IT Concerns Over the Health Insurance Exchange Backbone

[somarco]

The Obamacare Health Insurance Exchange will go live in October of this year, or will it . . .?

I have a very good friend who is a systems IT expert with a lot of awards and designations. Her husband is an insurance agent and they have discussed the issues of getting HIX up and running from a technical perspective.

I got tag teamed in on an email this AM that contained these observations.

The Department of Health and Human Services (HHS) recently announced several contract awards that will support the development of the federal “fallback” insurance Exchange:

•CGI Federal Inc. will build and host the IT infrastructure for the federal Exchange option, which will include a consumer website, plan enrollment, and other functions.

•Booz Allan Hamilton was awarded three policy development contracts and will provide services relating to:
1. The consumer eligibility appeals process;
2. Plan certification and oversight; and
3. Design of an eligibility and enrollment strategy.

•A 5-year Data Hub contract was awarded to Quality Software Services. This federally-operated hub will verify citizenship, immigration status, and tax information with the Social Security Administration (SSA), the Department of Homeland Security (DHS), and the Internal Revenue Service (IRS).

and her observations about this task . . .

"Will the software and websites and data interfaces be up and running when enrollment time arrives this October 1"


First, she's worked on some very big projects for Fortune 100 and 500 companies, but this dwarfs those efforts. Based on her experience, and given the accelerated time-frame, she thinks it's unlikely they'll be up and running in time, let alone error-free.

Second, there is a finite universe of folks like her (like thousands, but certainly not 10's of thousands), and she's VERY active on [a popular business network] (she recentyly won some [popular business network] award to for number of hits or something like that - nothing she was working for, just got a "congratulations" email from them). She noticed a dog that hasn't barked: no one is talking about being on such a project, or being approached to be on such a project. How likely is it that someone wouldn't put THAT kind of experience on [a popular business network]?

So if the gummint isn't talking to folks like *her,* who *are* they working with?

Now go have some fun with this . . .

 

[timsip]

Let's put this in terms we all know: October 1st is 164 days away. The government hasn't started building the exchange website. This website has to interact with no fewer than four governmental agencies. The website has to interact with multiple private insurance carriers. Millions of people across the country will be using this website.

What could go wrong?

 

[taterpeeler]

AND SOME OF YOU WERE QUESTIONING WHY hhs WAS NOT GOING TO ALLOW THE BROKERS TO USE THE ... sorry the govt portal... remember ?.... here is one reason why:

if the system is not up an running WE the broker community can enroll into the HIX via our normal process now... just different plan designs...hell, that will all be on norvax/quoit/ehealth..... they will say ok brokers, you know the rules of subsidies so guesstomate their figure and we will figure it out....they could tell the insurance companies we will use the agents guess and pay you on that and after we get the system up and running we will settle up down the road.....

this is the and I mean THE ONLY way they can pull off an Oct 1 enrollment start... period... again, we hold ace king suited and the board is showing we hit ace king.... now we can get sucked out on, but we are all in and they know exactly what cards we have

 

[Yagents]

A bigger hurdle is linking up with each of the state's medicaid systems, each are different, each on different platforms/language, each antiquated and haven't been updated in years.
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HHS is realizing they need experienced agents, willing to spend their own private capital, who already have a network of contacts, to get the word out, enroll people, and make ACA a success in terms of enrollment. They also know they would rather have us speaking to clients to clean up any messes that might ensue, and provide a better consumer experience .......vs overwhelming their call centers.

 

[timsip]

A bigger hurdle is linking up with each of the state's medicaid systems, each are different, each on different platforms/language, each antiquated and haven't been updated in years.
-------------------
HHS is realizing they need experienced agents, willing to spend their own private capital, who already have a network of contacts, to get the word out, enroll people, and make ACA a success in terms of enrollment. They also know they would rather have us speaking to clients to clean up any messes that might ensue, and provide a better consumer experience .......vs overwhelming their call centers.

I forgot all about that! Iowa is so antiquated, when I am in a home of a dual eligible for MAPD and call the carrier to verify, they have never been able to get into Iowa's system.

 

[AllenChicago]

It seems that Kathleen Sebelius is spending all of her time at public events, or testifying before various committees. On two occasions this week, she's sworn before Congressional Committees that the Exchanges they're responsible for, WILL BE READY.

Story: http://www.modernhealthcare.com/art...belius-says-insurance-exchanges-will-be-ready

The article above says that they're shooting for a January 1, 2014 Exchange Activation date. That must be a typing error?

The person who actually interfaces (supposedly) with the contractors that are building the Federal Exchange is HHS's Gary Cohen. He's been unusually quiet lately, compared to prior months.

Unless HHS grants yet another delay, the insurers who will be participating in the Exchanges must submit their plans/rates to HHS not later than April 30th.

Two to three month later, HHS is supposed to fire up the Exchanges and begin doing dry runs in preparation for October 1st. If everything works well, the Technical People overseeing this should be awarded ObamaCare Presidential Medals of Honor by the President himself.
-ac

 

[somarco]

sworn before Congressional Committees that the Exchanges they're responsible for, WILL BE READY.

And Obama campaigned in 57 states running on the promise of reducing health insurance premiums 3000%.

 

[Ann H]

I don't see why this process is so difficult, anyway (said tongue in cheek). Check out the subsidy determination flowchart(s) on pages 6-20 at this link:

http://www.statereforum.org/sites/default/files/magiflowchartfinalrule.pdf

 

[Yagents]

That is one hell of a flow chart. Made my eyes gloss over. Notice on page 18, they consider an unborn child to be counted in household size for medicaid..............can count em' for handouts, but not when it comes to abortion rights.

 

[AllenChicago]

I don't see why this process is so difficult, anyway (said tongue in cheek). Check out the subsidy determination flowchart(s) on pages 6-20 at this link:

http://www.statereforum.org/sites/default/files/magiflowchartfinalrule.pdf

I realize that computers are fast, but it's not likely that a consumer will receive an eligibility determination from the government within 60 seconds of hitting the "submit" button, is it?
- - - - - - - - - - - - - - - - - -

That is one hell of a flow chart. Made my eyes gloss over. Notice on page 18, they consider an unborn child to be counted in household size for medicaid..............can count em' for handouts, but not when it comes to abortion rights.

Apparently the U.S. Government is admitting to condoning the murder of it's own citizens, by authorizing abortions. Yet we are upset with Syria for killing their own people?