SaaS State-Based Marketplace Solutions For Healthcare Insurance?

Nov 27, 2021
3 min read

Since the introduction of the Affordable Care Act (ACA), states have had the facility to operate their health insurance marketplace in a Federally Facilitated Marketplace (FFM or health.gov), establishing a State-Based Marketplace (SBM), or a composite model called the State-Based Marketplace- Federal Platform (SBM-FP). As states begin to gain cost savings or gain more local policy control, they are moving to establish their exchanges (SBMs) with the FFM and SBM-FP models.

These committees come with a different set of technology challenges. The state's choice of a technology platform in building a state-based marketplace affects the overall success of policy ideas, budgets, timelines, and exchanges.

State-Based Growth and Statistics

  • Gartner forecasts end-user spending on public cloud services to reach $396 billion in 2021 and grow 21.7% to reach $428 billion in 2022.
  • 25% of B2B SaaS Sales are headed to cloud Marketplaces.
  • Salesforce alone grew from $161 billion in January 2020 to $251 billion in September 2021.

Below we take a look at customer exchange builds that affect speed to reduce risk and development time, technology transfer from another state, and systems that are software-a-service (SaaS) are provided by:

Custom Build

In the early days of the state-based market, custom-built solutions were the only way to provide viable solutions. However, these solutions face challenges when responding to ever-changing needs and regulations.  Ongoing improvements, security updates, and additional features to enhance operational efficiency, all of which require continued investment beyond initial implementation.

Long-term growth times can also be a challenge when customers develop solutions.  Depending on the resources and skills available, users with 100% IT resources have time to design and develop state-of-the-art solutions. During this time of development, the needs and policies of the states may change, and possibly change, making this solution potentially obsolete.

Accelerated

System integrators, which offer custom-built results, constantly address the use of accelerators to jeopardize solution implementation. However, these high-speed pre-built tools or widgets can be used as a building, some of which are functionally developed that are needed to deploy new exchanges, often as a box functionality. These speeds can certainly reduce the development time required for the initial development of the exchange, but they do not meet the ongoing maintenance requirements of the exchanges and the ongoing cost of enhancing the customer solution to ensure that the needs of the state are being met.

Open Source-Based Custom Build

Open-source software is usually circulated in the public domain by one developer and made accessible to others as they see fit. This type works well for operating systems and is widely used in the components of the developer community support.

Purchased state-of-the-art healthcare IT solutions, such as Exchange, do not have the extensive developer support needed to maintain and enhance the platform.  Such solutions require that client states continue to invest in improving or expanding the platform as there is no financial incentive for independent developers or other entities to invest in the platform.

Source: Appscrip Blog

Software as a Service (SaaS)

SaaS is a way of delivering software as a service that has grown rapidly in the private sector. SaaS vendors provide "on-tap" functionality by deploying their software in the cloud and taking advantage of a shared codebase between users. This method is very useful because it enables budgeting for development, infrastructure, and other costs, and does not force users to have large technical teams to maintain and support the platform.

Some of the best examples of SaaS we use every day include SalesForce CRM, Microsoft Office 365, and Google Docs, platforms that offer new features as part of a platform enhancement that is available to all users

Why Is State-Based Marketplace More User Friendly For Everyone?

We give you better control of your health insurance market through our exchange technology. The state-based marketplace can be more user-friendly for everyone. It can be:

  • Eliminate the risk of auto-renewal with Healthcare.gov.
  • Purchase and enrollment support for medical purchases, state subsidies, or tax credits.
  • Support the unique diversion requirements between Medicaid, Medicaid Purchase, and QHPs.
  • Provide administrators with the data they need to target access efforts in specific countries, cities, and towns.
  • Provide multilingual language support where appropriate
  • Support workflow that allows consumers to use their insurance cards (an issue that many states have seen in the past)
  • Enable advocacy with maximum use of health plan wellness services.

Conclusion

As we move toward the open enrollment period of 2022, states will move forward with innovation to reduce operating costs, increase policy flexibility and autonomy, and drive health insurance enrollment, leading to a SaaS-based state. Marketplace solutions will have access to acceptable technology.