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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Utah leads out with new virtual health insurance exchange

Exchange (ĭks-chānj’) n.

  1. To give in return for something received; trade
  2. To give and receive reciprocally; interchange
  3. A place where things are exchanged, especially a center where securities or commodities are bought and sold

There have been several interesting health finance innovations that have been announced recently which have relevance to health reform in general and the some of my work at the Healthcare X PRIZE specifically. I wanted to first start with an announcement from the State of Utah that their version of a Health Insurance Exchange is now “open for business”. The Utah Health Exchange is based on a multi-year, multi-stage health reform effort in the very progressive but conservative state (is that possible?). The plan has three main components:

  • Defined Contribution
  • Virtual Health Insurance Exchange
  • Risk Adjustment

Each element is described in a detailed communication from Edmund Haisimaier, a Senior Fellow Research Fellow in the Center for Health Policy Studies at the Heritage Foundation. Before you dismiss this effort as some conservative schtick from the right, you should actually look at what they are doing and how they are doing it. It is actually a fascinating read.

My take: BRAVO! What Utah is doing in health financing is something we should be seeing alot more of in the future. Couple points of comment:

Defined Contribution. I also love the notion of a “defined contribution” coming from employers. This is also a no-brainer – let the employees both see how much you are contributing to their health as well as give them the flexibility to make their own choice. These ideas were made popular by Definity Health, and I love seeing this concept move forward. For me, this will be the “death knell” of employer based insurance if this concept takes off – which I see as a very positive outcome.  I have already ranted about Employer Based Insurance in the past and the sooner we decouple this unnatural relationship the better off our country will be.

Virtual Health Insurance Exchange. Leveraging a technology platform (eInsurance in this case) to bring together all the disparate information to make an apples to apples comparison of various health insurance options. This allows the consumer to make rational choices based on their own preference sensitivity of price, features, benefits, and other metrics. I love that insurers, and the brokers who push their products, will have to do more than convince an HR manager who makes a company wide decision, but rather have to compete consumer by consumer by offering the best value. The technology makes it possible to compare dozens of different plans based on age and family status simultaneously. The agent role turns much more into that of a value added advisor.

Risk Adjustment. This is actually much harder to follow. Essentially, Utah is laying the foundation to create a state wide pool with everyone who has insurance being a part of a single pool. On the “front end” when the consumer purchases the insurance there will be some variation in pricing based solely on age and family status. However, on the “back end” the insurer taking the diabetic will actually get a little bit more of the premium. Furthermore, any insurer who has an inordinate amount of large expenses or wide variations in claims will receive additional credits from the other insurers. This innovative wrinkle can actually entice other insurers to participate as these “adjustments” further minimizes the risk that their “pool” performs worse or costs more than others. Essentially, the Utah Health Exchange pools premiums from all the consumers, each insurer provides coverage during the year, and at the end of the year they redistribute a portion of their premiums to any insurer who took an excessive hit during the year. The details of how this will work in practice were not included but the concept is very interesting.

This is exactly the type of health financing innovation we need to be seeing. New ways to pay for insurance, new ways to acquire insurance, new ways to spread and pool risk, and new business models that will allow these concepts to flourish.

9 comments on “Utah leads out with new virtual health insurance exchange

  1. Matthew Holt says:

    Sounds like communism to me! Actually Scott two more things needed to make this Enthoven-ish. 1) Compulsory mandate–everyone must buy in 2) Standardized benefits, or else risk adjustment is impossible.

    But Bennet was getting there

  2. thomas says:

    Utah exchange program seems to be ok, though when looking for I found that already has everything in one place. You can shop compare and apply online for any type of individual or family health plan.

    Just my opinion I don’t see why people have problems finding a plan, I could not believe how many choices you have with this company…

  3. alicia smith says:

    Well you can’t knock it until you give them a few years to get off the ground. The group side will take some time and remains to be seem if it will be successful.

    On the individual side or private health insurance plans as they call them, they have done an outstanding job in putting on as a local vendor or whatever you want to call them for comparing individual or family health plans.

    That is where we are sending all our part time employees to get health insurance.

    Hopefully this will be a success with the exchange but they do have a long way to go. If they get the correct partners in helping them they just may be able to pull it off. If they where able show the health insurance rates in utah on the individual plans like they do at then they may be able to make this work…

  4. Greetings. To start with I need to say that I really like your webpage, just determined it the past week but I have been following it sometimes since then.

    I seem to acknowledge with most of the ideas and opinions and this post is no different. absolutely agree with you.

    Thank you for a wonderful website and I hope you preserve up the good work. If you do I will keep on to browse it.

    Have a very great evening.

  5. Jacki Sorensen says:

    Incredible site. I was referred from the exchange to, I talked with the agent and was able to drop my group plan that I was paying 432.00 a month for and picked up a plan with them for 256.00 a month and better coverage.. It’s all about who you deal with.

    I am 56 years old and my company was charging me for maternity. I don’t need maternity at 56.
    I would go to to your health insurance

  6. John says:

    Thanks Jacki for the referral, I found our plan at and it was exactly what you said. Why are olding people paying for maternity on group plans. It is the only site I could find that did not ask me for private information.

    It was an option to give them my info.. I like that. Companies need to follow what they are doing.. Thanks Jacki

  7. Thank you for the nice quote Jacki. We try to do our best and give people the option of picking what plan they want.

  8. Tommy Baxter says:

    Very interesting article. Very good information. I hope everything works out well for the exchange. Utah health insurance is going up way to fast. Hopefully this will help ease the pain when looking for health insurance in utah.

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