Preliminary Discussions with IT and Implementation Subcommittee –
Strategic IT Decisions
November 21, 2011
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Role is to provide guidance to COHBE executive leadership and
early input into major strategic decisions such as IT investments,
acquisition of services and procurement strategy
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These initial acquisition decision(s) will likely be in the order of
tens of millions of dollars over the first 3 – 5 years
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Procurements will be structured to be competitive, fair and
transparent
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Due to the political sensitivities and visibility surrounding the
COHBE, it is important that there be no real or apparent conflicts
of interest in procurements activities and operational decisions
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1. Should the Exchange use a SAAS model or acquire (borrow/build/buy) the capital
IT Exchange assets? – analysis framework provided
2. Should the Exchange consider the Federal partnership model? If so, for which of
the core areas? – analysis framework provided
3. Should the State develop a vision and strategy for replacing or upgrading CBMS
so that investments in modifying CBMS and PEAK to meet the requirements of
healthcare reform are rationalized against the strategic direction? – Yes and
analysis framework confirmed with HCPF
After analysis frameworks (alternatives and criteria) are confirmed with COHBE
Board, analysis will be completed and presented in mid-December
COHBE “owns” #1 and #2
State (HCPF, DHS) “owns” #3
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High-Level Timeline – COHBE Policy & Business Decisions and IT
2011
11/11
2012
01/12
03/12
Policy & Business
Decisions and Activities
Policy & Business
Decisions
Impacting IT
05/12
07/12
2013
09/12
11/12
01/13
Supreme Court
Ruling on Mandate
03/13
05/13
07/13
COHBE Certification
by HHS
Operational Activities
Evolving Policy and Business Decisions based on CCIIO/CMS/Board/Executive Director/Legislative
Oversight/etc.
Start-up and Operational Decisions
Start-up Activities
IT/Systems
Pilot Phase
04/13 – 10/13
HIX - SHOP
Analysis/Confirmation of
Current Approach & Prel
RFP
Procure IT Systems &
Services for HIX
Design/Build/Test HIX Systems for SHOP
HIX SHOP
Integration Testing
HIX Deployment
Establish PMO
Pilot Phase
06/13 – 10/13
HIX - Individual
Analysis/Confirmation of
Current Approach & Prel
RFP
Procure IT Systems &
Services for HIX
Design/Build/Test HIX Systems (Eligibility/Enrollment/Plan Mgmt and Associated
Services Interface w/ Federal Data Hub, Other Data Sources, MMIS, PEAK/CBMS)
HIX
Integration Testing
HIX Deployment
Note: Accompanying timeline for required enhancements to PEAK
& CBMS not shown
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Schedule is extremely tight for a product release of this magnitude and complexity, i.e. 20 months
until SHOP “go-live”
•
Implementation dependencies with changes to CBMS and PEAK increase complexity and
schedule risk
•
Asset acquisition (with federal funds) likely to result in lower sustainability costs vs. SAAS model
with lower upfront costs
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Three major components must be procured:
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Exchange technology solution (acquire/license or rent)
Exchange technology solution hosting (outsource)
Exchange administrative and customer support services (outsource)
Procurements will be:
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•
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Well-structured
Efficient
Competitive
Fair
Transparent
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Opportunities to coordinate solutions, procurements, etc., with other states is challenging and
becomes more challenging daily; coordinating across states (and multiple state agencies for each
state) in this political environment creates additional dependencies and increases execution risk
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Federal Exchange partnership model is not compatible with Colorado having its own Exchange
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Exchange Alternatives
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SAAS Model
COBHE Acquires Asset; Operated by 3rd Party
Criteria
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Cost
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Risk
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•
•
•
•
•
•
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•
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Implementation
5-Year operations
Schedule risk
Cost risk
Consumer experience
Reliability/simplicity in getting consumers enrolled
Reliability/backend complexity of having all solution components fully
functioning
Ability to share solution components with CBMS
Privacy and security
Impact on COHBE operations/and alignment with ops plan
Strategic direction and latitude
Stakeholder acceptability
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Should the Exchange use a SAAS model or acquire the IT Exchange assets and
have the asset operated by a 3rd party?
