October 1, 2013. With fewer than five months to go for states to comply with the eligibility and open enrollment mandates under the Affordable Care Act (ACA) deadlines, it’s easy for states establishing health insurance exchanges (HIX) to get tunnel vision while focusing on getting all of the complex components in place and ready to go.
According to the Centers for Medicare & Medicaid Services (CMS), state exchanges are major IT implementations that combine portal technologies, content management, full e-commerce, CRM, online user experience and other information systems to produce a fully functional online marketplace. This herculean implementation is made even harder by the reality that most state IT infrastructures involve an assortment of legacy systems for eligibility-based assistance programs and many of these systems are not easily interoperable, which means that standing up an HIX by integrating outdated systems with separate, new out of-the-box HIX-components, is challenging and risky.
What’s more, the decisions made and the approach taken today will affect future initiatives and the ability of the HIX to keep pace with healthcare reform. Indeed, the argument for investing in modernizing a state’s IT infrastructure, and building the new HIX and other government assistance programs on this foundation, falls into place easily when you think of Oct. 1 not as a deadline, but as a beginning. States should think not just about Oct. 1 but also Jan. 1, 2014, Jan. 1, 2015, Jan. 1, 2016 and beyond. Systems that focus solely on Oct. 1, 2013 will not be sustainable as the U.S. health care system continues to evolve in complexity, and as state HIX policies and requirements change.
States that will run exchanges on their own or in partnership with the Federally Facilitated Marketplace (FFM) have an enormous amount of work ahead to meet the minimum requirements. Despite such pressures, the exchanges present states with several money saving opportunities.
States can create sustainable IT infrastructures that leverage reusability and achieve interoperability, enabling integration of existing legacy systems with newly deployed platforms, while ensuring that they are tomorrow-ready to embrace future platforms. If they seize these options, states can provide systems that better serve their citizens, can adapt to changing needs and give them more value for their money.
One key to seizing these opportunities is to develop an exchange solution that embraces reusability. Reusability means the capacity to tap existing functionality without having to replicate or modify it for another environment. A reusable platform allows one system or application to use the components it needs for one purpose, while also allowing another, perhaps in a different department or agency, to harness the same components for a different reason — without having to adopt the entire technology stack.
The flexibility to use and repurpose specific layers within a tiered architecture is crucial for the exchanges. Agencies with existing systems could reuse a service developed and published on the HIX platform, such as notification or authentication, for their own non-exchange purposes.
Scalability is also a key advantage of modernization. States that modernize their infrastructures can rely on the reusable platforms developed today to be flexible and adaptable for further integration. As needs change, states can stand up new applications and continue evolving.
Keeping all of these benefits in mind, it’s also important to remember that the cost of not modernizing could be billions of dollars. Simply put, solving the immediate problem without building a bridge to the future can often mean needing to re-architect and redesign — effectively having to start over to accommodate future needs. And outdated systems contribute to the cost due to the increased odds of system failure. Their monolithic structure requires existing, otherwise reusable functions to be recreated, while the lack of interoperability demands more coordination among systems and a lack of scalability can cause the need to invest in new technology as policies develop.
This week, thought leaders from the public and private sectors will convene in Baltimore to share best practices about state IT implementation, in the context of ongoing health care system changes, at the 2013 State Healthcare IT Connect Summit. While each state’s ACA compliance experience will be unique, the integration and data challenges are common, and coming together to discuss experiences, challenges and solutions is invaluable.
In the race toward initial HIX implementation and beyond, even as we keep red letter dates in mind, let’s remember that Oct. 1 isn’t really a deadline – it’s the beginning of an ongoing commitment to smart, secure and sustainable health care.
Date: May 20, 2013