A Conversation with Exchange Leaders: Part Four—Talking Tech

Underlying every health insurance exchange is a complex technological infrastructure designed to perform the many functions of the marketplace from eligibility and enrollment to consumer assistance such as plan comparison and cost calculator tools. To conclude our blog series interviewing exchange leaders, we hear from Juli Baker, Chief Technology/ Information Officer atCovered California and Christine Ferguson, Executive Director of HealthSource RI, who reflect on lessons and successes related to the build and implementation of their exchange technology platforms, as well as innovations planned for the year ahead.
Reflecting on 2014 open enrollment, what were some top successes in the build and implementation of your technological infrastructure?
Juli (CA): Our top success is that we were able to open our marketplace on October 1 and successfully enrolled 1.4 million consumers. We began our IT build in June 2012, meaning we had to be up and running in 15 months, an aggressive timeline for a project of this size and complexity.
Christine (RI): Similarly, our success was that thousands of Rhode Islanders were able to enroll from the first day of our launch. Rhode Island was also one of the few state-based exchanges to collect both individual and SHOP premiums and that ran a successful Small Business Health Options Program (SHOP) Exchange.
What factors contributed to your success?
Christine (RI): We were able to drive the message that our technology supports our wider business goals—operations, customer support, marketing and outreach. In addition, we succeeded in creating an integrated eligibility system that addresses multiple needs across agencies, and balances the business interests, expectations, and system and information needs across those agencies. For design of our SHOP, we ensured that our capabilities were on par or above off-exchange and private exchange options.
Juli (CA): I attribute our success to a good governance structure that included the California Department of Health Care Services [Medicaid agency], stakeholders, and our vendors. We worked hard early on to establish these relationships, which enabled us to align expectations, and convened regularly which kept people engaged.
Can you describe something you learned mid-course that turned out to be very important?
Juli (CA): Enrollments ran at a higher rate than we anticipated—nearly twice our projection—so we launched contingency plans right away. Noticing a pattern of peak volumes near enrollment deadlines, we constructed a series of mechanisms to free up system capacity during peaks. We developed five different points that would redirect consumers to other parts of our system at times of peak volume. For example, consumers might be sent to our cost estimator site where they could SHOP for plans while waiting for volume on our application site to decrease. We also made adjustments to run large batch transactions at night, when fewer users were on the system.
For 2015 open enrollment, we have purchased the extra infrastructure capacity we need, about three times what it was before.
Christine (RI): It was critically important to make the right investment in skilled technical resources to help effectively manage the work and deliverables of our vendors. In addition, a clearly articulated and defined communications and escalation process around system issues and problems proved to be a necessity.
Can you discuss your priorities and upcoming opportunities you see as you plan for 2015 and beyond?
Christine (RI): We will continue to focus on extending our capabilities for SHOP. From the eligibility and enrollment system side, we will continue to increase our system stability, as well as our response time for addressing defects and issues. We will also focus on building out our information and analytics tools to provide insights that help support exchange customers and drive our business goals.
Having web-based tools, as well as trained contact center staff, is essential to helping consumers make effective choices about plans. We created a wrap-around consumer front-end, separate from the enrollment and eligibility system, which included consumer decision tools. We will continue to invest in expanding front-facing tools to increase transparency of information and the ease of use.
Juli (CA): We also seek to continuously improve the consumer experience. We’ve obtained stakeholder and consumer input on what we can do to improve navigation and comprehension of the site. We have used web analytics to determine the flow of traffic through our site, and are re-aligning the site design to better reflect consumer needs. We are streamlining business processes to quicken application response time. For example, we want to create a process to directly “attach” verification documents to a consumer’s case instead of requiring service center representatives to sort through batches of uploaded files for necessary documents.
Renewal will be key; we began communicating with consumers this month about upcoming events. We are running an automated redetermination system based on the latest income data available from a consumer’s tax return. Sixty-seven percent of our members gave us permission to access their tax returns for the purpose of renewals. They will receive notices of what they might be eligible for based on their income updates, with an option to automatically reenroll in existing coverage.
This blog series is produced by the State Health Exchange Leadership Network, a project that supports exchange leaders and staff, housed at NASHP. The State Health Exchange Leadership Network is supported by state contributions and the Robert Wood Johnson Foundation.