Last Thursday, state-based health insurance exchange executives gathered in Chicago to reflect on their experiences establishing their respective exchanges. While these executives were meeting, the full D.C. Circuit Court announced it would rehear the Halbig premium subsidy case and the Oregon exchange board met to discuss dismantling Cover Oregon and moving remaining functions to existing state agencies. As these recent events reflect, this is a period of great uncertainly on the state-based exchange front. As a result, state exchanges, the contractors that built those exchanges and plans participating in them need to be vigilant as to the risks and opportunities that lay ahead.

Northwestern University’s Kellogg School of Management convened a day-long symposium last week on state-based exchanges to discuss year one of operations, what went well, what did not, and lessons learned. During the panel presentations, exchange executives talked about revisiting previous discussions about how exchanges can drive delivery system reform. Some indicated that after focusing on the basics in the first year or two of operations, they are ready to revisit conversations about standardizing benefit packages and using the exchange to impact the health care delivery system. There was specific mention of modifying QHP standards to drive changes in the products offered on the exchange so those products advance ACOs and other delivery system reforms. Insurers participating in state-based exchanges should be on the lookout for future changes including exchanges selectively contracting with a limited number of health plans or using additional criteria to select plans offered on the exchange based on factors such as affordability, prevention and wellness efforts, provider contracting methods, efforts to reduce health disparities, patient access to health care, and other criteria aimed at improving the health delivery system.Continue Reading State-Based Health Insurance Exchanges: What Does The Future Hold?