Massachusetts and Utah: A look at the original pioneers of health insurance exchanges

Published: February 05, 2013

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The goal of President Obama’s Affordable Care Act (ACA) was to put people in charge of their health care instead of insurance companies. With the act, states are expected to establish health insurance exchanges (HIXs) to serve as a central marketplace for people to compare health plans based on rates, benefits and quality. The objective is to give people wider access to customer assistance tools, in addition to better choices in health care plans. States must have these HIXs up and running by January 1, 2014.

Massachusetts and Utah are two states that saw the importance of getting people insured long before the ACA was legislated. Both states successfully implemented online marketplaces for consumers and small businesses to purchase health plans; however, their stories are very different.  

On April 12, 2006, Massachusetts passed legislation for the Health Connector, a system that would provide affordable insurance to qualified individuals. Computer Sciences Corporation (CSC) was awarded a five-month contract to build and design the state’s Health Connector website, which was based on program processes and customer needs. Massachusetts wanted the website to be informational and interactive in order to appropriately educate consumers on the state’s reform efforts, and allow for easy browsing and purchasing of plans.
A customer service center was set up to assist with enrollment, billing, and extensive communication and outreach services. Implementation of the Health Connector was fairly speedy, and as a result, there were several lessons learned. First, the state realized that the Health Connector’s flow was not exactly as smooth as originally intended, which was a result of user-specific tabs. For instance, consumers thought they could only use the website if they were ready to buy. Another issue with its design was the content’s readability. The website’s small font was too dense, which made it challenging for consumers to comprehend and indentify key differences between health plans they were comparing. Moreover, there was a high need for automation. Originally, consumers were required to mail in payment of their health plans instead of paying online.
In order to alleviate concerns of the Health Connector’s first implementation, Massachusetts contracted with Dell in 2008 to improve its Web portal, billing systems and enrollment process. Dell’s contract also included implementation of complex information technology systems such as an integrated voice response (IVR) system and customer relation management (CRM) services. 
Utah approved legislation to establish an exchange in March 2009. After a year-long assessment, the state selected bswift LLC to serve as its exchange administrator. The exchange launched in August 2009 and provided consumers with information on health care financing, a means to compare and purchase health plans, and standardized enrollment systems facilitated by a universal insurance application. Bswift was responsible for providing online health plan enrollment and administration technology.
The first phase of Utah’s exchange allowed registration of small employer groups (2 to 50 employees); larger employer groups eventually gained access for plans available in 2012. Overall, the exchange offered high flexibility, user-friendless, and side-by-side comparisons of plan options. The Utah Health Exchange encouraged private competition and transparency in the health care system, giving users necessary information and purchasing power. It was also able to handle complex administrative tasks and transmit electronic feeds from multiple carriers.
Today, both states are moving along with initiatives to implement ACA-compliant health insurance marketplaces. Massachusetts, an Early Innovator Grant recipient, has received $98.8 million in federal funding under Exchange Establishment grants. The state is taking a two-step approach to implement its health insurance exchange and integrated eligibility system. Utah’s current exchange covers 7,600 people and is utilized by more than 300 businesses. Governor Herbert is having discussions with the Department of Health and Human Services (HHS) regarding needed enhancements to the current system, which he would like to maintain.
So far, 18 states have received federal approval to set up a state-based health insurance exchange. States have until February 15, 2013 to submit plans to implement a partnership exchange. Only a few have received federal approval thus far in moving forward with this model.