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Topics• Colorado Health Benefits Exchange (COHBE)
• State Based Exchange (SBE) Policy, strategy and operational latitude
• Effort, cost and time to build a state-based exchange (SBE)
• Interoperability between CO Medicaid Systems and the Exchange
• Opportunities to Leverage Federal Funds
• Alternatives and decision framework
• Responses to a couple of Questions to the Health Insurance Exchange Workgroup
3
Colorado Health Benefit Exchange (COHBE)
4
Mission
To increase access, affordability, and choice for individuals and small employers purchasing health insurance in Colorado.
To reflect the unique needs of our state, seek Colorado-specific solutions, and explore the maximum number of options available to the state of Colorado in meeting the goals of access, affordability and choice.
5
SB11-200: The Colorado Health Benefit Exchange Act of 2011
• Passed in May 2011
• SB 200 establishes the framework for the state Exchange
• Governed by a Board of Directors
• Legislative Implementation Review Committee
Helping Small Employers
Qualifying small businesses and non-profits with up to 25 full-time employees can receive tax credits NOW to help pay employee premiums.
Current tax credit is up toof premium cost 35%
In 2014, tax credit will be up to 50% of the premium
7
COHBE’s 2012-2014 Exchange Timeline
Create policies for finance, audit, and prevention of fraud
Certify benefits
and health plans
Develop, implement and test web portal and customer
service functions
Implement Navigator program
Jan. 1 2014Coverage
Begins2012 2013
Test all systems
Exchange launch(Oct. 2013)
8
COHBE Guiding Principles
• Minimum interoperability between Exchange and state Medicaid systems
• One exchange with two lines of business (SHOP and Individual)
• Market competition
• Continuity of care and personal responsibility
• Meet federal deadlines
• Leverage existing solutions
• Work collaboratively with state agencies (Medicaid, Human Services, OIT)
• Maintain Division of Insurance as the single regulator
9
State Based Exchange (SBE) Policy and Strategy and
Operational Latitude
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• COHBE has identified over 40 areas of policy and operations where flexibility is afforded SBEs
• Strategic guidance provided by SB-200, input from stakeholders and direction from the Board
• Goal is to create a competitive marketplace that meets the needs of Colorado’s consumers, small employers
• Key areas of state flexibility and alignment:– SHOP exchange– Employer-employee choice– Role of brokers– Customer service– Interoperability with State Medicaid systems– Inter-dependencies with the State DOI– Supplemental plans– Financial model
SBE Policy Latitude
11
SBE Strategy and Operational Latitude
Supporting TechnologyPeople/Organization
Business Processes
Eligibility & Enrollment
Plan Management
Financial Management
Customer Service
Oversight
Implementation Operations
Exchange
Solution
Core
Are
as
Phase
Strategic and operational decisions across numerous areas
User experience (technology and customer service)
Balancing needs of consumers, small employers/employees, carriers
12
Effort, Cost and Time to Build a SBE
13
Effort• On an on-going basis COHBE’s primary role will be policy and oversight of the Exchange, i.e.
COHBE will be a relatively small organization
• All transactional/operational responsibilities are outsourced
• However, for Exchange implementation (2012 – 2014) COHBE will have a project team/staff of approximately 25-30; 2/3s will transition into steady-state operations
• Requires close coordination with state Medicaid agency, Division of Insurance and carriers
• Federal oversight; but not burdensome
• COHBE’s Systems integrator (CGI) has approximately 80 staff including subcontractors
• Approximately 250,000 person-hours (COHBE and contractors)
14
Cost/Funding• Major Exchange (outsourced) cost components are:
– Implementation– Licensing– Hosting– Support and Maintenance– Customer Service Center
• Five-year life-cycle costs likely to range from $60M - $100M
• Annual technology and customer service costs $10M - $20M
• Costs likely to be prohibitive in small population states
• SB-200 prohibits use of State General Fund for any Exchange activities
• COHBE received an $18M Level One grant in Mary and expects to receive a 2nd Level One grant for $42M in October
15
Time• Exchange implementation requires 16-24 months
• Only a handful of SBEs expected to be operational by 2014
• States beginning the acquisition process now (or even starting implementation) for a SBE cannot meet the January 2014 deadline
• HHS SBE certification required in January; certification requirements are extensive
16
Interoperability between CO Medicaid Systems and the
Exchange
17
Integrated TimelinesCOHBE – HCPF - OIT Implementation High-Level Timelines
Procure IT Systems & Services for Individual Exchange
01/12 03/12 05/12 07/12 09/12 11/12 01/13 03/13 05/13 07/13 09/13
2012
Individual ExchangeIntegration Testing and Establish Support
Services
