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Colorado Health Benefits Exchange

Colorado Health Benefits Exchange. Preliminary Discussions with IT and Implementation Subcommittee – Strategic IT Decisions November 21, 2011. Charge for IT and Implementation Subcommittee.

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Colorado Health Benefits Exchange

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  1. Colorado Health Benefits Exchange Preliminary Discussions with IT and Implementation Subcommittee – Strategic IT Decisions November 21, 2011

  2. Charge for IT and Implementation Subcommittee • 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 • These initial acquisition decision(s) will likely be in the order of tens of millions of dollars over the first 3 – 5 years • Procurements will be structured to be competitive, fair and transparent • 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

  3. Three Strategic IT Questions that Need to be Answered over Next 30 – 60 days Should the Exchange use a SAAS model or acquire (borrow/build/buy) the capital IT Exchange assets? – analysis framework provided Should the Exchange consider the Federal partnership model? If so, for which of the core areas? – analysis frameworkprovided 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

  4. COHBE Timeline Note: Accompanying timeline for required enhancements to PEAK & CBMS not shown

  5. Introductory Comments • 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 • Three major components must be procured: • Exchange technology solution (acquire/license or rent) • Exchange technology solution hosting (outsource) • Exchange administrative and customer support services (outsource) • Procurements will be: • Well-structured • Efficient • Competitive • Fair • Transparent • 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 • Federal Exchange partnership model is not compatible with Colorado having its own Exchange

  6. Question #1: Should the Exchange use a SAAS model or acquire (borrow/build/buy) the IT Exchange asset(s)? • Exchange Alternatives • SAAS Model • COBHE Acquires Asset; Operated by 3rd Party • Criteria • Cost • Implementation • 5-Year operations • Risk • 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

  7. Proposed Analysis Framework Should the Exchange use a SAAS model or acquire the IT Exchange assets and have the asset operated by a 3rd party?

  8. Interoperable Systems and Multiple Doors Eligibility Enrollment HIX Carrier Systems Screening & Eligibility Determination MA/CHIP/PTC/RCS Plan Shopping & Selection Enrollment Customer A Carrier Systems Federal and State Real-Time Data Exchanges MA/CHIP Eligibility Rules & Real-time Eligibility Decision Interoperability Layer What interoperability is feasible? State Systems/ Programs PEAK CBMS SNAP, TANF, MA/CHIP/MA ABD/LTC MMIS Customer B

  9. Question #2: Should the Exchange consider the Federal partnership model? If so, for which of the five core areas? Considerations of Federally-facilitated Exchange: • Cost of Federally-facilitated Exchange is TBD; likely to charge carriers • 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 • 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. • For Consumer Services, HHS coordinates with the State regarding plan oversight, including consumer complaints and issues

  10. Strategic IT Issues that Need to be Resolved Should the Exchange consider the Federal partnership model? If so, for which of the two optional areas?.

  11. Draft COHBE Guiding Principles for Systems and Implementation

  12. …Discussion

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