Strategic IT Considerations of Health Insurance Exchange Implementation | Part Two: An interview w/ Melissa Boudreault, Vice President within State Health Solutions for CGI
Melissa Boudreault is Vice President within State Health Solutions for CGI, a leading IT and business process services provider. In this role, she works with states and commercial carriers across the country to develop blueprints and strategies for ACA and health care reform implementation.
A national leader in the strategy, design, and implementation of health insurance exchanges and the ACA, Ms. Boudreault was one of the founding Directors of the Massachusetts Health Connector.
Healthcare IT Connect sat down to discuss the current disposition of state health insurance exchanges (HIX) as health IT leaders implement State, State/Federal Partnership, and Federally-Facilitated Exchanges.
This is the second part of a two part interview with CGI’s Melissa Boudreault. Part One of our interview with Melissa Boudreault is available to read here.
Zach Urbina: Some have suggested that States going with the State-Federal Partnership and Federally Facilitated Exchange (FFE) Models will in the end have less flexibility to support State-based programs and also to query the Federal eligibility and enrollment system. Is there anything states can do to overcome obstacles such as these?
Melissa Boudreault: We are fortunate that, at this point, very little is carved in stone and decisions are not irreversible. Some states may get into the next calendar year and decide they want to look at other opportunities.
By all accounts so far, the FFE looks to be a very robust, comprehensive and nimble system. So even for states not planning to build something on their own, they will still benefit from some powerful decision support and rules in the technology.
There are a couple ways states can try to retain some flexibility or control. Defining agency needs and goals is very important. For states expecting an uptick in Medicaid eligibility, even if through other systems, they must determine what is needed programmatically to manage that. For example, will there be any system, policy or regulatory changes needed.
Focusing on the business process work is another way to retain some control and offset some lack of flexibility. Looking hard at the points of intersection — those places where there will be pain points — is probably the best way to anticipate the changes that will start coming in October.
The Federal Data Hub presents us with an incredibly powerful source of information. Even for states that initially are choosing not to engage, there is value in looking at what the data offers and seeing how it supports other systems. This is particularly true for states focused on program integrity as it is an opportunity to avail their programs with the most current information.
In my mind, of all the things happening with the ACA, the move to MAGI (Modified Adjusted Gross Income) will be the most powerful as it will give states a way to completely transform their way of delivering services.
ZU: What trends are you seeing emerge around states sharing models and IT resources for HIX implementation and in your view have they been successful to date?
MB: Reuse is the area where we are probably having the most conversations among states. The original notion of exchanges, particularly with early innovator states, was there would be reusable components. There has been a lot of conversation around plan management because that came out early, and both the Centers for Medicare & Medicaid Services (CMS) and states were looking at it at the same time.
The technology challenge we have is that we are all building for the same time period. One benefit we probably did not fully anticipate is that the drive to share and reuse has allowed IT providers to build real efficiencies into their delivery capabilities. For example, at CGI we created a HIX Center of Excellence in Texas where we do most of our testing. There, we are able to share use cases and outcomes among states, particularly when testing similar projects. Another area where there has been tremendous shared benefit is in cloud computing and hosting. Three of our HIX clients have chosen our secure government cloud for their state-based exchanges.
Many of us initially thought reuse would encompass a very tangible transfer of information and data. But this has turned out to be more nuanced in terms of generating efficiencies and leveraging resources. We have seen everything from contracts and requirements to usability matrices being shared among states. As we move into October and January, the focus will be less about technology and more about having a robust discussion across states that have not yet implemented an exchange, but want to know what is out there that they can leverage.
I am constantly struck by the amount of inter-state communication that is happening. Even though states are extremely busy, so many are still taking the time to talk with one another to understand and share best practices.
ZU: States are of course moving forward with diverse health reform agendas across the country including their decisions around HIX, and are modernizing their IT systems to support their strategies. Could you comment on the opportunities that exist for states to share data between HHS agencies and use analytics to better coordinate care and reduce the costs of supporting such programs?
MB: So this is the opportunity so many of us have been waiting for. We have all this data at our fingertips, but how do we bring it together in a meaningful way? Something I have been thinking about for years, and am excited that it is getting closer every day, is the intersection of health insurance exchanges and health information exchanges.
What if, when a member logged into a HIX portal, there was also a decision support tool that looked at their claims history to recommend plan options? The coming together of all this data to really help the consumer is going to start to become a reality.
However, it is going to take some time. 2014 is going to be about stabilization. Since exchanges will be deemed successful based on how effective they are in bringing in a wide range of residents and retaining them over time, the first year will be about stabilizing not the systems, but the communications, outreach and business processes.
Also, a few states are starting to do some very creative things above and beyond healthcare reform. Vermont is a great example. They are implementing an exchange, but they are also looking closely at how they can move to a single-payer model. As new initiatives start to develop, and we see how states are leveraging data and information for those initiatives, they will create some pathways for other states.
The challenge lies in finding a way to get the data into one place. As we start to bring in new systems, but still have legacy systems providing resources, much of the work is going to be around strategically thinking about what data is available and how to integrate it and use it for decision support.
ZU: CGI has been an advisor and integrator for many states when they’re assessing their options for implementing Health Insurance Exchanges, which application areas and associated opportunities are emerging for vendor organizations supplying solutions or as you said COTS (commercial off-the-shelf) solutions to Health Insurance Exchanges?
MB: An exchange is really an amalgamation of many different disciplines because it has to do many different things. The soundest HIX approaches bring together expertise and best practices in state health programs, commercial insurance, and things like e-commerce and premium billing.
For CGI, building exchanges, and looking at either a new eligibility system or bridging to an existing one, has been a big focus of our efforts. Even our teams working on implementing an exchange only are still very engaged in different aspects of eligibility and legacy system interfaces. This is an area where CGI traditionally has done a lot of work, and where we are very comfortable. So we knew we could not show up with these independent COTS solutions and implement them painlessly.
As I mentioned earlier, we also have been able to leverage our secure government cloud for exchanges. The notion of states being able to take advantage of cloud computing in a secure facility has been very, very attractive to them. Quite rightly, CMS is very focused on security. So our secure government cloud has given us an opportunity to take that concern away from the states so they could focus on building their exchanges.
Part One of our interview with Melissa Boudreault is available to read here.