The Patient Protection and Affordable Care Act (PPACA) could end up creating 4 rather different health insurance exchange programs.

Patrick Howard, Gregory Scott and Dhan Shapurji — consultants at Deloitte, New York — discussed that possibility in San Francisco, at a session at a meeting organized by America’s Health Insurance Plans (AHIP), Washington.

AHIP has been holding its Institute 2011 annual meeting there this week, and it also has presented separate but related meetings focusing on compliance and health insurance exchanges.

Some states, such as Florida, have been experimenting with small group or individual health insurance exchanges for years, and Utah and Massachusetts have been using exchanges to try to help individuals get easier access to coverage.

Exchange provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA) call for all states to have exchanges by 2014.

Individuals and small groups are supposed to be able to use the exchanges to buy subsidized coverage.

A state can set up one exchange for its residents or several exchanges, or it can join a multi-state exchange consortium. A state also can let the federal government provide exchange services for its residents.

Federal officials say an exchange could take many forms.

The Deloitte consultants suggested that 4 distinct operating models will emerge.

  • Information aggregators, which serve mainly to help individuals and small groups get information about coverage.
  • Retail-oriented exchanges, which want to maximize sales.
  • Market curator exchanges, which try to offer consumers and employers the best plans.
  • Guided exchanges, or exchanges that will impose strict standards on the available plans without providing the same kinds of tools that the market curator exchanges will provide.

Managers of the retail-oriented exchanges and the market curator exchanges may face challenges when it comes to meeting customer service goals, because they will share responsibility for dealing with the customers with the health carriers, the consultants say.

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