Colorado Health Benefits Exchange

1. Colorado Health Benefits Exchange IT and Implementation Committee Strategic IT Decisions December 14, 2011

2. Overview • Discussion points from 12/12 Board meeting • “Optimal” Level of “Interoperability” with State Medicaid/CHIP Systems and Business Processes • Storyboard • Areas of Potential Interoperability and Input (IT, Call Center, Plans) • Cost Allocation of Interoperability • Additional Information from RFI process • Path Forward

3. Discussion points from 12/12 Board meeting

4. Discussion points from 12/12 Board Meeting • Input into RFP • Risk management • Ask vendors how they would reduce implementation risk • Ask vendors how they would reduce operational risk (2+ options; pros/cons of each; one biased towards pmpm and one pmpm neutral • How will they align with the COHBE on a sustainable basis • Heavy weighting on call center / customer service experience • Provide COHBE latitude to create partnerships with “best of breed” companies by unbundling (recommend one technology solution for SHOP and individual exchanges) • Evaluation Team • 6 – 8 members is ideal • HCPF will participate • Concerns re adequacy of IT resources • Developing options

5. “Optimal” Level of “Interoperability” with State Medicaid/CHIP Systems and Business Processes

6. What is the “optimal” level of “interoperability” and coordination with the State’s Medicaid/CHIP systems, business processes and existing customer support services? Interoperability Between COHBE & State Medicaid/ CHIP Systems and Business Processes CBMS/PEAK & Medicaid/CHIP Eligibility & Enrollment Business Processes COHBE Eligibility & Enrollment Systems and Business Processes Extent of “interoperability” (i.e. amount of overlap) between COHBE system and business processes and CBMS/PEAK and associated State eligibility and enrollment business processes increase s complexity and schedule risk but improves some consumer populations’ experience

7. “Optimal” Level of “Interoperability” with State Medicaid/CHIP Systems and Business Processes COHBE Systems State Systems

8. What is the “optimal” level of “interoperability” and coordination with the State’s Medicaid/CHIP systems, business processes and existing customer support services?

9. “Optimal” Level of “Interoperability” with State Medicaid/CHIP Systems and Business Processes • Interoperability System and Business Process Alternatives • Minimum level of systems interoperability (from design principles, guiding principles and best practices): • Single/shared MAGI eligibility process for Private Insurance and Medicaid/CHIP • Single sign-on • Comprehensive MPI (Exchange and Medicaid/CHIP population) • Data only entered once • Request only information needed for determining eligibility for healthcare • Maximize “no touch” eligibility adjudications • Interface from PEAK to MAGI process to support “no wrong door” requirement for medical eligibility • Provide links to non-medical eligibility processes and pre-populate with data previously collected during medical eligibility processes • Moderate level of systems interoperability: • Interfaces • TBD • Maximum level of systems interoperability: • TBD

10. “Optimal” Level of “Interoperability” with State Medicaid/CHIP Systems and Business Processes • Tiered Sets of Requirements Example Only

11. “Optimal” Level of “Interoperability” with State Medicaid/CHIP Systems and Business Processes • Analysis of Alternatives – use cases and preliminary estimate of populations Preliminary

12. “Optimal” Level of “Interoperability” with State Medicaid/CHIP Systems and Business Processes • Use Cases and interoperability considerations Eligible for SHOP Coverage What is this population? Eligible for Subsidized Private Coverage CHIP Eligible CHIP Eligible What is this population?

13. “Optimal” Level of “Interoperability” with State Medicaid/CHIP Systems and Business Processes • Storyboard shows moderate level option of interoperability

14. “Optimal” Level of “Interoperability” with State Medicaid/CHIP Systems and Business Processes • Interoperability System and Business Process Alternatives • Shared call center with HCPF • Four types of calls anticipated: • Exchange call center – eligibility, site, information, assistance, billing, etc. • State Medicaid call center (MAXIMUS) – eligibility, claims, etc. • Carrier call center – policy questions, claims, etc. • Division of Insurance – complaints • Should #1 and #2 be combined? (shared /consistent support processes, infrastructure, capacity management flexibility, consumer experience, need for specialization or separation) • Carriers offering plans that bridge private and public healthcare coverage to enable household to be covered by one carrier/similar provider network, etc. • Prevalence of “mixed” household populations being researched, e.g. • Single parent eligible for subsidized private coverage and children eligible for CHIP. • One parent receives subsidized coverage from SHOP employer, spouse eligible for subsidized private coverage and children eligible for CHIP

15. “Optimal” Level of “Interoperability” with State Medicaid/CHIP Systems and Business Processes • Analysis of Interoperability Alternatives – feasibility of alternatives versus critierai

16. Interoperability Decision Criteria

17. Additional Information from RFI Process

18. State RFP’s – Vendor Input All state-run procurements. • Maryland – stringent to the point of limiting vendor creativity; all risks put on vendor • Minnesota – structured to get the best functional modules; presents significant integration challenges; Phase 1 complete vendors to built exchange prototypes; available to other states • Washington – design, develop, implement (DDI) model; ignores significant investment in exchanges currently on market; SaaS only solutions excluded • Mississippi – phased approach (e.g. web portal/shop & compare, unsubsidized exchange, subsidized exchange eligibility determination); open to multiple vendors across phases; risky with lots of unknowns (federal guidelines, etc) • Regular conference call with CCIIO indicates that the following states have or will have issued RFPs by the time COHBE RFP is issued (MA, MD, MS, WA, NY, OR, MN)

19. COHBE RFI summary

20. COHBE RFI Summary • Information on costs will require additional analysis and follow-up with vendors • Preliminary estimates for Exchange technology and services range from $30 million to $60 million per year w/ implementation costs amortized over 4 years

21. Background Material

22. RFP Workplan

23. COHBE Implementation and Start-up Timeline Note: Accompanying timeline for required enhancements to PEAK & CBMS not shown

24. Draft COHBE Guiding Principles for Systems and Implementation

25. Solution Cost Estimate – Cost Drivers 1 of 3

26. Solution Cost Estimate – Cost Drivers 2 of 3

27. Solution Cost Estimate – Cost Drivers 3 of 3

28. Role of IT and Implementation Committee • Role is to provide guidance to COHBE executive leadership and early input into major strategic decisions such as IT investments, acquisition of services and Acquisition strategy • These initial acquisition decision(s) will likely be in the order of tens of millions of dollars over the first 3 – 5 years • Acquisitions 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 Acquisitions activities and operational decisions • Meet weekly leading up to the start of the formal acquisition process