“The law is the law, whether you like it or not. It doesn’t matter if you like it. It’s the damn law.” 

Many governors and insurance department heads awoke this morning with Mississippi Insurance Commissioner Mike Chaney’s words ringing true after last night’s reelection of President Obama. States holding out for a change in federal leadership on health reform now have fast decisions to make. The numbers are staggering for Mississippi: one in five people lack health insurance; it leads the “States of Misery” in health, poverty, and crime statistics; and has the highest level of obesity in the country at 34.9 percent. Despite Governor Phil Bryant calling for a stall on Obamacare, Chaney is creating a health insurance exchange (HIX) under his own authority, and with an Obama victory, plans to file a blueprint on November 16, unless he receives a court order from “some idiot out there trying to stop me.” Though his words could be considered somewhat crude, the logic behind them is solid: State’s ignoring the law does not mean the law disappears, and these words come from someone against Obamacare.

Exit polls from last night showed that roughly a third of voters listed health care as an important factor in their vote. Despite Obama being reelected, several states had voter efforts approved to limit Obamacare, including Missouri, Alabama, Wyoming, Florida, and Montana. Although some states were opposed to health care reform from the beginning, those that started the exchange planning process are finding that they have run out of time, and will likely adopt the federal exchange until a state-based exchange can be built.

With a scramble to hit the 2014 deadline, procurement strategies may be expedited, like Connecticut’s sole-source award to Deloitte for both its HIX and its integrated eligibility system. Expect to see even the early innovators relying heavily on federal hub resources for the first enrollment period. As Chaney pointed out, there is no more waiting; the Affordable Care Act is the law. Deltek will be watching as blueprints are submitted to the Center for Consumer Information and Insurance Oversight by November 16, 2012, and how federal-state relationships play out as the nation addresses health care reform.

As always, be sure to follow Deltek’s Health Care and Social Services Team on Twitter @GovWin_HHS, or connect with us through LinkedIN. Stay tuned for more information around a new Health Insurance Exchange Vertical Profile addition in the near future!

To sum up, if a given agency is dealing with a deluge of data that it needs to analyze in real-time, you can probably bet that agency will have a more pressing need for a big data solution and may be more inclined to fund an investment immediately.  The agency with the "less pressing" data analysis need is likely going to be able to start with a smaller big data investment.  This agency may initially buy a small number of commodity servers for processing and some advanced analytics software with visualization capabilities before moving to a larger system.  In comparison, the agency with the more pressing big data requirement may make a larger initial investment and require consulting support to understand the kind of investment they need to make.  Therefore, understanding the type of data being accumulated and the real-time versus post-storage analytical requirement are hints suggesting where big data sales and discussion efforts at federal agencies should be focused.

During the Medicaid Enterprise Systems Conference (MESC) in August, Massachusetts representatives held several presentations updating attendees on the state’s progress in implementing a statewide health information exchange (HIE). As with most other states, Massachusetts’ Medicaid agency has been the most active stakeholder in planning. In a survey of 27 states regarding HIE planning, 15 were using a mixed technical approach, with seven having a single statewide health information organization (HIO), and five states connecting local nodes. Massachusetts’ Medicaid-centric HIE was Medicaid funded, which freed up Office of National Coordinator grants for its Last Mile Program, which allows EHR connections directly through a local access network distribution (LAND). There will also be a Web browser solution to connect to the HIE for organizations that cannot stand up their own IT infrastructure.

The first phase for Massachusetts’ HIE focuses on breadth vs. depth and developing the infrastructure needed to connect the state’s 13 regional HIEs. The first phase is estimated to go live on October 15, 2012. The second phase will focus on analytics and population health, and the third phase will include search and retrieval capacity for medical information. The state estimates that it has delivered more than $101 million in electronic health record (EHR) incentives.

Massachusetts has found that 80 percent of the EHR market is covered by seven vendors, with nine vendors covering 90 percent of the market. Only one vendor currently includes a connection to NHIN (National Health Information Network) Direct, and most surveyed by the state did not have a plan for when they would have that capability. When Massachusetts began its health care reform, 70 percent of its citizens supported the initiative, but continuing costs and national debate have since increased public cynicism. Through its implementation, Massachusetts has learned that, if we build it, they may not come. Agencies need to have good policy in place, community and legislative support, and cultural support to ensure future success in the HIT arena.