Health Insurance Exchanges (HIX)
iPad-Compatible Course in a Convenient, Flexible Electronic Magazine Format

View HIX E-zine Excerpt

Your organization's guide to understanding Exchanges and their transformative impact on the US healthcare system

By 2019, health insurance Exchanges (HIX) are expected to cover 24 million Americans. These new marketplaces will carry a tremendous impact for patients, payers, and providers—changes for which biopharm commercial teams must be prepared if they hope to successfully navigate and remain competitive in this new landscape.

For example, insurance companies are currently grappling with whether and how they will participate in state HIX plans, including how to structure their formularies. To help secure favorable positioning for their products within these new plans, commercial teams must be able to engage their payer customers around how HIX-related issues affect formulary decisions.

In this course, participants navigate the world of Exchanges through the eyes of individuals who need insurance, small business owners who need to insure their employees, and insurance executives whose businesses are effected by these regulations.

After completing this course, participants will understand:

  • What a health insurance Exchange is
  • How state and federal governments will run the Exchanges
  • Who will purchase insurance through the health insurance Exchanges
  • How payers will design plans for the Exchanges
  • How individuals and small businesses will purchase plans on the Exchanges
  • How the various stakeholders will interact on the Exchanges
  • The role of private health insurance Exchanges
  • How to interact with payers when discussing their participation in Exchanges

Course Outline

I. Definition: What Are Health Insurance Exchanges? Who Is Involved?

  • People and businesses buying insurance on the Exchanges
  • Health plan issuers
  • State and federal governments

II. Who Runs the Health Insurance Exchanges?

  • State vs. federal exchanges
         - State exchange
         - Partnership exchange
         - Federally facilitated exchange
  • Current status of the US state programs
  • State navigator programs
  • Timeline for HIX implementation

III. Who Will Buy Insurance on the Health Insurance Exchanges?

  • Current options for people not insured with an employer
  • Eligibility criteria
  • Profile of typical purchaser
  • Low-income individuals

IV. How Will Payers Design Health Plans for Exchanges?

  • Essential health benefits
  • Benchmark plans
  • Drug benefit design
         - Minimum drug coverage
         - Drug classification methodology
         - Provision for non-covered drug requests
         - Utilization management features
  • Plan levels: Bronze, Silver, Gold, Platinum
  • How plans are accepted onto an Exchange: open vs. active
  • Emerging players
         - Co-ops
         - MCOs

V. Putting It All Together: Exchanges in Action

Scenario: Jennifer chooses a plan

  • Using a HIX website
  • Comparing health plans

Scenario: Mateo (low-income)

  • Choosing a plan
  • Calculating a subsidy

Scenario: Brett (low-income, Medicaid recipient)

  • Concept of churn
  • Why churn is an issue
  • Potential solutions to churn

Scenario: Cathy (small business owner)

  • SHOP definition
  • Business eligibility
  • Options for insuring employees
  • Benefits and costs for participating in SHOP

VI. The Other Exchange: Private Insurance Exchanges

  • Definition
  • Key features
  • Two types (including names of emerging players)
         - Single-carrier
         - Multi-carrier
  • Big business leaning toward private Exchanges

VII. Putting Knowledge Into Action: The Payer Conversation

  • Issues to research before meeting with an insurance company executive
  • Questions to ask to gather more information about health insurer’s plans to participate (or not) in health insurance Exchanges


Our e-courses are only available for group and corporate-wide licenses. Pricing is based on the estimated number of users. Please contact us to learn more about incorporating Managed Markets Excellence® into your corporate training program. We can also develop custom training solutions to meet your specific training needs.

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