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Access Health CT

Reform Update: Connecticut offers exchange website technology to other states


By Darius Tahir
Posted: May 29, 2014 - 3:45 pm ET
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Connecticut is offering to sell the tech behind its acclaimed insurance exchange website, Access Health CT, as some states mull the complicated task of fixing sites that crashed even harder than HealthCare.gov.

“Folks need to admit mistakes were made (in rolling out exchanges) and look for workable solutions,” Connecticut Gov. Dannel Malloy said at a May 13 event at the Center for American Progress in Washington.

One workable solution, Malloy suggested, is to pay Connecticut for its expertise.

Some states are interested in buying. Maryland has decided to work with Connecticut and Deloitte to rebuild its online marketplace, which was one of the biggest failures among those in states that chose to operate their own exchanges.

According to a spokeswoman from Maryland Health Connection, it's estimated using Connecticut's technology will cost the state $40 million to $50 million, and is the cheapest option – though the estimate comes from Deloitte itself. The state is “already underway,” in adapting the Connecticut technology, the spokeswoman concluded.

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It's not as simple as popping a disc into a computer and downloading the right program. It may indeed help states like Maryland that had disastrous results with their homegrown tech, but won't be a perfect solution.

“(It's) not a seamless purchase,” he said, “but these platforms are already built, proven and viable,” said Dan Schuyler, the senior director for exchange technology at consultancy Leavitt Partners.

Connecticut's website rollout went smoothly because its whole organization was strong, Schuyler said. Its director, Kevin Counihan, was previously an executive with Massachusetts' Health Insurance Connector service. And Counihan set out reasonable expectations for performance and was quick to fix problems.

But Connecticut's success also relied on extensive analog efforts to complement its digital rollout, including what Malloy referred to as “Apple stores” for health insurance and meticulous call-center testing involving 450,000 calls in 20 different languages.

So taking Connecticut's website expertise, along with Deloitte, the main contractor, is helpful but not sufficient. Connecticut's website took 16 months to develop. Building from the Connecticut template could reduce that time—to perhaps six months, Schuyler said, owing to the need for local implementation and customization.

And, he added, states can pick and choose different modules of working software. “You don't have to eat the whole pie; (you) can take a couple pieces.”

One worry in translating exchange technology from state to state are the interactions between exchanges and each state's Medicaid program. A state with a modernized Medicaid platform is able to “speak the same language” as its exchange platform, Schuyler said. That allows the state to employ a software module that can shift consumers from Medicaid to the exchange (and subsequent premium subsidies) relatively seamlessly, resulting in a better customer experience and increased ease with handling churn.

If the Medicaid and exchange platforms aren't conversant, the software vendor has to build a rules engine module that reconciles whether an applicant is eligible for Medicaid or exchange subsidies. In addition to complicating the implementation, that leads to a more cumbersome experience for consumers.

And attention to local issues will extend beyond the initial installation period. Malloy said one of his frustrations with the Connecticut exchange was the number of small-group purchasers – there were too few. “People may be used to getting insurance through other access points,” he said during the Center for American Progress event, and they often didn't even go to the exchange to shop. “We need to have more success.”

Small-group success in Rhode Island?

Connecticut's disappointing results with small groups contrasts with Rhode Island's success. Rhode Island's technology has been working well for small groups, and, like Connecticut, Rhode Island is trying to market its work to other states, according to a spokeswoman for the state's exchange.

Rhode Island has signed up 165 businesses with fewer than 50 employees, covering more than 1,000 customers, said Christine Hunsinger, a spokeswoman for HealthSource RI. “Our small business component is truly an excellent piece of the exchange,” Hunsinger said. “We expect those numbers to steadily increase over the course of the year.”

More exchange turbulence

Many states' exchanges continue to struggle with their technology. Oregon officials discussed their failures in a Wednesday hearing in the state legislature. The federal government will handle eligibility and enrollment by November, while the state will cover “consumer outreach, plan certification and initial plan management,” according to a report on OregonLive.com, the website of the Oregonian newspaper. State officials said their initial plans were too ambitious, and that they had hired Deloitte to perform a “gap analysis.” One of the areas of focus will be addressing a backlog of Medicaid redeterminations.

Follow Darius Tahir on Twitter: @dariustahir


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