Design/Build/Test Individual Exchange System (including Interface w/ Federal Data Hub and State Systems), Contact Center and Services
2013
Individual ExchangeTechnology and Customer Contact Center and Services
Pilot Phase07/01/13 – 08/31/13
Individual Exchange Deployment
Procure IT Systems & Services for SHOP Exchange
SHOP ExchangeIntegration Testing and
Establish Support ServicesDesign/Build/Test SHOP Exchange System, Contact Center and Services
SHOP Exchange Technology and Customer Contact Center and Services Pilot Phase
05/01/13 – 06/30/13
SHOP Exchange Deployment
ContractAward 06/12
Deployment10/01/13
Deployment10/01/13
ContractAward 06/12
Draft and Submit APD for PEAK/CBMS and Other State Systems &DeloitteContract Negotiations
State SystemsIntegration Testing and
Establish Support Services
Design/Build/Test State Systems (including Interfaces with Individual Exchange)
Modifications to :PEAK/CBMS and Other Supporting State Systems Pilot Phase
07/01/13 – 08/31/13
State Systems Deployment
Full Deployment
10/01/13
APD Approved
State Systems
Exchange Systems
18
Coordination with HCPFCOHBE and the State Medicaid agency (HCPF) will execute two overlapping projects which will be closely coordinated
19
Increasing degrees of interoperability improves the consumer experience for a segment of the population but increases the overall complexity and schedule risk for the Exchange
Extent of “interoperability” (i.e. amount of overlap) between Exchange systems and support processes and CBMS/PEAK and
associated State eligibility and enrollment business processes
Interoperability between Exchange and Medicaid/CHP+ Systems
20
Consumer Experience- Make enrolling in coverage for the individual/household as fast and as simple as possible- Balance administrative simplicity, efficiency and effectiveness- Enable continuity of care- Provide user-friendly access to all eligible CO citizens and small CO businesses that desire access- Leverage and integrate with State systems and business processes as appropriateReliability/Simplicity in Getting Consumer Enrolled- Make enrolling in coverage for the individual/household as fast and as simple as possible- Leverage and integrate with the State system(s) and business processesReliability/Backend Complexity of Having All Solution Components Fully Functioning- Leverage and integrate with the other systems w/o reducing reliabilityPrivacy and Security- Leverage and integrate security, i.e. account management and MPI- Minimize proliferation and transmission of PIICost- Minimize costs to the COHBE, consumers, employers and carriers
Risk to COHBE Project Deadlines- Minimize Risks of: 1) not meeting federal milestones, 2) delivering baseline scope and 3) completing the project within the baseline budgetStrategic Direction and Latitude- Maximize flexibility to change its direction; enable the state to go in a different direction in the future without COHBE or State incurring a large potential cost impact or disruption to end users; this could include a different Exchange solution provider (re-compete) or a different Exchange solution direction such as building or buying the Exchange software and integrating with State system in futureStakeholder Acceptability- Recognize limitations of interoperability given political realities, funding constraints, etc.
Interoperability Decision Criteria
21
Coordination between COHBE HCPF and OIT
Single/shared MAGI eligibility process (9 interfaces) and interface w/ federal data hubSingle sign-onComprehensive/shared MDMData only entered onceLinks to non-medical eligibility processes and pre-populate with data previously collected during medical eligibility process
COTS rules engineClient correspondence
Client interfaceWorker interface
Non-exchange interfacesDecision support tools
Technical infrastructure re-build
22
Interoperability
SHOP ExchangeEmployers,Employeesand Brokers
Individual ExchangeHouseholds &Small BusinessEmployees
State ProgramsHouseholdsseeking public assistance,i.e. Medical, Food or Cash Assistance
Pre-screening
SHOPExchange
PEAKHomepage
IndividualExchange
Account Mgmt & MPI
EligibilityDetermination
Plan Selection &Enrollment
MAGI(including interfacing w/ federal data hub)
Set-up Employee Roster
Create Account
MMISCBMS
Pre Screening
Enrollment inCarrier Systems
Create Account/Account Mgmt
Review Subsidy/Out-of-Pocket Costs
Select Plan & Enter Enrollment Information
Interface Enrollment
Information to Carriers’ Systems
Review Out-of-Pocket Costs
Select Plan & Enter Enrollment Information
Eligible for Employer Plan &
Amount of Coverage
Interface Enrollment
Information to MCO Systems
High Level Architecture and System Boundaries
Boundary between COHBE and State
Systems
Boundary between COHBE and State
Systems
PEAKLog-in Page
PEAKBenefits
Selection/Application
MDM & Identity
Management
Estimated EnrollmentsSmall Employers: 14K – 33K
Individual Households 200K – 400K
23
COHBE’s Solution Architecture
24
Architecture
SHOP ExchangeEmployers,Employeesand Brokers
Individual ExchangeHouseholds &Small BusinessEmployees
Pre-screening
SHOPExchange
IndividualExchange
Account Mgmt & MPI
EligibilityDetermination
