The state-based exchange (SBE) market is a dynamic and ever-evolving one. When the Affordable Care Act first launched, separate vendors for different solutions and bespoke systems dominated the field. However, marketplace fragmentation of contact centers, MAGI systems, outreach, and AI tools, led to siloed technological advancements, low health care coverage rates and a cumbersome experience for consumers. This fragmented approach also burdens agencies with constant contract management and coordination headaches.  

The rise of automation and artificial intelligence (AI) is challenging this outdated model, advocating for a unified approach where a single vendor handles both technology and customer service. This integrated model not only enhances operational efficiency and service quality but also simplifies resource allocation, providing SBEs with clear accountability and consumers with a seamless experience. The days of silos are over.  

Harnessing Automation and AI 

Automation and AI are revolutionizing customer service in SBEs by handling routine tasks like eligibility checks. When a single vendor manages both technology and customer service, automation can be deployed holistically, reducing call center costs and allowing for reinvestment in further technological improvements. This ensures efficient, scalable, and superior customer service. 

Streamlined Integration with APIs 

Smooth integration with technology platforms via APIs is crucial for customer service improvements. A single vendor managing both tech and customer service ensures seamless and efficient integrations, eliminating delays and coordination issues for quick implementation of new features. 

Multi-Channel Customer Engagement 

Modern customer service requires a multi-modal approach, including mobile apps, chat, voice, SMS, and desktop interfaces. A unified vendor can maintain high service levels across all channels, providing consumers with a seamless and cohesive experience regardless of their chosen platform. 

Meeting the Expectations of Modern Consumers 

Standalone call center vendors often struggle to provide the self-service tools desired by younger generations. . Integrated platforms offer these tools, enabling consumers to manage their health insurance independently, improving satisfaction, and allowing customer service representatives to focus on more complex issues. 

Efficient Coordination with Medicaid and Other Programs 

An integrated model facilitates effective coordination between SBEs and programs like Medicaid. For example, Virginia’s transition from the federal exchange in 2023 allowed it to determine Medicaid eligibility, streamlining processes and reducing administrative burdens. This frees up staff to address more complex issues, improving overall efficiency. 

Enhancing Targeted Outreach and Education 

Integrated technology and Consumer Assistance Centers (CAC) support state marketing, outreach, and education efforts. For instance, CACs can conduct targeted outreach to individuals who have received eligibility determinations but have not enrolled, ensuring they receive the necessary information to make informed health insurance decisions. 

In summary, an integrated solution organized around the consumer experience and key health coverage outcomes will set up a state-based exchange for success, offering agencies a single point of accountability to help achieve what matters most—maximizing coverage. This approach is seamless, coordinated, and orchestrated to enhance efficiency and deliver superior service. By leveraging automation, ensuring seamless integration, and offering multi-modal customer service, SBEs can meet the needs of today’s tech-savvy consumers and adapt to future challenges in the health care landscape.