Health Insurance Exchange is born

Today is the launch of the health insurance exchange!!!  Congratulations to all of the people who worked so hard to create this capability.  I was recently asked if there was a role for master data in the insurance exchanges.  It seems to me that we have lots of eligibility transactions but no consolidated view of the beneficiary, member, or subscriber.  A book of record would be very useful.  The book of record would create an aggregate view of the person or household and answer questions such as:

  • How many times has this person tried to enroll?
  • How many times have we denied this person coverage?
  • When did this person's incarceration status change?
  • Is this person a member of a household and what are the coverages provided to other members?
  • Show me the historical responses for this person from the SSA and IRS

Provided below are a few major requirements for key components of the master data management business areas.  State HIX should support an efficient and robust master data management feature that will have the following key components:

  • Consolidate and provide a single view of data across the HIX and all other solutions it will connect to
  • Provide standardization and de-duplication of data across the solutions
  • Resolve data discrepancies across multiple solutions through the rules set by the State
  • Allow easier search and identification of data records with probabilistic and partial match mechanisms
  • Manage the data through effective and efficient:
    • Data Collection
    • Data Aggregation
    • Data Matching
    • Data Transformation and Standardization
    • Data Checking (QA)
    • Data Storing
    • Data Sharing
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ABOUT THE AUTHOR

Greg