The rise of health insurance exchanges

With citizens required to sign up for health insurance or face a penalty, up to 33 million more Americans will acquire health insurance by 2021 according to PwC. This demand will lead to the development of Web-based health insurance exchange (HIX) platforms like those developed by Oracle and Microsoft. Under ACA, the states must begin open enrollment for HIXes by October 2013 and full operations by January 2014.

As the development of ACOs leads doctors to collaborate and share information, statewide health information exchanges (HIEs) will be necessary to enable visibility into a patient’s history. Vendors participating in HIEs include HP, Harris, InterSystems and Sandlot Solutions. By enabling growth in compatible HIEs, data residing in isolated silos will be more accessible. “Providers and payers understand that by harnessing the power of IT, we can connect silos of data, improve clinical efficiency, empower patients, and accelerate innovation,” Dr. Andrew Litt, chief medical officer for Dell Healthcare and Life Sciences, said in a statement.

The demands on the health care system and more patients going to the doctor will lead to an increased need for storage of big data in virtual cloud platforms such as the Virtual Computing Environment, a joint venture of Cisco, EMC and VMware. A virtual computing environment will “allow IT to spend less time doing typical IT things and building relationships with patients,” said EMC’s Dimond.

With an increased demand on emergency rooms and in-patient services resulting from the mandate requiring people to purchase health insurance, opportunities for growth in telehealth could be a result from this trend as doctors need to keep track of patient conditions. Companies offering telehealth platforms include American Well, Consult A Doctor and Honeywell HomeMed.

As doctors collaborate on providing care as part of ACOs, they’ll need information exchanges, remote-monitoring and mobile health apps as part of a model of care called the patient-centered medical home, said EMC’s Dimond. It “gives a patient who’s chronically ill one touch point for care,” said Dimond. A patient-centered medical home also involves care coordination across a particular care population by using EHRs, decision support software and population-management tools.

The Obamacare legislation calls for a penalty for hospital readmissions for preventable conditions such as heart failure. Use of predictive analytics and software from companies such as Phytel, which tracks the conditions of patients after they leave an inpatient facility, can help hospitals avoid the return of patients to a hospital. Predictive analytics allows doctors to develop a sense of whether a condition will lead a patient back into the hospital or whether it can be solved in a week or two, said Dimond.

The Supreme Court’s ruling on Obamacare will likely motivate smaller hospitals and medical practices to adopt EHRs under ACA even more so than the meaningful-use stimulus incentives in the Health Information Technology for Economic and Clinical Health (HITECH) Act, suggested Nancy Fabozzi, senior industry analyst with Frost and Sullivan. “Smaller practices that have been sitting on the fence about EHRs for whatever reason are simply not going to be able to avoid this inevitable reality for much longer,” Fabozzi told eWEEK.

The increase in demand for health care as more people become insured will lead to a need for additional health care IT professionals to manage data systems for hospitals. IT services professionals that can make sense of actionable data in health care will be in demand, suggested John Birkmeyer, director of the University of Michigan’s center for health-care outcomes and policy, according to FINS.com, the Wall Street Journal’s careers site.

“ACA means that not only a larger number of patients will be coming into the system, but many of these patients will have complex conditions because they have been uninsured or underinsured for years,” said Fabozzi. With a need for more care coordination, health IT systems that enable remote-monitoring of patient conditions will be necessary.

An increase in the volume of patients and insured individuals leads to a surge in demand for revenue cycle management (RCM) applications, said Fabozzi. Providers will require an understanding of procedures for which patients are covered. They’ll also need applications for payment collection for the whole process, from precertification to final payment, she said. “That means many ambulatory practices will have to upgrade/replace RCM, and in the provider space, a lot of RCM/PM systems are bundled with EHRs,” said Fabozzi. “So they will just go ahead and pull the trigger for both systems.”