By Katie Kerwin McCrimmon
As Colorados health exchange managers sprint toward an October 1 launch, a top manager warned board members on Monday that a recent decision to build a new eligibility IT system poses the greatest risk of delay and could undermine the quality of the online health marketplace.
Adele Work, who is leading implementation for the exchange, made a presentation about key implementation risks during a technology update for the board.
No. 1 on that list of risks is the new decision to divide one planned IT system into two. The report to the board said that IT developers for the exchange are now having to contract with a team of eligibility experts to develop the new engine that will determine if customers of the exchange qualify for federal subsidies. State Medicaid managers are building their own separate system to determine if exchange customers are eligible for Medicaid. Previously, Medicaid and the health exchange were planning to operate one shared eligibility service, the report said.
This decision was made about a risk to our go-live date, Work told board members.
In order to try to open the exchange on time, Work also told board members that IT developers will delay some functions to future years.
Exchange board member Eric Grossman, an expert on health care technology who works for TriZetto, a health care technology company, asked about planning in case IT systems dont work.
The best laid plans go awry, Grossman said. Whats plan B? We cant just keep dumping stuff on the plan.
Exchange Executive Director and CEO Patty Fontneau responded that shes putting a halt to any new components.
We cant do anything else, Fontneau said. Were done. At this stage, were drafting a letter to HHS (the U.S. Department of Health and Human Services) saying, if you tell us something else, we cant do it.
Fontneau also warned board members that the exchange would need to hire and absorb extra costs in the first year for more workers to do jobs by hand in the back office. She previously anticipated those functions would be automated through tech systems.
Overall, Work said that IT projects are on schedule, but that lack of time could be problematic.
Were on track with the plan, Work said. But she added, its a highly aggressive plan. It would be silly to tell you its easy.
The other greatest risk, according to Works report, is that there could be functionality gaps or coding errors in the basic exchange IT systems. And there will be little time to fix them.
We will not know the full impact until later testing phases, the report said.
Solutions reported on March 27 on a variety of tech troubles that could hobble the health exchange. Fontneau and communications consultants declined repeated requests for interviews on the problems. Asked Monday if she wished to talk about how the exchange is handling technology challenges, Fontneau said: No comment.
Exchange managers also declined repeated interview requests on Monday and Tuesday to explain the new decision to shift technology plans at such a late date. The exchange board did not vote on this decision.
Despite the fact that the health exchange is a public entity that is spending tens of millions of taxpayer dollars and must be responsive to the public, exchange managers are now refusing to conduct interviews about exchange operations with Solutions and will only answer questions in writing.
In a written response from communications consultant George Merritt, managers said that: COHBE (the Colorado exchange), HCPF (state Medicaid managers) and OIT (Colorados Office of Information Technology) collectively decided earlier this year for COHBE to build the portion of the eligibility system related to access to new federal financial assistance to reduce the cost of health insurance and for HCPF to build the system that determines eligibility for Medicaid and CHP+.
This plan is on the back end, does not affect the customer experience and will not cost more. Customers will still apply (sic) be able to apply for coverage through COHBE or through PEAK (the state benefits system) and our systems will share information. This plan creates a path to a successful launch in October that best serves Colorado consumers, Merritt wrote.
State Medicaid managers also said consumers should not be affected by the change.
The engine decision will not impact clients as both the exchange and Medicaid will have a no wrong door approach so that no matter which system a client chooses to use, they will be able to apply for benefits, Rachel Reiter, communications manager for HCPF said in a written statement.
Among other technology updates, Work reported that:
- IT contractor CGI, which the exchange is paying $66.3 million for technology, is taking commercial, off-the-shelf products, making changes to them and delivering the software in six releases.
- So far, exchange managers say they have received the first four releases. There is some method to the madness in terms of building a plan. We have a lot of work to do in a very short period of time, Work said. But, We and CGI have met all of our milestones to date.
- While outside analysts say the federal data services hub with which exchanges must communicate in real time to determine if customers are citizens and eligible for federal subsidies is only 40 percent complete, Works report said theres been significant improvement on the hub. She expects to begin testing with the hub by May.
- Exchange workers and contractors have been working to fix problems uncovered through an outside analysis by First Data.Work said three of six problems uncovered in First Datas initial analysis have been fixed. The compressed completion schedule will make it difficult to excel in all categories that the analysts monitor.
On other matters related to the exchange, the board voted to allow customers who call insurance companies directly or who are renewing insurance policies to purchase new exchange products directly through insurance companies.
Exchange staffers estimate that about 400,000 Coloradans currently buy health insurance through the individual market and about half of them or 195,000 people will probably be eligible for new tax credits and subsidies through the exchange.
George Lyford, a lawyer for the Colorado Center on Law and Policy, urged board members not to allow insurance companies to sell exchange products directly to consumers.
That means they will never access this state-of-the-art marketplace, Lyford said. He said consumers wont have key information they need about subsidies and may not understand their options.
How will they select a plan that is best for them? Lyford asked.
Exchange staffers estimated that between 30 and 50 percent of individual health insurance polices sold in Colorado are the result of a consumer who contacts an insurance company directly. The board will require sales staffers at insurance companies to inform consumers about the health exchange and let them know they may qualify for public health insurance or federal subsidies.
Exchange managers are also planning to set up six assistance networks throughout the state. Under three different scenarios, the health exchange would spend between $12 million and $20 million a year offering in-person assistance to exchange clients. Managers expect clients to need as much as 90 minutes each to explore health plans and learn about options they might choose. One of the staffers who tried filling out the necessary forms said it took her nearly 40 minutes and shes savvy about health insurance.
Board members also received an update on a new communications plan.
The exchange contracted with a group called Corona Insights in Denver to analyze who the potential customers might be.
The typical uninsured Coloradan will most likely be a young man ages 25 to 34 who is a cook or works in the construction or entertainment industry. He would earn about $25,000 to $49,000 a year.
The typical customer who purchases individual insurance in Colorado has a household income of about $100,000 or greater, is between 55 and 64, and is white. Both men and women fit into this group and are most likely to be managers or sales people in the restaurant or construction industries.