Plan Selection &Enrollment
MAGI(including interfacing w/ federal data hub)
Set-up Employee Roster
Create Account
Pre Screening
Enrollment inCarrier Systems
Create Account/Account Mgmt
Review Subsidy/Out-of-Pocket Costs
Select Plan & Enter Enrollment Information
Interface Enrollment
Information to Carriers’ Systems
Review Out-of-Pocket Costs
Select Plan & Enter Enrollment Information
Eligible for Employer Plan &
Amount of Coverage
High Level Architecture and System Boundaries
Boundary between COHBE and State
Systems
Boundary between COHBE and State
SystemsMDM & Identity
Management
Estimated EnrollmentsSmall Employers: 14K – 33K
Individual Households 200K – 400K
25
Landing Page
26
Key COHBE Solution Components
27
COHBE’s Exchange Architecture
28
Hosted Solution
hCentive Healthation
Ora
cle
BPM
/Ide
ntity
Mgm
t
Hosted InfrastructureData CenterHardware
Infrastructure SoftwareTelecom/Network
Operations MonitoringShared Support Services
Used across states
JbossRules Engine
RightFax/H
yland/Data Cap
Thurderhead/Informatica/COGNOS
SHOP & IndividualExchange Application
hCentive Healthation
SHOP & IndividualExchange Application
CGI HIX 360
CGI HIX 360
Configurable for each state
29
Opportunities to Leverage Federal Funds
30
Opportunities to Leverage Federal Funds
• Use of COHBE’s technology by states under a contracted software-as-a-service solution (Hosted Solution) in CGI’s federal cloud facility (Phoenix)
• Re-use of COHBE’s Exchange solution (Re-use Solution) in a the ID state or other hosted environment
• Leveraging COHBE’s backoffice (fiscal administrative) services and/or customer contact center services
31
Value Proposition for Other States and COHBE
Ability to deploy a state-specific SHOP and Individual Exchange solution:
In less time With fewer (internal) resources At a lower cost than otherwise possible
This will strengthen the state’s sustainability model
Potential to decrease COHBE’s expenses for operating the Exchange
32
Value Proposition for All ParticipantsPartner Expected Benefit Expected Contribution
Potential StatesAbility to deploy a state-specific SHOP and Individual Exchange solution: In less time. With fewer (internal) resources. At a lower cost than otherwise possible.This will strengthen the state’s sustainability model.
Fee for service under the Hosted Solution model.Transfer fee under the Re-use Solution model which will permit COHBE to recover some of its on-going operational costs.
COHBE/State of CO
Revenue potential to decrease COHBE’s administrative expenses for operating the Exchange.
Sharing acquisition, implementation and operational costs and efforts with other States (depending on the model).
HHSEnables more states to adopt state-based Exchanges sooner.Leverages federal funds by decreasing Level 1 and Level 2 state grant requirements.Provides fewer systems/sync points (i.e. less coordination) with federal systems.
Support for use of COHBE (Hosted Solution or Reuse) models.Assist COHBE in coordinating/ channeling interest from other states.Providing/approving additional funding required to successfully partner with other states.
OMBReduced expenditure of federal funds to implement the Affordable Care Act.
Support for HHS and acknowledgement of HHS efforts to leverage federal funds.
Systems Integrator (CGI)Ability to implement solution in more states to increase revenue from services to support implementation and operations.Opportunities to “win” additional states without expending considerable time and effort in the acquisition process (assuming states are able to contract with CGI through COHBE).
Providing strategic and technical input into formalizing the Hosted and Re-use solution models.Developing a COHBE-CGI marketing plan and opportunity assessment framework.Assigning resources to opportunity assessment.
3rd Party Software Providers(e.g. hCentive, Healthation, Oracle)
Ability to license products to other states or to otherwise increase revenue opportunities
Participation in strategy and planning activitiesReduction in upfront and on-going licensing costs for COHBE.
33
Example Strategic Decision Framework
Alternative Description/Approach
CostAbility to Leverage
Federal Funds
Consumer Experience
Reliability/Maintainability/
Scalability
Impact on COHBE
Operations and Systems
State’s Strategic Direction and
Latitude
Political/StakeholderAcceptability
Implementation Costs (federal &
SGF)
5-Year Operational Costs
(federal & SGF)
Use FFE or partnership model indefinitelyNote: FFE is not planned to be available indefinitely
Start with FFE or partnership model then transition to SBE (2015 or later) and implement transfer system and operate
Start with FFE or partnership model then transition to SBE (2015 or later) software as a service model
Assumption: In all cases there is insufficient time to implement a SBE by January 2014
34
Wrap-up
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Questions addressed:# 3#4#5#6 #7#8
Questions Posed by Governor Which Were Addressed in Today’s Presentation
36
Q & A
37
Website: www.getcoveredco.org
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