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IT developer notes challenges in designing state exchanges

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The CEO of a backbone developer for private and public exchanges offered a glimpse into the infrastructure buildout of state health insurance marketplaces envisioned by the health care reform act, describing informational hurdles ahead.

What the glimpse reveals is that IT companies need to be nimble and dexterous in a period of uncertainty for exchange implementation rules, tightening deadlines and reported SERFF (System for Electronic Rate and Form Filing) delays.  

Sanjay Singh, chief executive officer for Northern Virginia’s hCentive Inc., which creates technology to help states and insurers deal with the complexity of integrating their internal systems, says that there are many unknowns affecting with the IT and infrastructure buildout of exchanges under the Patient Protection and Affordable Care Act (PPACA.) Singh’s comments came in the week after the deadline for states to submit their blueprint applications to run a type of marketplace called a state-based exchange. 

IT companies are waiting for information from the U.S. Department of Health and Human Services (HHS) and its agencies and the NAIC’s SERFF partnership on how plan management will work, of course, the navigator parameters  and the mechanisms by which products will be uploaded, according to Singh, who co-founded GlobalLogic, a 3,000-person plus software product engineering company, out of his basement.

SERRF is now pushing back to March its ready date for rate and form filing uploading integration for exchanges, so hCentive is creating its own alternative integration technology to upload product data for use by state exchange  clients, Singh said. Once SERFF is ready, “we will just switch over to SERFF,” he said.

it is unclear what other IT platforms relying on SERFF for rate and form filing uploads across the country, including the federal government, are doing to preparing the event of a protracted delay.

The NAIC is planning to have a big role in states’ ability to adequately perform plan management activities related to health insurance exchanges.

The NAIC wants to support both exchanges that are state-based and state partnership exchanges by giving them the capacity to handle the technology infrastructure needs that will come with plan management, according to a blueprint the NAIC has posted online for interested parties. SERFF is working from the “Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges,” a document provided by the Centers for Medicare & Medicaid Services (CMS), an arm of HHS.

As for the federal data services hub to run verification checks on individuals logging in, “how will that work?  That is kind of a black box today?” Singh asked, saying he would take a wait and watch approach. The hub has come under fire recently from Republican lawmakers concerned about the relationship between the company awarded the contract by CMS to build the exchange, Quality Software Services Inc. (QSSI),and Minnesota-based insurance giant UnitedHealthcare.

Chairman of the House Committee on Energy and Commerce Fred Upton, R-Mich. and Sen. Charles Grassley, R-Iowa, ranking member on the  Senate Judiciary Committee wrote Dec. 10 to UnitedHealth Group CEO Stephen J. Hemsley that QSSI’s role in finalizing technical and system requirements to develop and deliver plan management services, including certifying health plans and monitoring compliance “raises serious questions about the conflicts of interest that may exist a a result of the acquisition of QSSI by Optum,” a UnitedHealthcare subsidiary.

“For example, this contract creates a situation whereby the exchange’s ultimate designer, QSSI, is in a position to tailor the system to favor the interests of its parent company, UnitedHealth Group, and further maintain a monopoly over information that is unavailable to competitors , potentially allowing such information to be exploited as invaluable market intelligence and used to gain an unfair advantage over competitors.” 

 hCentive was founded by Singh, a political junkie and  software start-up innovator in 2009 specifically to take advantage of the coming health care reform, which he has watched develop and survive over the past few years, although at times he says it felt like he was walking on eggshells, waiting to see how the Supreme Court would rule on the Act. 

Now the biggest obstacles are not benchmark court cases nor the election but the  the still-uncertain elements under development at HHS and the thus-far immovable timeline, which calls for open enrollment to begin October 1, 2013, with exchanges operating in just a year and two weeks, or by January 1, 2014, according to Singh.

hCentive is working with four states–Massachusetts, which is the most advanced, having built its own state exchange, New York, Colorado–the state Health Benefit Exchange–, and most recently, Kentucky either directly or with system integrators (SIs) as a subcontractor to provide a backbone for the state exchanges. All four states are members of a pack of leading states that have conditional approval from HHS already and which have made more headway than many others.

As HHS Secretary Kathleen Sebelius stated in her blog December 14, it was announced that the District of Columbia, Kentucky, and New York have made significant progress setting up their marketplaces, and conditionally approved their plans and “are on track to meet all exchange deadlines and be ready for open enrollment in ten months.”

Previously, HHS conditionally approved exchange plans for  Colorado, Connecticut, Massachusetts, Maryland, Oregon, and Washington

In addition, state-based exchange blueprint applications were filed by the Dec. 14 deadline by  from the following states: California, Hawaii, Idaho, Minnesota, Mississippi, Nevada, New Mexico, Rhode Island, Vermont, and Utah. States have until February 15, 2013 to choose a state partnership exchange.

hCentive’s full state exchange product, WebInsure State is a ready-to-deploy online marketplace solution for. It is PPACA/HIPAA-compliant  and can be can be configured and customized for states’ functional and technical requirements, and  work with state and federal systems, according to its description. Within it, individuals, employees, employers, brokers and navigators each have their dedicated portals. 

Even with states ahead of most, the timelines matter and there is much anxiety because there is so much complexity in integrating so many systems. And then there were states waiting until the last minute, hoping the Supreme Court would overturn PPACA. Now there is no time, Singh said. 

There is a lot of anxiety because of timelines and knowing what needs to be done and the time left to do all that. If you are a state commissioner, I am sure you are. It is the toughest thing– even if you started in time. The complexity is such and the regulation are still being developed and refined–the setting up of  call centers, plan management, the financials … ,I mean, it is just a lot of work that needs to be done in a very short time,” Singh said. 

As a small company, there is no other way to survive than to be nimble, he said.

hCentive also has insurance clients such as Coventry Healthcare and Delta Dental and a Blues plan in Tennessee.  

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