Stuck with exchange software too flawed to fix, Maryland Health Connection leaders are choosing a novel solution that paves the way for other beleaguered state exchanges to seek help from their better performing peers.
The Maryland Health Benefit Exchange board of directors voted to replace Maryland Health Connection's software system with a platform offered by Access Health CT, the first such deal since Connecticut's insurance exchange put itself on the market as a HIX serves provider.
"Functionality in the IT system has improved dramatically since December" but "it remains deeply flawed," wrote board members Maryland IT secretary Isabel FitzGerald, health commissioner Joshua Sharfstein, MD, and acting exchange director Carolyn Quattrocki in a recommendation memo.
Maryland Health Connection exceeded its original enrollment goals, with 295,000 signed up for Medicaid and private insurance, although more than two thirds of those are Medicaid enrollees. With only 63,000 enrolled in private plans as of April 4, the exchange fell fall short of its initial private plan enrollment goal, 150,000, and may still miss its revised baseline of 75,000.
After firing the original IT servicer, Noridian, the board ended up evaluating whether to find a new contractor to remediate the existing software system, migrate to the federally-facilitated exchange, or upgrade to another existing state platform, with the choices narrowed down to either Kentucky's Kynect or Access Health CT.
Based on feasibility reviews by the Maryland Health Connection's emergency general contractor QSSI, a UnitedHealth Group business, the board concluded that trying to fix the existing software would take over a year, cost more than $65 million and "likely still not meet our needs or provide a stable, sustainable system."
Defaulting to the federal exchange would also bring problems, they found: the "state would still have to build or transfer an eligibility and case management solution for Medicaid," a task that would bring a range of new costs.
The best option, the board recommended, is to "leverage the Connecticut IT platform to upgrade Maryland Health Connection in time for the second open enrollment period that begins on November 15, 2014."
This "allows for rapid implementation of a proven IT solution," offers a feasible timeline and lets Maryland continue using existing software licenses and hardware valued at more than $8 million, the board wrote.
Buying Access Health CT's services would likely be the most affordable of the three options, costing between $40 million and $50 million in development costs along with around $6 million a year, the board estimated.
How much of that the state will pay and how much the federal government will pay remains to be seen. Maryland Health Connection's board is planning to submit the idea to the Centers for Medicare & Medicaid Services as a part of a corrective action plan, which if approved would make the state eligible for continued exchange funding.
To help guide the transition, Maryland Health Connection's board is hiring the consultant Deloitte, Access Health CT's main systems integrator.