Creating a model for health care shopping
$35.6 million federal grant will help develop online health care exchange

By Jim Fessenden
UMass Medical School Communications

UMass Medical School will partner with the Massachusetts Executive Office of Health and Human Services (EOHHS) and the Massachusetts Health Insurance Connector Authority to develop an online “health care exchange,” a resource through which consumers and small business owners can efficiently shop for health insurance plans. Creation of the exchange is supported by a $35.6 million grant from the U.S. Department of Health and Human Services (HHS).

Massachusetts is one of seven “Early Innovator” states to receive grants from HHS as the nation prepares for implementation of federal health care reform. Starting in 2014, all states will be required to set up online health care exchanges to help individuals and small employers shop for, select and enroll in high-quality, affordable private health plans that fit their individual needs at competitive prices.

“We thank the Obama Administration for supporting our efforts to ensure that the people of the Commonwealth have the tools they need to find the best and most affordable coverage plans for their individual needs,” said Governor Deval Patrick.

“Health care reform means that consumers will be more directly involved in health care decisions, starting with the purchase of their insurance coverage,” said Michael F. Collins, MD, UMMS Chancellor and University Senior Vice President for the Health Sciences. “This grant will help the nation reach the place where we are in the Commonwealth, as it designs and implements a comprehensive, user-friendly mechanism for consumers to more fully control their health care expenditures. UMass Medical School is uniquely positioned to play a key role in this process. Our Commonwealth Medicine division has been an important partner with the state over the past decade in creating and implementing health care policy.”

Secretary of Health and Human Services JudyAnn Bigby, MD, said, “We are proud to have been the national model for health reform and the creation of exchanges and look forward to working with the other New England states to develop an infrastructure model that can be replicated nationwide.”

By providing a place for one-stop shopping, online exchanges will make purchasing health insurance easier and more understandable. A sophisticated, consumer-friendly technology infrastructure – similar to web sites employed by consumer-based industries such as airlines or banks industries – will be critical to the success of the exchanges.

“We want to make the shopping experience for individuals and small businesses as customer friendly and efficient as possible,” Jay S. Himmelstein, MD, MPH, professor of family medicine & community health and medicine and director of Public Sector Health Information Technology Policy.

Although exchanges are not scheduled to launch until 2014, work is already underway to design and implement them across the country. Using these new federal funds, the Early Innovator states will develop exchange models that can be adopted and tailored by other states.

Working with Massachusetts EOHHS and the Health Insurance Connector Authority, UMass Medical School will help create and build a flexible exchange information technology framework in Massachusetts to be shared with other New England states. An innovative part of the plan is the involvement of the New England States Consortium Systems Organization (NESCSO), a non-profit corporation organized by the six New England health and human services agencies to foster communication and collaboration.

The UMMS framework is expected to be completed by 2013, a year ahead of the federal deadline. Lessons learned from its creation and implementation will be used to inform best practices, help gain efficiencies and accelerate development for participating New England states. This will help those states establish their exchanges quickly and efficiently using the models and building blocks created by the Massachusetts project. At the same time, individual states will continue to have the flexibility to develop an exchange that best meets the needs of their unique health insurance market without having to start from scratch.

Grant applicants were selected based on their readiness to develop and use innovative technology approaches for establishing an exchange systems. Massachusetts, which requires individuals to get health insurance as part of its own health care reform act passed in 2006, already operates an exchange through an agency called the Massachusetts Health Insurance Connector Authority and has demonstrated a technical expertise and ability to develop these systems on a fast track schedule.

“We look forward to not only improving the web-based shopping experience for Massachusetts consumers but sharing our knowledge and experience with other New England states looking to establish health exchanges by 2014 that are in compliance with new federal standards,” said Glen Shor, Executive Director of the Massachusetts Health Insurance Connector Authority. “While Massachusetts will not have to reinvent the wheel, we’re probably going to have to change the tires.”

“The Massachusetts Health Connector was such a success story that we used it as a model for helping people across the country find the right health insurance plan” said Senator John Kerry. “This investment keeps us out front building a more cost-effective and consumer-friendly health insurance marketplace that looks out for people and small businesses.”

About Commonwealth Medicine

Commonwealth Medicine (CWM) is the public, nonprofit health care consulting and service organization founded by UMass Medical School. Government agencies, nonprofits and managed care organizations benefit from CWM’s expertise in clinical service delivery, health care financing strategies, policy management and quality improvement. CWM programs have helped Massachusetts—and many other state, international and local health care agencies—to increase the value of health care expenditures while improving access and delivery of care to at-risk and uninsured populations. Commonwealth Medicine programs were developed, in part, as a way for UMMS faculty and staff to have a direct and profound impact on the communities of Massachusetts, and now provide critical opportunities for UMMS faculty and students to serve the community.

Related links:

Commonwealth Medicine
New England States Consortium Systems Organization (NESCSO)
Massachusetts Health Connector