Alternative Description/
Functions
SAAS
Model
Cost
Risk
Implementati
5-Year
Schedule
Operationa
on
Risk
Costs
l Costs
Cost
Risk
Consumer
Experience
Employer/
Employee
(Richness of
Features &
Functionality
Reliability/
Simplicity in
Getting
Consumers
Enrolled
Reliability/Back Ability to
Impact on
end Complexity
Share
Privacy
COHBE
of Having All
Solution
and
Operations
Solution
Componen Security
/and
Components
ts w/
Alignment
Fully Functioning
CBMS
w/ Ops Plan
Strategic
Direction
and
Latitude
Political
Acceptability
w/ or w/o
shared rules
engine
Acquire
Asset
Operated
by 3rd Party
Other-TBD
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Eligibility
Enrollment
HIX
Customer A
Carrier Systems
Screening &
Eligibility
Determination
Plan Shopping
& Selection
Enrollment
MA/CHIP/PTC/RCS
Carrier Systems
Federal and State
Real-Time Data
Exchanges
Interoperability Layer
What interoperability is
feasible?
MA/CHIP Eligibility
Rules &
Real-time Eligibility
Decision
State
Systems/
Programs
CBMS
Customer B
PEAK
SNAP, TANF,
MA/CHIP/MA
ABD/LTC
MMIS
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Considerations of Federally-facilitated Exchange:
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Cost of Federally-facilitated Exchange is TBD; likely to charge carriers
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HHS is responsible and accountable for ensuring the Exchange meets all of the
standards; State role is limited
•
Two proposed areas of partnership that can be operated by states as part of the
agreement are Plan Management and some Consumer Services
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For Plan Management, State helps select plans and collects a standardized set
of data on them to plug into Federally-facilitated Exchange's eligibility and
enrollment functions.
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For Consumer Services, HHS coordinates with the State regarding plan
oversight, including consumer complaints and issues
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2. Should the Exchange consider the Federal partnership model? If so, for
which of the two optional areas?.
Core
Exchange
Functions
High-Level Exchange
Requirements
Which Functions Are Candidates
to be Met via the Partnership
Model
Partnership Model for Each Core
Function
YES
NO
Accept applications (web/phone/mail)
Conduct verifications of applicant information
Eligibility
Determine eligibility for enrollment in QHP and for
insurance affordability programs
Connect Medicaid and CHIP-eligible applicants to
Medicaid and CHIP
Conduct redeterminations and appeals
Operated and maintained by HHS
Enromment of consumers into QHPs
Enrollment
Plan Management
Transactions with QHPs and trasmissions of
information necessary to initiate advance
payments of premium tax credit and cost-sharing
reductions
Plan selection approach (e.g. active purchaser or
any willing plan)
Collection and analysis of plan rate and benefits
package information
Issuer monitoring and oversight
On-going issuer account management
Issuer outrach and training
Operated and maintained by HHS
State helps select plans and collects a stardardized set of
data on them to plug into Federally-facilitated Exchange's
eligibility and enrollment functions.
HHS coordinates with the State regarding plan oversight,
including consumer complaints and issues with
enrollment reconcilliation.
Data collection and analysis for quality
Consumer support assistors
Education and outreach
Navigator management
Consumer Assistance
Call center operations
Website management
Written correspondence with consumers to
support eligibility and enrollment
User fees
Financial Management
Consumer assistnace functions that a State would operate
under this propoposed partnership option include:
- In-person assistance
- Navigator management
- Outreach and education
Consumer assistance functions that HHS would operate
under this proposed partnership option include:
- Call center operations
- Website management
- Written correspondence with consumers to support
eligibility and enrollment
Financial integrity
Operated and maintained by HHS? Need to Confirm
Support of risk adjustment, reinsurance and risk
corridor programs
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Category
Exchange Functions,
Features and
Business Processes
Guiding Principle
Meet the minimal requirements of federal regulations; enhanced functions, features and integration will
be considered in the future. New business processes to execute Exchange business processes shall
minimize the impact to other State agencies’ business processes or systems.
Exchange Customers Customers of the Exchange are individuals and small business owners and their employees.
There will be a single Exchange. The Exchange will have two business lines: 1) the SHOP Exchange and 2)
and Business Lines
the Individual Exchange
Market Competition Encourage competition in the market whether it is inside or outside the Exchange.
Continuity of Care
Ensuring continuity of care is a personal responsibility; the Exchange will not pro-actively enroll or change
enrollments of consumers (i.e. individuals and small employers and their employees).
Integration with
Medicaid
Minimize integration with Medicaid eligibility in the near-term; consider tight integration (and possible
upgrade of State’s eligibility system) in long-term (i.e. 3-5 years); make investments based on this strategy.
Send consumers to the “right” door first but enable cross (MAGI) eligibility determination.
Federal Deadlines
Work with State Medicaid agency but do not jeopardize meeting federal and state deadlines.
Solution Acquisition
Leverage existing solutions and solution components from other states and federal partners to the
maximum extent possible.
Inter-agency
Partnerships
Work in concert with all State agencies, e.g. HCPF, DHS, OIT and Insurance Department.
Regulatory Authority Maintain the Colorado Insurance Department as the single regulator.
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