BROOMFIELD, CO – When the Affordable Care Act established health insurance exchanges – centralized databases to allow individuals and small businesses to compare health plans – OXLO Systems, a Colorado-based Software as Service company, recognized that data integrations between insurers and exchange partners were going to be complex and time consuming. OXLO responded by creating OXLO IntegrateOnce™,  an online hub that performs all the integration work necessary to meet the unique requirements of each of an insurer’s exchange partners.

“Companies are devoting significant time and resources to doing data integrations with exchange partners on a case-by-case basis. OXLO IntegrateOnce™ offers a simpler, faster alternative. Integrate with the Oxlo hub one time, and we take it from there,” explains Gene Brothers, CEO and President of OXLO Systems.

OXLO will be premiering IntegrateOnce™ at the 3^rd Annual Leadership Summit on Health Insurance Exchanges hosted by World Congress on July 24 and 25, 2012. The heart of IntegrateOnce™ is a patented self service interoperability platform that supports real-time dynamic routing of exchange business process messages. The core required integration features enable the platform to transform a single transaction into compatible formats for multiple business partners.  All transactions are managed and monitored 24x7x365 as Software as a Service.

Oxlo works collaboratively with each client to develop specifications that will pave the way to smooth integrations with multiple exchange partners. Clients then use an online portal to access business process and transaction reporting, integration specifications and self service integration tools.

Oxlo offers a complete product overview of IntegrateOnce™ for free download at healthinsurance.oxlo.com.

About OXLO Systems, Inc.
OXLO Systems was founded in 2004 in Broomfield, Colorado. The company provides competitive business intelligence and data solutions for a wide range of industries including automotive, financial services, insurance and health care. OXLO currently provides data and information solutions to the top health insurance companies in the U.S. Visit Healthinsurance.oxlo.com for more information.

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The insurance exchanges have been created as part of President Obama’s health care reform bill, to help American citizens obtain affordable healthcare. The Exchanges present state-regulated and standardized healthcare plans offered by insurance carriers allowing individuals to opt-in to individual health insurance that has met oversight rules imposed by the govt. The Insurance Exchanges are envisioned to fulfill the vision of providing consumer protection and oversight while making sure that hospitals remain cost-effective rather than abusing their privilege. While health insurance exchanges are a contentious issue, they have been put into action recently under the direction of Obama’s staff and other relevant agencies.

Early Stages of The Insurance Exchanges

The first models for health insurance exchanges were already in operation when President Obama ushered the healthcare reform bill into law. Even though insurance exchanges were relatively young, many government officials felt that the system had merit and could be brought on a larger scale in the United States. As a result of the debate in the House and Senate, the health insurance exchanges became state initiatives allowing each state to create their own Exchange. States could choose to partner and create regional Exchanges, create their own health insurance exchange or do nothing and have their state Exchange managed by the Federal govt..

There have been some success stories within the United States since inception of the Insurance Exchanges. One of the most famous is a New York based non-profit health insurance exchange called HealthPass, which has made tremendous strides. They have helped provide a model of what kind of protections can be offered to those who buy-in while allowing price protection at the same time.

The Insurance Exchange – An Enabler of Higher Quality Healthcare

The health insurance exchange goal is to help individuals and small businesses obtain health insurance that meets standardized requirements for price and benefits and drive quality into the healthcare by expanding the risk pool. This increases the bargaining power of the pool and theoretically allows the pool to access higher quality care. social scientists, such as Washington Post writer Ezra Klein, have said that the health insurance exchange is one of the most important aspects of the new healthcare reform movement. The low quality of care is due to a lack of bargaining, and the Exchanges seek to change all that.

In the United States many large and small companies provide employees with health insurance options. The company’s ability to bargain, related closely to its size, provides collective group purchasing advantages for employees. Unfortunately, choice is limited and the best insurance option choice for the group takes precedence over each individual. Health plan options are often limited and do not meets the needs of specific individuals.

The Insurance Exchanges are envisioned to help the problem of price and choice by representing a large group of individuals and thus opening up the size risk pool and lowering rates. In theory, this enables individuals to obtain higher quality care than they would typically have access to on their own and benefit from the collective bargaining price benefits that usually only come with group insurance.

