Tag Archive: IT integration

Exchange executives, IT vendors held accountable for flawed launches

The health benefit exchange marketplace is essentially one that exists in cyberspace. As such, it is very dependent on a well-functioning IT platform. If that platform fails to work properly, the marketplace falters. And when that happens, those in charge look for someone to hold accountable.

So far, the list of those being called to account includes the primary IT contractor for the federally operated web portal, healthcare.gov, after last fall’s problematic rollout that stymied enrollments on the front end for consumers and the back end for health plan issuers. Its contract was not renewed.

The list also includes the executive directors of five state-run exchanges (Maryland, Oregon, Hawaii, Minnesota and most recently this week, Nevada) where enrollment problems can threaten the continued existence of the exchanges since they must under the Patient Protection and Affordable Care Act be financially self-sustaining starting next year on enrollment-based fees paid by participating plan issuers. Some of the IT contractors could also be called to account in the courts, where they face potential litigation claiming they didn’t deliver a functioning web portal per their contracts.

The take away for the health benefit exchange marketplace: it stands or falls on IT implementation.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Federal data hub IT readiness likely factor in delay of large employer health coverage offer mandate

Employer push back on the complexity of requirements for reporting information on employer sponsored health plans was cited by the Obama administration for this week’s announcement by the U.S. Treasury Department of a one year enforcement delay for the Affordable Care Act’s “shared responsibility” provision requiring employers of 50 or more workers to offer minimum, affordable health coverage to full time employees.

But there’s likely another and just as important factor. It’s the federal government’s IT integration project to create a “data services hub” that pulls together information from multiple federal agencies to help determine the eligibility of an applicant for health coverage in the state health benefit exchange marketplace.

The federal hub interfaces with state insurance assistance programs for the poor including Medicaid and the Childrens Health Insurance Program.  It also should include a dataset of employer-sponsored health coverage to help exchanges determine if an employed applicant for individual coverage is already offered qualifying employer-sponsored coverage and thus ineligible to purchase an exchange plan that comes with advance tax credit subsidies.

IT experts agree integrating all of these data sets as well as often outdated state program software platforms in order for state exchange eligibility workers to make a quick, “one touch” eligibility determinations is an IT integration challenge of enormous proportions that would normally take years to implement. However, in order for the system to be ready to go live when exchange enrollment opens October 1, all of these data sets would have to be integrated and operational in July for testing and debugging.  It’s now July and most likely that deadline isn’t going to be met.

The federal government’s announcement noted proposed rules are forthcoming this summer governing employer sponsored health plan reporting requirements. It hinted the regulations will allow for self certification (the key word is “voluntarily”) by employers of their sponsored employee health coverage for 2014, while at the same time giving IT integrators another year to prepare the federal data hub to include this data set in time for 2015:

Once these rules have been issued, the Administration will work with employers, insurers, and other reporting entities to strongly encourage them to voluntarily implement this information reporting in 2014, in preparation for the full application of the provisions in 2015.  Real-world testing of reporting systems in 2014 will contribute to a smoother transition to full implementation in 2015.

Update:  On 7/5/13, the federal Department of Health and Human Services published in the Federal Register an extensive final rulemaking that allows exchanges that do not have information on employer-sponsored coverage obtained from electronic data sources or the SHOP exchange to accept an individual applicant’s self attestation that their employer does not offer them minimum affordable coverage (subject to possible future reconciliation of advance tax credits) and authorizes exchanges to investigate inconsistencies for individual plans covering 2014.

The final rule also gives exchanges the option of relying on HHS to verify an employed applicant’s eligibility for advance tax credit and cost sharing subsidies in 2015 and later.  The relevant provisions are effective September 15, 2013 and codified at 45 CFR 155.320(d), Verification related to enrollment in an eligible employer-sponsored plan and eligibility for qualifying coverage in an eligible employer-sponsored plan.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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