Confidence low on HIX readiness

What's the likelihood of state and/or federal health insurance exchanges (HIXs) being ready for operation by the Oct. 1, 2013 deadline mandated in the Affordable Care Act (ACA)? Fairly low, according to healthcare professionals surveyed by information-exchange software provider Edifecs. Some 70 percent of respondents said they are skeptical of HIXs being ready to launch by the deadline.

The survey polled health insurers and healthcare provider attendees of Edifecs' 2013 Healthcare Mandate Summit, which was held Feb. 4-6, 2013 in Austin, Texas. The resulting report was published Feb. 20.

The study also found that respondents are concerned about states’ ability to overhaul existing IT systems to comply with all aspects of the ACA, and to create interfaces among the Medicaid, HIX and Children’s Health Insurance Program (CHIP) systems at the same time they are developing their HIX infrastructure. Even if they choose not to run their own exchange, many states must complete significant system upgrades.

Other top findings from the HIX survey include:

  • Seventy-five percent are very concerned with being able to reconcile premium, enrollment and payment records received from HIXs.
  • Eighty-eight percent are concerned about potential disruption to existing IT enrollment infrastructure and processes.
  • Ninety-three percent say state exchanges should share more information with — and take more feedback from — health insurers.


The survey polled more than 125 senior healthcare professionals who are actively involved in their organization’s compliance initiatives and carry significant responsibility for ensuring compliance with government mandates, according to Edifecs researchers. They represent a wide range of healthcare organizations, including commercial health insurers (68 percent), healthcare providers (11 percent), government entities and agencies (9 percent) and other healthcare industry organizations (12 percent).

Whether or not there is a delay on open enrollment for HIXs, payers across the country are moving forward with their plans to participate by the Oct. 1, 2013 deadline, according to Edifecs. Ninety-five percent of health insurers attending the Healthcare Mandate Summit reported they plan to participate in an exchange, and 80 percent will be on an exchange in 2014.

The study follows last week’s deadline for states to inform the federal government of whether they intend to leverage a partnership HIX or participate on the federally facilitated exchange.

“The message we heard from Summit attendees is that while compliance with mandates such as health insurance exchanges is no easy feat, there are considerable benefits to be gained, including increasing member enrollment,” said Jamie Gier, vice president of corporate marketing for Edifecs, in a press statement. “The value of the Healthcare Mandate Summit was in helping healthcare organizations confirm whether they are on the right path toward compliance and where they can improve. And as the results of the survey demonstrate, many health insurers are embracing the opportunities that exchanges can provide.”

The full study, "HIX Insights from the 2013 Healthcare Mandate Summit," can be found here.