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Meeting with State of WYSeptember 11, 2012

Gary SchneiderCOHBE IT Program Manager970.420.1656Gschneider@cohbe.org

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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

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Colorado Health Benefit Exchange (COHBE)

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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.

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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

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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)

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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

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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

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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

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Effort, Cost and Time to Build a SBE

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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)

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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

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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

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Interoperability between CO Medicaid Systems and the

Exchange

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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

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Coordination with HCPFCOHBE and the State Medicaid agency (HCPF) will execute two overlapping projects which will be closely coordinated

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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

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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

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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

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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

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COHBE’s Solution Architecture

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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

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Landing Page

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Key COHBE Solution Components

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COHBE’s Exchange Architecture

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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

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Opportunities to Leverage Federal Funds

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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

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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

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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.

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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

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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

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Q & A

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Website: www.getcoveredco.org

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