This is an excerpt from a column posted at BizOpinion.
If you meet someone who claims to know how health care reform is going to play out over the next year, hold on to your wallet. You’re probably talking to a con artist.
The advent of the Affordable Care Act means many states are scrambling to set up insurance exchanges, which are online marketplaces to shop for private insurance, while other states will rely on a federal exchange. This shuffle is taking place just as rules covering Medicaid eligibility are changing for millions of families, including about 92,000 in Wisconsin.
Meanwhile, most private health providers are falling into one of two categories – predator or prey – and the entire U.S. system is figuring out how to absorb tens of millions of uninsured people just as legions of doctors are retiring.
Confused? Don’t worry. You have plenty of company, from the architects of “Obamacare” on down to the medical professionals at your hometown clinic.
In Wisconsin, the transition may go smoother than in most states thanks to cutting-edge technology embedded in the state’s Medicaid Management Information System. It’s a network that should give providers and consumers alike the kind of flexibility needed in changing times.
The “interChange” system in Wisconsin is one of 13 certified nationwide by the federal Centers for Medicare and Medicaid Services. Designed over time by the former Electronic Data Systems and its successor company, HP Enterprise Systems, interChange is the platform through which Wisconsin manages BadgerCare and Medicaid. It processes 41 million claims per year for doctors and hospitals, enrolls and communicates with 70,000 providers, verifies patient eligibility for about 1.3 million people, authorizes a range of services and generates reports essential to system accountability.
