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9/20/2012
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Xerox Wins Contract For Nevada Health Insurance Exchange

Nevada awards $72 million to Xerox to build its health insurance exchange system--and to prepare the state for the onslaught of users.

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Nevada has awarded Xerox a contract worth $72 million to provide the technology and services to design and build the state's health insurance exchange (HIX). Under the agreement, Nevada's Silver State Health Insurance Exchange will use Xerox's cloud-based technology and Web portal to support the HIX website, where individuals and small business employers will compare and buy health insurance plans that meet their needs.

Officials at Xerox said the company's technology and services will support premium billing, processing, collection, aggregation and remittance, data analytics and actuarial support, health plan quality review and compliance reporting, and incorporation of tax credits and subsidies in cost calculations. The company also will establish a call center in Las Vegas that will answer customer questions.

According to Jon Hager, executive director of the Silver State Health Insurance Exchange, Xerox's technology and service allows Nevada to improve its management of the exchange. "There is very little margin for error in getting an exchange fully operational by 2014 and self-sustainable by 2015," Hager said in a statement.

Nevada's Exchange recently received a Level Two Establishment grant from the federal government worth $50 million, which will go toward building the exchange's IT infrastructure and services to meet certification requirements in January 2013, provide coverage to enrollees by Jan. 1, 2014, and achieve self-sustainability by January 2015.

"States need to bear in mind that consumers coming to use these exchanges already have a lot of experience using websites in other markets, such as retail or financial services," said Janice Young, program director at IDC Health Insights.

[ Looking for a PACS platform to replace an outdated system? See 9 Must-See Picture Archiving/Communication Systems. ]

In an interview with InformationWeek Healthcare, Young said states need to create user-friendly websites that are simple, and relatively intuitive, and that give individuals opportunity to easily identify their benefits, look at their options, and enroll without difficulty.

She added that health plans are looking for partners to help them build a technological infrastructure to support the millions of individuals expected to purchase health insurance through the exchanges.

"Many health plans expect HIX activity to increase online volume, but few have the online capacity to support the level of complexity and responsiveness needed for product selection, enrollment, etc. that these and any high-volume online presence would require," she noted. "Many are looking to solutions partners to create or enhance their capabilities in this regard."

In a separate announcement earlier this week, Xerox said it will partner with HealthPlan Services (HPS), to provide technology that will help health plans enroll and participate in state insurance exchanges.

Under the agreement between Xerox and HPS, health plans will use HPS's Go-To-Exchange, which offers specific tools that help health plans connect with exchanges. These include:

-- The ExchangeLink, which integrates the HIX platform with health plans' existing core systems and business processes. -- The ServiceLink, which manages members' accounts, including calculating and billing member contributions, applying premium tax credits, and reconciling membership and tax credits across state and federal agencies.

The partnership also calls for Xerox to provide health plans with technology and services to support customer care for existing members, new enrollees, and prospects; a full suite of third-party administration services; and payment recovery to prevent waste, fraud, and abuse. It also will provide customer communication services. Those services will include a summary of benefits and coverage statements, explanation of benefits, and correspondence.

Jeff Bak, president and CEO at HPS, said two of the most significant challenges confronting health plans and their participation in state insurance exchanges are unpredictable volumes, and steep ramp-up requirements during open enrollment. Both are difficult to accurately predict and problematic when trying to decide on how many resources are required. Bak recalls that this was a lesson the industry learned during the first year of Medicare Advantage, when participating carriers struggled to meet enrollment demand.

"To avoid repeating that history, carriers need a highly flexible and rapidly scalable HIX framework. That framework can best be provided when vendors team up to deliver a multi-solution approach," Bak told InformationWeek Healthcare. "The reality is that individual solutions, no matter how superior, have limited capacity, while a partnership such as HPS and Xerox enables resources to be scaled in response to fluctuating demands."

InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)

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