Oracle's Solutions for Health Insurance Exchanges


On March 23, 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (PPACA), into law. In response to this law, the vast majority of states are planning to launch their own state-wide Health Insurance Exchanges (HIX) by the mandated deadline of 2014. The establishment of a sustainable HIX by 2014 presents serious challenges to state governments. But this fast-approaching PPACA requirement also presents an unprecedented opportunity: legislators not only can take a lead role in determining what the future of health care should look like for the citizens in their states, but they can help support those small employers that are so crucial to innovation and economic growth, and that create millions of new jobs every year. And, while the stakes are high for all involved, the functions and services required to make an HIX successful are already available from Oracle.

Only Oracle can provide states with a flexible solution that will integrate with their existing Medicaid, CHIP, and other state-run health and human services platforms and also has experience in providing open standards-based, commercial off-the-shelf systems that deliver all necessary functionality based on CCIIO and ONC guidance yet meets the requirements of more comprehensive and integrated state-run programs, focused on holistic outcomes.

Oracle has a long history of working with private health payers (8 of the top 10 US commercial healthcare insurers run on Oracle) and commercial providers, nonprofit insurers including Blue Cross Blue Shield, public-sector agencies, and institutions across the health and human services, criminal justice, tax and revenue management, and other government functional areas at the international, national, state and local government levels. As a result, Oracle has quickly established a position in support of early innovator State Health Information Exchanges (HIE) and HIX reference design and deployment efforts.



Business Drivers Oracle Enables You to With These Products
Establish a consumer-oriented, fully integrated HIX Platform by 2014
  • Identify and authenticate applicants securely and efficiently
  • Provide role-based views and functions for workers and citizens
  • Allow plan comparisons and selection based on healthcare preferences
  • Manage complex eligibility and changes of circumstances
  • Enable consistent and accurate benefits calculations
  • Run customer marketing campaigns to rapidly build HIX clientele
Onboard, manage, and improve cost and performance of your HIX vendors
  • Establish and audit policies for all applications to ensure governance and compliance
  • Record a complete audit trail of how decisions are reached
  • Incorporate assessments for adherence to plan level requirements
  • Identify provider plan trends and structural characteristics as opportunities for improvement
Support integrated health and human services programs delivery
  • Transform service delivery and reduce burden on call centers, drastically reducing costs
  • Evaluate and streamline all constituent data by capturing and integrating it into a single, secure data hub
  • Track the cost and frequency of use by service delivery channel type and process executed; identify points within the process to improve efficiency and transparency
  • Consolidate and build economies of scale across multiple programs
  • Build and analyze metrics against expected outcomes and the overall effectiveness of various service delivery operations instead of relying on siloed programs
  • Report program success and create transparency and accountability
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