits and payment processing.

The HIX also helps states manage reporting of financial details to the government.

Siebel customer relationship applications provide states with the infrastructure to operate multichannel customer service and include analytics tools for evaluating calls. Siebel also handles case management for the exchange, Curry said.

Another key component is the Oracle Policy Automation (OPA) rules-based engine, according to Curry. OPA allows states to use Word and Excel documents through a Web-based service to determine how government policies affect coverage. The software also makes calculations based on entitlement and provides decision support.

Other middleware components include Identity Management, which provides automated user account provisioning and security challenges at each stage of the application life cycle.

Meanwhile, the HIX also includes Master Data Management Suite, a set of programs that distribute master data to other operational and analytical applications as a shared service.

Oracle is already working with Oregon on an initial HIX platform.

On Feb. 8, Microsoft also announced a state health insurance exchange platform, collaborating with Extend Health, which runs a large private Medicare insurance exchange.

In addition, on June 20 Adobe unveiled its Digital Enterprise Platform to enable the health care industry to create HIXs. The platform runs applications on a modular open-standards infrastructure. It integrates online chat, electronic health records (EHRs) and Google Maps to locate doctors.