For the 13 states that have committed to implementing their own healthcare exchange, many are realizing that the biggest hurdle isn’t in the IT plumbing, but upfront with the consumer.

According to a recent Wall Street Journal article, the main obstacle is that people don’t know what an “exchange” is, and they don’t even like the word, feeling it conjures images of loopholes, fine print and having to trade what you have for something worse.

This skepticism is consistent with what we’ve found about consumer attitudes and behaviors when it comes to health insurance. They think of it as a “black hole.” In our view, more attention needs to be paid to consumers on the front end. That’s where a favorable customer experience starts, not at the back end.