The new reform efforts are envisioned ,to allow American citizens to obtain high quality healthcare that they have needed for many years. While these Exchanges are currently in the early stages of development, they have shown a promising beginning that may indeed help many citizens in the country who are unable to provide themselves and their family with good quality healthcare.

In an effort to reform the existing healthcare problems that exist in the United States, President Obama, along with a number of democrat and some republican lawmakers, came together to create the Affordable Care Act. Although this act is being debated and contested by many opponents, there currently exist many new programs that allow for healthcare benefits. One of those programs is referred to as a health insurance exchange. While it is new, there are several ways that health insurance exchanges can be beneficial.

Origins of Health Insurance Exchanges

Before the act passed and came into law in 2010 there were actually a few exchanges already functioning. The House of Representatives wanted to create a single national exchange, but the Senate passed a state-based exchange network instead. The federal government is supposed to provide a health insurance exchange in the absence of a state Exchange.

Overall, the health insurance exchanges are meant to make healthcare markets more efficient by organizing the system and providing much needed oversight to thwart abuses. The existing system is far too complex for most citizens, which makes costs go up due to disorganization.

Benefits of Health Insurance Exchanges

There are many of benefits for the health insurance exchanges that are starting to pop up in states across the country. As mentioned earlier, the sole problem for most of the healthcare woes in the United States is the lack of organization. The health insurance exchange helps people to organize their healthcare and get better plans for their family.

Most employers do not offer more than a few options for health insurance. Although you may get your own insurance, the private market is quite difficult for unskilled people to learn. There is no bargaining power like your employer has and your insurer can push you around. If you have a past illness then the provider will most certainly increase the prices drastically as well. Many of the private insurers will provide plans that are unnecessary or have loopholes that provide little help to the patients.

However, for those using a health insurance exchange, the options are much different. Within the exchange, there will be dozens of insurance companies competing with different benefits and prices, but all meeting minimum requirements as set for comprehensiveness. The health insurance exchanges offer the choice that you are afforded with private health insurance combined with the bargaining power you might see with an employer. In fact, the exchange will have even higher bargaining power than an employer because of the large base of customers.

Inevitably this all means that the cost of healthcare and the quality of services will increase. Efficiency in this muddled system is exactly what is needed in the healthcare industry. Many reformers have considered the health insurance exchange to be the most important part of Obama’s new Affordable Care Act.

The theory sounds great, but many critics are not convinced. Without evidence that the health insurance exchanges can work on a large scale, many are unwilling to accept this kind of collective bargaining. Free market capitalists do not trust these cooperative groups because they are fearful of the implications.

Exchanges in the Beginning

The health insurance exchanges in the beginning are going to be difficult to garner success with. Many critics are worried that it will never be a success because there will be limited individuals involved at the beginning. This will lead to a lack of bargaining power and ultimately make the exchange fail. Others fear that only the businesses with sick and expensive workers will decide to buy in to the system, which would leave the pool much more expensive and unable to sustain itself. The costs would be even higher with these expensive workers, which would keep other individuals from buying into the system. More importantly, if there is any success, it would have to come from the government’s cooperation with the state exchanges. Many people fear this.

Nevertheless, success has already been shown on a number of levels. The health insurance exchanges in Connecticut and New York have proven themselves capable of helping people find alternatives to their existing healthcare coverage. More importantly, they have shown that small scale models are useful for the nation as a whole.

The health insurance system in the United States is currently confusing and hard to decipher. The health insurance exchange will provide the benefits necessary for Americans to live comfortably with the knowledge that they are in good hands with their coverage.

The debate about healthcare in the United States has been raging for many years. More recently it has gotten serious attention because of president Obama’s healthcare reform acts. Many of the provisions are points of contention, but many are necessary for a quality healthcare system that benefits American citizens. Important to this debate are the Accountable Care Organizations, which have garnered increasing interest with critics and proponents alike. Each Accountable Care Organization (or ACO for short) is within a network of heath care providers that maintain accountability for the care of Medicare patients enrolled in the program.

Origins of the Accountable Care Organization

The first mention of creating ACOs was made in 2006 by a director of research at Dartmouth Medical School. After that time the idea evolved and became a widely known term used by the media and policy makers as well. It became so influential over those three years that it was incorporated into the Patient Protection and Affordable Care Act.

