Health Insurance Exchange Deadlines Challenging for States, IT Firms

 
 
By Brian T. Horowitz  |  Posted 2013-06-29 Email Print this article Print
 
 
 
 
 
 
 


Of senior health care professionals interviewed for a recent survey by software company Edifecs, 88 percent were concerned about disruptions to their current IT enrollment infrastructure and processes when they join an HIX.

The state HIXes will likely incorporate a way to link to electronic health records (EHRs) and health information exchanges (HIEs), according to Riley.

"Once you've created an HIX, you're going to have to connect with providers, EHRs, telemedicine and there needs be some sort of big data analytical package," Riley said. "The health plans are the ones that will need the EHR and telemedicine platforms," he explained.

Administrators of HIXes will determine eligibility based on data such as age and income, and they'll use data mining to produce reports at a state level, he said. They'll need the big data analytics to produce reports to keep Congress up-to-date on the status of the exchanges, Riley said.

Another vendor, Opera Solutions, is building a big data analytics platform for CMS that will detect insurance fraud in the exchanges.

In a response to the GAO report, the Department of Health and Human Services (HHS) said it expects the exchanges in all states to be up and running by Oct. 1.

For the IT vendors building the insurance exchanges for states, it's "all hands on deck" to meet the Oct. 1 deadline, said Kevin Walsh, a senior vice president and managing director for at Xerox's Government Healthcare Solutions group.

Xerox is working to build Nevada's health insurance marketplace, called HealthLink. Its team doesn't intend to get much rest this summer, Walsh told eWEEK in an email.

"We're working diligently to implement the Business Operations Solution, including the customer-facing Web portal, [to] go live on Oct. 1—that's when we'll fully launch open enrollment in Nevada—but it's a compressed time frame."

Xerox has hired contractors, and employees are working long hours to develop the IT infrastructure for the Web-based exchanges, he said.

"Health care reform is a massive transformation and standardization effort, and the pace is pretty daunting," Walsh continued. "There are going to be obstacles and unknowns. Any technology vendor who meets with success will be prepared to accommodate the unknowns either through rapid system corrections or manual workarounds."

Some systems that usually take two to three years to build will be constructed in less than a year, he noted.

"They will have challenges—but you have to be sure you have the trained staff and supporting processes to work around those challenges," Walsh said. "That's what we're doing to make sure Nevada HealthLink is robust, easy to use and on time."

Kansas and New York are two of the states furthest along in setting up HIXes for Oct. 1, according to Frost & Sullivan's Riley.



 
 
 
 
 
 
 
 
 
 
 
 
 

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