Health insurance exchange (HIX) is the latest trend in an online market place. Recent market trends indicate that the global online health insurance marketplace or exchanges industry is estimated at around USD 2 billion as reported by Forbes.
The key drivers identified for this market include federal health insurance mandates, policies (Obama Care Policy in the U.S.), and numerous funding sources from federal governments. The shift in trend towards contributing model is expected to help reduce health care costs and benefit consumers by making it affordable.
The growing application of IT in the health sector and the shift in trend towards integrated environments, among several other growth factors have ensured that cloud-based technology is expected to provide lucrative opportunities in the HIX market.
According to the Affordable Care Act (ACA), HIX is a key provision that helps to establish a selection or a list of vendors competing by diverse offerings such as qualified plans.
These qualified plans are designed to meet standards which are set by the ACA. Stiff competition between the providers is also likely to encourage them to provide improved quality and pricing of the offered plans.
The strategy is practically carried out through online portals where consumers visit virtual ‘shops’ for their health insurances. Those people who qualify for cost-sharing subsidies or premium subsidies can obtain these grants via these online portals in various HIX schemes.
The concept of HIX has originated from the heart of Obama Care in the U.S. An array of online shopping centers filled with medical benefits have been created under the program, and the idea was commercialized in 2010.
The motive behind this online commercial insurance selling and buying are to create an expedient for medical coverage by dismissing airplane tickets. It is done to avoid bringing insurance companies together which compete among each other to prevent affordable plans.
The health insurance business transaction is carried out in three phases. The implementation phase dominated the global HIX market in terms of revenue in recent years.
The operation and maintenance phase help to determine the potential market growth, which is measured in terms of increased post implementation requirements, which includes facility support, systems management, network operations, hardware and software upgrades, trouble reporting, troubleshooting, storage management, system performance reporting and monitoring and disaster recovery services.
The HIX industry is mainly driven by third party administrators (TPA), brokerages, consultancies and firms catering to diverse end-use industries.HIX has several components including services and software, which is expected to gain higher revenues as compared to hardware components.
Periodic or routine upgrades of different modules and functions of the software components to foster compatibility are likely to spur segment growth. Compatibility requires the installation of additional features, and information on recurring nature of services which are necessary for ongoing reports. The compatibility framework also checks the increased shift from legacy mainframes to the cloud and Saas IT-enabled business models.
IT vendors generate the highest revenue for the HIX market, measured regarding several components such as planning, designing, implementation of exchanges, system integration, program management, operations, and maintenance.
However, factors such as data privacy, security issues, high capital investments, lack of awareness especially for the private exchanges, the complex set of technologies and changing regulations are expected to thwart industry growth. Lack of skilled manpower regarding knowledge on healthcare domain and technical expertise may also pose a challenge to market growth over the forecast period.
The global industry has been segmented by type, phase, component, end-use industries and geography. By type, the health insurance exchange market is further divided into public and private exchanges.
By stage, the health insurance exchange market is divided into pre-implementation phase, implementation phase or infrastructure delivery, program management, independent validation and verification (IV &V) which includes quality assurance (QA), operations and maintenance.
By component, the global health insurance exchange market is divided into services, software and hardware. Based on end user the market is further divided into government agencies, third parties, brokerage firms, health plans/players. Major regions covered in this report include North America, Europe, Asia and the rest of the world (RoW).
The U.S. occupies highest share in the global industry and is expected to continue dominating the global market over the forecast period. North America is also likely to witness highest CAGR on account of increased adoption of private health exchanges among increasingly aware consumers.
Currently, Asia, Europe, and RoW do not have a considerable stake in this market. However, rising adoption of HCIT (Healthcare Information Technology) and HIE (Health Insurance Exchange) and increased outsourcing are likely to generate higher revenues over the forecast period.
Prominent players in this market include Accenture, CGI Inc., Deloitte, IBM Corporation, Infosys, MAXIMUS, Oracle Corporation, Xerox Corporation Ltd., Connecture, Cognosante, hCentive, Hexaware – Technologies, HP, Innovation Inc., KPMG, Microsoft Corporation, Noridian Healthcare Solutions, TCS, Wipro Ltd., and others.
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