Since then there have been numerous ACOs that have provided both sides of the political spectrum with ammunition. Many supporters of these Accountable Care Organizations note that the few existing systems are still being built slowly with new things being learned every day. Those who are opposed to them point to the problems that ACOs are already having. Nonetheless, as part of the latest healthcare reform act, the ACOs will continue to grow, learn from their mistakes, and hopefully become more efficient at providing the care that is needed.

Accountable Care Organization Information

ACOs – What is an Accountable Care Organization

Generally, the Accountable Care Organizations are designed to place some financial responsibility on healthcare providers so that they will improve conditions and manage the facility better. This is supposed to limit the amount of unnecessary expenditures that many facilities use, which is a reason why the costs of healthcare have been historically high in the United States (in more recent times in particular). Additionally, the goal of the ACO is to still allow patients to select their preferred facilities freely.

Overall, Accountable Care Organizations can help to reduce unnecessary medical spending by doctors and facilities while also maintaining a higher level of service for patients. While there have been problems implementing the system thus far, the savings between 2012 and 2015 are estimated at around $470 million. This is far from the gap that healthcare in America is costing, but at the same time it is still a good start. However, each Accountable Care Organization will need to prove why they should be maintained and how they can be made more efficient.

Stake in Accountable Care Organizations

One of the best ways to answer the question “what is an Accountable Care Organization?” is to explain the parties that have a stake in its success. Within the ACO system there are three stakeholders that maintain the system. The first of these three is the provider group, which is comprised of the hospitals, clinics, and other healthcare associates. Within the ACO network, there are many providers that must work together to provide the coordinated care that the patient population needs. The reason they have a stake in the ACO is so that they can control the costs of their maintenance and still provide the care that patients need.

The second important group is the payers. In the ACO system in the United States, the payers are usually the federal government paying through Medicare or some similar program. However, there are other payers, such as private insurance and employer insurance, which can cover the costs as well.

Finally, the last and final group that is necessary for a successful ACO system is the patient group. The beneficiaries of Medicare, private, or employer insurance will be the able to use the ACO system. However, unlike many other systems, the patient population can also include homeless or people who are uninsured.

Challenges of the Accountable Care Organization

As with any new program, there are many challenges that need to be overcome before the Accountable Care Organizations are successful. Chief among these challenges are the way in which these organizations are to be organized. The lack of specificity for implementation leaves gaping holes in the system that must be immediately repaired. Additionally, there are legal problems with the Accountable Care Organization because anti-trust laws might be violated. The government has offered voluntary anti-trust reviews of the Accountable Care Organizations, but that is not enough to placate the critics. Nonetheless, the system is young and needs more time to grow into something useful for the country.

1. March 23, 2010 – The Patient Protection and Affordable Care Act.
2. March 30, 2010 – The Health Care and Education Reconciliation Act of 2010.

Section 1311 of the Affordable Care Act establishes Health Insurance Exchanges (Exchanges) and sets a milestone January 1, 2014 for the Exchanges to begin offering health care coverage.

The Vision of the Health Insurance Exchange

These government-based Exchanges will help individuals and small employers shop for, select, and enroll in private-sector health plans known as Qualified Health Plans (QHPs). The Insurers who offer QHPs must meet specific criteria and the plans they offer must include the Essential Health Benefits.

Exchanges envision making purchasing health insurance easier and more understandable. The IT systems of these Exchanges are required to support a simple, seamless identification of people who qualify for coverage through any of the State’s subsidized health care programs: Medicaid, Children’s Health Insurance Program (CHIP), the Exchange, or any other State-specific subsidized coverage. Coverage through the Exchange can be subsidized by either Advanced Premium Tax Credits (APTCs) or Cost-Sharing Reductions (CSRs).

Core Exchange Functions

At a high level, each Health Insurance Exchange will address six business functions and supporting services that are critical for facilitating the acquisition of health insurance by individuals:

1. Plan Management
2. Eligibility & Enrollment
3. Financial Management
4. Customer Service
5. Communications
6. Oversight

A State Level Integration Problem – Core Exchange Business Functions Require Integration

Each State has the opportunity to establish a State-based Exchange, subject to certification that it meets Federal standards. The deadline for certification is January 1, 2013. If a State does not achieve certification by the deadline, the State will default to the Federal-facilitated Exchange as required by the law.  Some States have expressed a preference for a flexible Federal-State Partnership model, combining State-designed and operated business functions with Federally-designed and operated business functions.

