Isn’t that the million-dollar question? Not a single day goes by that I don’t hear or read opinions about the strategies to implement state-based health benefit exchanges, various architectures that will be required and, for that matter, the probability that HBEs will come into existence at all. And don’t get me started on the volumes of patients expected to use HBEs. I’ve heard numbers ranging from 20 million to 150 million by 2016, and all those widely disparate estimates were supported by sound research and logic.

These are early days for health care reform in general and HBEs in particular. A lot of very good ideas are floating around, some of which will succeed and some that will fall by the wayside. There’s too much political uncertainty even for truly great ideas to have a 100 percent probability of success. So what is an organization to do? Can a commercial plan start strategizing their business around state-driven exchanges? Can a vendor start planning for a common platform that could be used by most, if not all, states to deliver the exchange services? Can a small employer expect to ally with similar-sized employers to enhance its leverage with large plans?

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