Meeting with State of WY September 11, 2012 Gary Schneider COHBE IT Program Manager 970.420.1656

1. Meeting with State of WY September 11, 2012 Gary SchneiderCOHBE IT Program Manager 970.420.1656 Gschneider@cohbe.org

2. 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

3. Colorado Health Benefit Exchange (COHBE)

4. 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.

5. 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

6. 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 to of premium cost 35% In 2014, tax credit will be up to 50% of the premium

7. Develop, implement and test web portal and customer service functions COHBE’s 2012-2014 Exchange Timeline • Create policies for finance, audit, and prevention of fraud Exchange launch (Oct. 2013) Test all systems Jan. 1 2014 Coverage Begins • Implement Navigator program • Certify benefits and health plans 2012 2013

8. 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

9. State Based Exchange (SBE) Policy and Strategy and Operational Latitude

10. SBE Policy Latitude • 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

11. SBE Strategy and Operational Latitude Strategic and operational decisions across numerous areas User experience (technology and customer service) Balancing needs of consumers, small employers/employees, carriers Exchange Solution People/Organization Supporting Technology Business Processes Eligibility & Enrollment Plan Management Core Areas Financial Management Phase Customer Service Oversight Implementation Operations

12. Effort, Cost and Time to Build a SBE

13. 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)

14. 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

15. 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

16. Interoperability between CO Medicaid Systems and the Exchange

17. Integrated Timelines

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

19. Interoperability between Exchange and Medicaid/CHP+ Systems 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

20. Interoperability Decision Criteria

21. Coordination between COHBE HCPF and OIT COTS rules engine Client correspondence Client interface Worker interface Non-exchange interfaces Decision support tools Technical infrastructure re-build Single/shared MAGI eligibility process (9 interfaces) and interface w/ federal data hub Single sign-on Comprehensive/shared MDM Data only entered once Links to non-medical eligibility processes and pre-populate with data previously collected during medical eligibility process

22. Interoperability

23. COHBE’s Solution Architecture

24. Architecture

25. Landing Page

26. Key COHBE Solution Components

27. COHBE’s Exchange Architecture

28. Hosted Solution SHOP & Individual Exchange Application Jboss Rules Engine CGI HIX 360 hCentive Healthation SHOP & Individual Exchange Application CGI HIX 360 Oracle BPM/Identity Mgmt RightFax/ Hyland/Data Cap hCentive Healthation Hosted Infrastructure Data Center Hardware Infrastructure Software Telecom/Network Operations Monitoring Shared Support Services Used across states Thurderhead/Informatica/ COGNOS Configurable for each state

29. Opportunities to Leverage Federal Funds

30. 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

31. 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

32. Value Proposition for All Participants

33. Example Strategic Decision Framework Assumption: In all cases there is insufficient time to implement a SBE by January 2014

34. Wrap-up

35. Questions Posed by Governor Which Were Addressed in Today’s Presentation Questions addressed: # 3 #4 #5 #6 #7 #8

36. Q & A

37. Website:www.getcoveredco.org • Unsubscribe