The Centers for Medicare & Medicaid Services (CMS) has been participating in a collaborative business analysis effort to create business blueprints that describe the goals for Exchanges and an operational view of Exchanges. These business blueprints consist of detailed definitions of business processes, business services, and supporting data necessary to support the implementation of the services for each of the Exchange business area.

The reality is that each core Exchange function will require real-time, bi-directional information exchange between the function stakeholders. Stakeholders include but are not limited to the following:

1. Federal agencies
2. State Agencies
3. Insurance Carriers
4. Employers

A Large Magnitude Integration Problem

Think about this from the Carrier perspective for a minute. Single state Carriers have a complex health insurance exchange integration problem in one state alone. If you are a carrier that operates in many states, what does your integration problem look like?

Oxlo Systems provides a free to downloadable white paper related to these problems and many more. Get the free white paper, “Rapid Adaptation Strategy for Integrating with Health Insurance Exchanges“, for more state public and private Health Insurance Exchange information.

“If health insurance carriers are going to capture a share of the new business generated by Exchanges, they must be ready to interact and exchange data in new ways,” explains Gene Brothers, CEO and President of OXLO Systems. The new white paper uses the business blueprints published by the Centers for Medicare & Medicaid Services (CMS) to detail the required automated data integration that health insurance carriers must be prepared to support if they intend to offer QHPs through an Exchange.

According to the white paper’s author, DeLana Anderson, an independent consultant with ACA-Solutions, “The [Carrier's] ability to exchange data with the various governmental entities will be more successful if their technology closely mirrors the same standards and guidance to which the States must adhere. Carriers will need to receive data from, and send data to, many entities. This will require technology which can easily transform the Carrier’s data to meet the unique file formats and support the transfer protocols of each integration partner.”

“A Rapid Adaptation Strategy for Integrating with Health Insurance Exchanges” provides an overview of the data integration needs and requirements for successful Carrier participation in Exchanges, as well as IT recommendations and suggested timelines for implementation. The white paper is available for free download at http://blog.oxlo.com/rapid-adaptation-strategy-for-integrating-with-health-insurance-exchanges/.

About Oxlo Systems Inc.
OXLO Systems provides competitive business intelligence, secure Internet data integration, and information technology for the insurance and health care industries. The company has created IntegrateOnce™ technology to provide a solution for the complex data integrations required by Exchanges. Additional products and services include the Open Carrier Integration Hub, Health Insurance Oversight, Self Service Interoperability, and complex one-to-many enterprise integrations. Visit http://www.Healthinsurance.oxlo.com for more information

Oxlo Healthcare Insurance Solutions provides vital market intelligence for anyone contemplating an Accountable Care Organization, including Multi-provider Networks, Payer Collaborations, and Integrated Delivery Systems (IDS).

The customary distinction between Health Plan payers and the Health Care providers is changing. Providers are forming new risk taking relationships, including networks among competing providers, as well affiliations with Insurers. Growing networks of Hospitals across the country are unveiling plans to get into the health insurance business outright. The first target markets are direct employer contracting and small group insurance as small employers are struggling with the burden of rising premiums. The strategy of making benefits more affordable based on a more limited, but recognized local provider network is gaining momentum. By capturing the full employee benefit dollar, providers are able to control the flow of patient volume for a wide variety of both inpatient and outpatient profit centers.

In addition Hospitals, physician practices, and insurers across the country are announcing various plans to form versions of Accountable Care Organizations (ACOs), not only for Medicare beneficiaries, but also for commercial patients. Acting independently, neither hospitals nor health plans may have the optimal mix of resources and incentives to significantly reduce costs. The bet is that controlling the plan coverage and delivery will help make hospitals more profitable. Provider executives are busy segmenting their regional health insurance markets and considering the degree of risk they are willing to assume. To succeed in such a rapidly changing market, providers need market intelligence and a detailed understanding of their regional health insurance markets, as this change day to day.

Now emerging networks can get instant access to comprehensive insurance plan benefits and pricing data via subscription service vendor Oxlo Systems. Hospitals and other providers are obtaining more “critical mass” and their network footprints are growing via mergers and provider consolidations, intending to reach ever broader geographic markets. Competitive insurance plan information is essential to managing these aggressive strategies.

