Paul Tiede is trying to figure out what the Patient Protection and Affordable Care Act exchange system will look like when it grows up.
Tiede, an executive vice president at SunGard, is starting to think the next version of PPACA Version will emerge a few months after Jan. 1, and major program refinements could roll out periodically for years after that.
For his company, he thinks the big opportunities could lie in developing systems to help brokers and mid-sized insurers keep track of the many documents companies will have to receive, manage and send when they are educating consumers about the exchanges.
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In states with well-run, state-based exchanges, the health insurance marketplaces will open their doors this fall, quickly enroll about 60 percent of the uninsured and underinsured residents, and, he said, come to a troubling conclusion: "Oh, we missed a bunch."
Then, he said, the states will regroup and try to figure out how to reach the remaining 40 percent.
Today, Tiede said, many insurers use SunGard products to convert paper documents into a searchable, digital form, then manage the documents and the flow of work related to the documents.
Tiede sees several big technology companies developing soup-to-nuts exchange support systems for insurers.
One obstacle is the gap between how the states are building their state-based exchanges and how the Centers for Medicare & Medicaid Services is building the "federally facilitated exchanges," Tiede said.
"I don't think the business model has shaken out yet," Tiede said.
Meanwhile, even though health insurance marketers are warning that carriers will have to learn how to take a "one to one" approach to communicating directly with individual consumers, software tools to support that approach are rare, Tiede said.
In the real world, Tiede said, the few consumers who know about PPACA have little understanding of how it will work, and many seem to think that, starting in 2014, health insurance will be free for all.
"How are you going to educate and interact with individual consumers before they become customers?" Tiede asked.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
