Study: Health Insurance Exchanges Represent Immense Opportunity and Potential Risk for Health Insurers

Survey of 2013 Healthcare Mandate Summit Attendees Reveals Major Concerns, Though the Vast Majority Still Plan to Participate as Early as 2014

Bellevue, WA (PRWEB) February 20, 2013

Coming on the heels of last week’s deadline for states to inform the federal government of whether they intend to leverage a partnership health insurance exchange (HIX) or participate on the federally facilitated exchange, a study released today by Edifecs, Inc., shows that health insurers recognize both the promise and peril of HIXs. At the recent 2013 Healthcare Mandate Summit, more than 95 percent of senior healthcare professionals surveyed said they plan to participate in at least one HIX. Of those, a surprisingly large majority—80 percent—will do so in 2014. However, the study also reveals skepticism among respondents that state or federal exchanges will be ready to launch by the October 1, 2013 deadline. And once HIXs are up and running, respondents fear potential disruption to existing IT infrastructure and the difficulties in reconciling premium, enrollment and payment records from the HIXs.

Healthcare industry experts view HIXs as central to the effectiveness of the Affordable Care Act (ACA) because they provide an online marketplace where consumers can shop for, compare and purchase health insurance. The Congressional Budget Office projects that nearly 12 million Americans will buy health insurance via an HIX in 2014(1).

The potential upside for a health insurer participating in an HIX is significant. According to a November 2011 PwC Health Research Institute report, the 12 million people who buy insurance through an HIX in 2014 will together pay approximately $60 billion in premiums. By 2019, those figures will grow to 28 million consumers paying nearly $200 billion in premiums(2).

The special report, “HIX Insights from the 2013 Healthcare Mandate Summit,” includes survey results from more than 125 senior healthcare professionals attending the 2013 Healthcare Mandate Summit that took place February 4-6 in Austin, Texas. The report reveals that while HIX participation will be high and the country’s health insurers are confident they will be ready by the launch deadline, they also have reservations about how HIXs will be implemented and run.

Key findings from the 2013 Healthcare Mandate Summit special report on HIX include:

    • Health insurers recognize the HIX opportunity and are taking preparations very seriously. When asked about their plans for participating in an HIX, 80 percent reported they plan to participate on an exchange in 2014—the first year HIXs will offer coverage and expected to be one of the largest open enrollments in history. When asked about meeting the October 2013 deadline, 70 percent of respondents said they were “very confident” or “somewhat confident” that their organization would be ready.



    • There is an urgent, immediate need for more information sharing and collaboration among health insurers and the HIXs they plan to join. Like any major business or technology project, transparency with stakeholders is imperative. However, most of the survey respondents reported a lack of good information coming from the state exchanges they are targeting for participation. Sixty-nine percent rate the quality of information as “poor” or “very poor.” In addition, an overwhelming 93 percent expressed a strong desire for exchanges to solicit input from them on how to define and operate their enrollment processes.



  • Health insurers are far more concerned about the ongoing challenges of operating on an exchange than the process of actually joining one. Each state has considerable leeway in determining how it will run its exchange, which means health insurers operating on multiple state exchanges face the daunting task of supporting multiple exchange formats and added levels of complexity. Just over 31 percent of those surveyed indicated they plan to participate on three to five exchanges, with another 15 percent planning to participate on more than eight.


“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. “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.”

To download the report, visit .

About the Report: “HIX Insights from the 2013 Healthcare Mandate Summit”
The survey was conducted among health insurers and healthcare provider attendees of the 2013 Healthcare Mandate Summit, an industry conference hosted by Edifecs that took place February 4-6, 2013 in Austin, Texas. The results are from a survey of more than 125 senior healthcare professionals—each of whom self-selected which questions they chose to answer, and this accounts for the variation in sample size by question. All respondents are actively involved in their organization’s compliance initiatives and carry significant responsibility for ensuring compliance with government mandates. Attendees represented a wide range of healthcare organizations, including commercial health insurers (68%), healthcare providers (11%), government entities and agencies (9%), and other healthcare industry organizations (12%).

The survey is not based on a probability sample, and therefore, no estimate of theoretical sampling error can be calculated. All decimals in this report are rounded to the nearest percentage point. This may result in certain numerical totals adding up to slightly more or slightly less than 100 percent.

The estimates and opinions expressed in this report are based on the survey results only, and the results do not purport to represent all entities or professionals in the healthcare industry.

About Edifecs, Inc.
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.

Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit