Late last fall, when considerable controversy surrounded the rollout of the healthcare.gov website, the consumer portal for purchasing health insurance under the Affordable Care Act (ACA), much of the controversy surrounded technical glitches in the website that were at that time leading many healthcare consumers to become frustrated attempting to navigate the site in order to purchase health insurance run by the federal government. Yet the state-run websites were experiencing far fewer problems, and some were in fact running quite smoothly.
One state government having a good experience early on was New York state, whose marketplace is called NY State of Health. In New York, Governor Andrew Cuomo create the state-operated exchange by executive order, and within six weeks of operation—between Oct. 1, 2013, when the exchange opened on schedule, and Nov. 12, 200,000 New York state residents had completed applications, and 48,000 had enrolled, in health insurance plans offered on the website.
As of March 4, 870,595 New York state residents had completed applications, and 557,840 had enrolled in health plans. The deadline for completing applications is March 15, for coverage beginning April 1, 2014.
With technical support from professionals at the Falls Church, Va.-based CSC, NY State of Health was one of the first state health insurance exchanges to become successful early on (along with the exchanges in California, Kentucky, and several other states). In late November, Donna Frescatore, executive director of NY State of Health, and Chris Harmer of CSC, spoke with HCI Editor-in-Chief Mark Hagland regarding their early experiences with the launch. Below are excerpts from that interview.
You’ve already been successful in your early efforts, with the rollout of your website. What is the ultimate universe of people who might enroll in health plans via NY State of Health?
Donna Frescatore: The estimate of enrollment after three full years at the end of 2016, is 1.1 million.
And you’ve been with NY State of Health from the very beginning?
Yes, that’s correct.
Tell me a bit about the IT infrastructure facilitating this health insurance exchange?
We were one of the states that were early innovators. We applied to HHS [the Department of Health and Human Services] for a grant for early development for the IT infrastructure. Our state received a grant award of $27.4 million over two years to design and implement the information technology infrastructure needed to operate the exchange.
There was a grant opportunity in December 2010. So that provided us with the funding. Under state law, we followed a process to select a systems integrator that was a contractor, to develop the IT system, and CSC, Computer Sciences Corporation, is that contractor.
When did CSC begin the physical build with you?
The contract was effective in early June 2012. Before CSC was on board, we had worked on doing a landscape of system needs and requirements, and had started to identify the business needs of the system, so when CSC began on board with us, they were able to hit the ground running.
Was there any contact among the states, as state governments began building their insurance exchanges?
There was a fair amount of discussions among the states; there were a number of learning collaborative and forums hosted by HHS, where people could talk about IT as well as other issues. Those learning collaboratives resulted in things like a uniform application form, a model application for consumers. It was the basis of what the person requires online. There’s a requirement to have a paper application as well. We’ve had relatively few, of the 200,000, who have wanted to apply in a paper-based way; the vast majority have come in through the website, and even our navigators and certified application counselors and licensed insurance brokers, all use the online application form. And also, UX2014, for User Experience, funded in part by the California Health Care Foundation, and the New York State Health Foundation, helped to fund a project to help states come together and develop this conceptual framework for what the consumer experience would look like. That project helped states to come together to see how they envisioned the application.
What were the biggest challenges, if any?
It was a brand-new system for New York, a website that would process applications not only for individuals who qualified for commercial insurance under the ACA, but also qualified for the Medicaid expansion. So it was a big undertaking, and a relatively aggressive timeline.
Chris Harmer: As Donna said, when you think of these exchange websites, they are literally the first of their kind; there’s not a reference point. So the design and flexibility were important. Chris Harmer, CSC Program Manager, for the exchange.
What have the biggest lessons been learned so far?
Frescatore: One of the lessons learned certainly in New York is that there really has been substantial interest in the marketplace and in people learning more about affordable health coverage. Consumers will see a 53 percent decrease in premiums, on average. And the lesson we learned before Oct 1 was that, as Chris said, this was the first time that this had been done, so it was important to make sure everything was tested in advance, and it was important to have backup plans. And within the first hour that the exchange was open, we were overwhelmed by people interested in signing on, and unfortunately, that prevented some people from logging in, so we had to deploy additional human resources.
How long did it take to manage that overflow?
Harmer: October 1 was a Wednesday, and the system was fully stabilized by that Saturday. We had to bring in more computing resources, not so much people. You had to understand the problem, and when you apply those resources—there's a process you have to go through to make sure everything’s balanced correctly.
Do you have any broad insights for provider IT leaders, based on your experience?
Frescatore: Certainly, our healthcare provider community in New York, our hospitals, physicians, every part of that sector, have been partners with us in planning the state marketplace. And certainly, as a healthcare delivery system, they are certainly impacted by the health insurance marketplace. And through the certified application counseling program, hospital employees actually can help them fill out an application online, or they might be receiving care in clinics. This opportunity for counselors was announced by the federal government in August. And not only hospitals, but also federally qualified health centers, are receiving funding from HRSA to help consumers. So we have hundreds of people, generally employees of those patient care organizations, are receiving training, completing the course, becoming certified, and then they interact with the website as the certified representative of the patients.
Harmer: We really interface directly from the IT side with the actual insurers, when someone enrolls in a plan.
And that side has worked well, too, then?
Frescatore: Yes, it definitely has.