Editor's note: H&HN Staff Writer Marty Stempniak blogged this week from America's Health Insurance Plans' Fall Forum 2012. This is his final report.

CHICAGO — There were sessions about health gadgets, or doctor-patient texting social media at AHIP's Fall Forum 2012 this week. But those mysterious insurance exchanges seemed to the topic most on the minds of payers and providers as the meeting started wrapping up Wednesday.

 

How am I supposed to maintain the continuum of care if my patient keeps bouncing back and forth between Medicaid and private insurance on the exchange ("churn" as they like to call it)? Is the role of the insurance broker just going to disappear (some seemed to think yes)? What types of health issues will this new population be dealing with that my staff needs to prepare for (who knows)?

I wish this was a blog that answered all your questions and put all your fears to rest, but it's not. Truthfully, even the experts seemed comfortable saying "I don't know" or fashioning a guess when responding to exchange-related queries. What I will offer up is some of the tidbits on the subject that I found interesting this week.

For those who have been cave-bound for the past few years, a health insurance exchange is a set of government-regulated health plans, from which consumers can buy insurance that's eligible for federal subsidies. (All spelled out in the Patient Protection and Affordable Care Act of 2010.) States have the option of setting up their own exchange, or defer to the federal version. Thus far, 18 states have declared that they're starting state-based exchanges, 18 have defaulted, 10 are undecided and five plan to run "partnership" exchanges (where the state coordinates with Health and Human Services to implement it).

Those numbers will likely change quickly, as states (mostly of the red persuasion) find that they'll have a lot more freedom by operating their own exchange, said Prabhakar Ram, vice president of products for the technology firm hCentive.

"I think they will realize early on that they can have a lot more control by operating their own exchange," he said.

The idea is that the uninsured or underinsured will be able to leap into these exchanges, where private payers will compete for their business. But how many patients are we talking? The federal government is saying it could possibly be 12 million entering the system next year, and 29 million by 2021, PricewaterhouseCoopers estimated in October. But Avik Roy, a senior fellow for the Manhattan Institute and former advisor to Mitt Romney's presidential campaign, worried that it's going to be much higher, and that some employers might just drop coverage and let their employees dabble in the exchange.

"Washington tends to look backwards, and businesses of course have to look forward. I think the exchanges are going to be a lot larger than the government projects," he said. "And I think employers will have a big economic incentive to drop coverage in certain industries and certain areas and let more people enroll in these subsidized exchanges."

Coverage for the exchanges must start by Jan. 1, 2014, with enrollment starting on Oct. 1, 2013. Ron Hill, vice president of healthcare consulting for the firm CGI in Boston, talked a little about what payers should expect of the new patients, based on his experiences while Massachusetts implemented health reform. Educating the population about their options was critical, as many in the state were unaware of their options. Those entering their state exchange spoke more than 20 different languages, he said, and many didn't have credit cards to pay their bill. Churn was a big issue, he said, with about one-third of members jumping back in forth between different insurance types.

One of the biggest buzzwords of the week was "consumerism." While providers are aligning themselves to tackle population health, payers are shifting from serving groups of insurance members, to tailoring their products to meet the needs of each individual.

How is your hospital getting ready for what's coming up in 2014?