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.”