Day 2 of the MESC Conference

Published: September 11, 2013

HHSHealth CareHealth IT

One of the most interesting sessions from my second day at the Medicaid Enterprise Systems Conference (MESC) really drove home the opening day’s remarks of working toward better health outcomes by taking different paths. The session featured speakers from West Virginia and Maryland’s Health Benefit Exchange (MHBE). West Virginia is on the state-federal partnership route, while Maryland chose to implement a state-based health insurance exchange (HIX). Although the paths they took weren’t identical, both states faced similar challenges and ended up with very similar lessons learned.
As an early adopter state, Maryland’s impetus toward a state-based exchange hinged on a supportive board of trustees, strong vendor engagement, and support from stakeholders and federal and state agencies. Though Noridian holds the main systems integrator contract, three other vendors also help deliver Maryland’s HIX: Curam, Connecture and EngagePoint.
For its first release on October 1, Noridian focused on the critical pieces it needed to hit federal mandates, and is deferring non-essential functions until a later point in time. Maryland and its contractors faced several common hurdles in implementing a brand new system: increasing security needs, Centers for Medicare and Medicaid (CMS) checkpoints, and integrating into new and old state and federal systems that are all in their own process of upgrades and release cycles.
West Virginia’s journey toward its HIX began before the Affordable Care Act (ACA) in 2009, with a State Health Access Program (SHAP) grant for the state to analyze its uninsured population and how those individuals utilized the health care system. The state utilized HIX planning grant money to hire BerryDunn, who developed a financial sustainability model to help the state decide which direction to take. The study found that West Virginia had a smaller population of citizens who would be estimated to use the exchange, which compared to costs charged for providers and health insurance plans, would not leave a self-sufficient, state-based exchange (which is a requirement by CMS by 2015).
West Virginia opted for a federal-state partnership, where the federal data hub will be determining eligibility, and the state will take over the rest. The feds will also be conducting navigator services and education/outreach on behalf of the state. Utilizing the partnership model was the least costly to the state, while giving better consumer services and protection than the full-fledged federal model. This path was also the least risky in terms of the compressed timelines and limited resources faced by states, and will ease the transition of moving to a state-based exchange in the future (if  feasible).
As with Maryland, West Virginia was challenged by the implementation of a brand new system with very limited historical information, and really chose the federal-state partnership model at a time when even the feds weren’t quite sure what it would look like. West Virginia is also focusing solely on mandated pieces for the October 1 go-live date, and will be working on adding other enhancements necessary for the consumer experience. Stay tuned tomorrow for more information from the conference!