Last year, President Obama signed comprehensive healthcare reform, the Patient Protection and Affordable Care Act (PPACA) into law. As part of PPACA, states must create American Health Benefit Exchanges that enable individuals to purchase insurance, as well as separate exchanges for small employers to purchase insurance. These new marketplaces will provide consumers with information to help them to choose among plans.
The establishment of a sustainable health insurance exchange by 2014 presents serious challenges to state governments such as enabling citizens and small employers to determine eligibility for subsidies; presenting plans from providers that best match their needs and family situation; enabling enrollment and premium payments; and enabling citizens and employers to better manage major life events. To meet these challenges, state governments must transform legacy IT systems into enterprise-wide platforms that can support multiple programs, be deployed more rapidly and cost-effectively as well as deliver a comprehensive view of the services provided to citizens and their families.
Oracle's comprehensive solution for healthcare insurance exchanges - which includes Siebel Customer Relationship Management (CRM) Applications, Oracle Policy Automation Solution for Public Sector, Oracle Hyperion Planning, Oracle Business Intelligence Applications as well as Oracle Fusion Middleware components including Oracle Identity Management, Oracle WebCenter Suite, Oracle SOA Suite and Oracle Master Data Management Suite - can support Health and Human Service programs and core business functions such as eligibility and enrollment; billings, collections and premium reconciliation; customer service; premium tax credit tracking; broker management; payment processing and financial and management reporting.
The Oracle solution enables state governments to phase in additional programs as requirements change or legislation dictates, while avoiding the need to “rip and replace” IT systems to meet those needs. For instance, the State of Oregon selected Oracle to help ensure the successful implementation of a Health Information Exchange in advance of aggressive deadlines.
The solution also supports key Center for Consumer Information and Insurance Oversight (CCIIO) and the Office of the National Coordinator for Health Information Technology (ONC) guidance including modular system integration, open service oriented architecture (SOA) and isolation of business rules which enables state governments to decouple business rules and integrations from underlying systems, for increased agility now demanded by legislators. This flexibility will enable states to react more quickly to policy changes so they can provide fair and consistent service to their citizens.
"The impending rollout of health insurance exchanges will require state governments to establish state-regulated and standardized health care plans, from which individuals may purchase health insurance that is eligible for Federal subsidies. To help address the challenges state governments will face related to these requirements, Oracle offers a robust solution which consists of proven technologies that are architected to work together, and include the necessary capabilities needed to deliver a successful program," said Mark Johnson, senior vice president, Oracle Public Sector.
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