Issue Briefs | Feb 12, 2013

A Strategic Approach for Insurance Exchanges to Select and Manage Qualified Health Plans

Wakely Consulting Group – Jon Kingsdale, Susan Tuite, Patrick Holland, and James Woolman

Wakely Consulting Group has prepared this policy brief to aid state Exchanges in their contracting strategies with qualified health plans (QHPs). Section I of this brief describes many of the types of decisions that Exchanges should consider in preparing to launch a clean, effective QHP solicitation process. Section II describes the standards that Exchanges will use to certify QHPs. It summarizes the major federal requirements that all QHPs must meet and sets forth examples of additional requirements that some states are considering. Section III sets forth options for “negotiating” key elements of the issuers’ proposals. Unlike many start-up tasks, certifying, re-certifying, de-certifying and managing the relationship over time with health plans is an ongoing and evolving set of tasks. Therefore, Exchanges should take a strategic approach to these functions, each state can craft plan selection and ongoing partnerships to support the achievement of its goals for health care reform.

Wakely also hosted a webinar covering the topics of this brief.