The race for hospitals to form ACO’s will cause a cascading effect on the market, where Hospital ACO’s (as they evolve) will clearly be positioned to compete with health insurance carriers for Commercial Small Group as well as individual subscribers. Alternatively, ACO’s may work collaboratively with existing health insurance providers, creating united contracting and risk funding organizations. Either way, the new challenge for each of these hybrid models will be real time market insight and competitive pricing precision.

Background
Oxlo helps Healthcare organizations manage the risks of a rapidly changing competitive landscape. Oxlo enhances their ability to remain nimble and release well-timed competitive plan rate and coverage’s for precisely defined market segments. OXLO HEALTH INSURANCE INSIGHT™ is a logical comparison tool used for maintaining/releasing new Health plan offerings. The ease of use of Oxlo “Visual Dashboards” also aid the decision process for evaluating Health Care Plan Insurers relationships or continued monitoring of specific Insurance market offerings.

ACO’s can access and collaborate on local, regional or national competitive markets with timely information from Oxlo. Oxlo provides industry wide Insurance Plan Data Aggregation, Plan Review & Rate Monitoring, Data Feeds, and a Reporting Engine, all currently used by the leading national Health Insurers. The bet is ACO’s overall health care services business and any related insurance plans offerings will benefit with new insurance products launched and marketed. All such providers have the option to offer price savings opportunities to encourage more patients / commercial groups to participate as insurance customers, but also to participate in their own healthcare management. Such products will likely include unique plan and network features such as “tiered” payment structures, higher deductibles… all requiring access to market wide insurance carrier plan benefits and health plan cost data, all currently available from Oxlo Systems.

Oxlo’s Health Insurance Insight is uniquely affordable, based on Oslo’s proprietary Software as Service SaaS platform. Just as Hospital ACO’s have the purpose of lowering costs by sharing resources, any organization offering health plans now also have the incentive to use Oxlo’s competitive tools, without having to add additional infrastructure. Oxlo processes massive amounts of health Plan data, and can make comparison plan rate data instantly available to heath care and insurer customers. See http://oxlo.com/download-health-insurance-reform-whitepaper.html for white paper.

Oxlo Provides Healthcare Insurance Transparency Solutions, OXLO HEALTH INSURANCE INSIGHT™
Industry Wide Insurance Plan Data Aggregation, Monitoring, Normalization, Data Feeds, and Report Engine Software as a Service solution for the Health Insurance industry, used by the leading Health Insurers and Hospital ACO’s.

BROOMFIELD, CO – Oct 11, 2011 – Oxlo Systems Inc., joins America’s Health Insurance Plans (AHIP) as an affiliate organization member. Oxlo provides strategic individual health insurance rates and benefits transparency solutions, data and services to Health Plan sales, marketing and competitive intelligence teams.  Come visit Oxlo at the 2011 AHIP Fall Conference.

Oxlo Systems transparency solutions aggregate, monitor, trend, and report on individual health insurance plan pricing and benefits for all 50 states and provides web portal services that contain online executive dashboards, reporting services, dynamic drill down on plan price and benefits details data and market monitoring services. Oxlo Health Insurance Insight™ is the leading individual health insurance pricing transparency and analysis solution and is used by the top Health Insurers in the United States.

Would you like to know what Health Plans charge for individual health insurance in specific demographic and geographic target markets?

Follow this link to get your free personalized individual health insurance plans market data.

About Oxlo Systems Inc.
Oxlo Systems Inc. (www.oxlo.com), based in Broomfield, Colorado offers insurance solutions that promote transparency and affordable care. Oxlo is the operator of Oxlo Health Insurance Insight™ for the Health Insurance industry, a software as a service solution used by the top Health Insurance Plans in the United States to support strategic competitive product pricing and benefits analysis, competitive business intelligence, marketing and sales.

About America’s Health Insurance Plans
America’s Health Insurance Plans (AHIP) is the national trade association representing the health insurance industry. AHIP’s members provide health and supplemental benefits to more than 200 million Americans through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. AHIP advocates for public policies that expand access to afordable health care coverage to all Americans through a competitive marketplace that fosters choice, quality and innovation.

For additional information or questions related to this press release please email oxlo-ahip@oxlo.com , call 303-285-2408, visit our website or use our contact form to contact Oxlo about individual health insurance solutions and services.

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