New York s Approach to ACA Implementation: Measuring Operational Success for Both Medicaid and the Exchange

Transcription

1 New York s Approach to ACA Implementation: Measuring Operational Success for Both Medicaid and the Exchange Jason A. Helgerson National Association of Medicaid Directors (NAMD) November 13, 2013

2 Implementing the Affordable Care Act: New York s Approach o New York State of Health (NYSOH) represents the Empire State s unique approach to ACA implementation. o NYSOH Exchange system has been built to ensure that New York s face no wrong door to health care access. o No wrong door is achieved by allowing people regardless of income to apply through a single web portal or through a single call center for both Medicaid as well as Qualified Health Plans through the exchange. 2

3 Implementing the Affordable Care Act: New York s Approach (continued) o NYSOH is also the system brokers and navigators use to assist people access affordable health insurance. o NYSOH is managed within the New York State Department of Health a single state agency which leverages both in-house expertise as well as existing systems/vendors which have contributed directly to our early success. o So far, implementation has been successful. Approximately 175K people have been determined eligible for affordable health care while 41K have enrolled. 3

4 Ingredients of Success o Highly engaged executive leadership providing sponsorship of all project aspects. o The New York Department of Health began work on the solution on April 12, o A single integrator responsible for the architecture, development, maintenance, and operation of the solution. This was coupled with tight integration of the solution between the MAXIMUS Call Center and CSC. o Co-location of Business Owners and Project Organization provided a highly collaborative atmosphere. 4

5 Ingredients of Success (continued) o Adaptive and flexible methodology approach allowed the team to quickly identify and modify our approach when dealing with frequently changing requirements. The project team was broken into dedicated vertical Tracks (Eligibility and Enrollment, SHOP, Plan Management, Customer Service, and Oversight), and a horizontal Integration Track. o The NYSOH Exchange system implements the no wrong door ACA vision, by incorporating Medicaid enrollment. 5

6 Solution Overview o The NYSOH solution is a heavily extended and modified version of the hcentive product o The solution is deployed as a highly extensible and flexible virtualized infrastructure in a New York based CSC data center o The NYSOH leverages about 40 web and batch service interfaces with State agencies and data sources in addition to the Federal Data Hub o NYSOH is a J2EE architecture J2EE (Java 2 Platform, Enterprise Edition) is a Java platform designed for the computing typical of large enterprises J2EE simplifies application development and decreases the need for programming and programmer training by creating standardized, reusable modular components and by enabling the tier to handle many aspects of programming automatically 6

7 Solution Overview (continued) o The solution provides the ability to re-sequence or pend applications at three discrete gates within the process. This feature is utilized when Federal Hub Services are not available, or if an application logic failure were to occur; by sending the applications to a special processing state within the system. When the Federal Services, or application logic become available, the re-sequenced applications can be systematically restarted from the point they entered the re-sequence state. o The NYSOH system actively monitors all web service interfaces (Federal & State), and notifies support personnel when any of these services fail to respond. This allows for appropriate action to take place, so New York consumers are not adversely affected. 7

8 Go-Live Challenges o The NYSOH Exchange went live October 1,2013, encountering significantly higher than expected volumes of website visitors, which challenged processing. o Technical support personnel quickly analyzed the situation, mapping causes and potential solutions. o After days of continued high volumes, and system tuning, the team decided to add additional infrastructure (400% capacity increase). The additional infrastructure did not independently resolve the situation, without additional system tuning. 8

9 Go-Live Challenges (continued) o On October 5, 2013 (12:35 EDT), after system tuning was completed, the system performance increased dramatically. o The system has been processing without significant issues since that time. 9

10 October Real Time Transactions % 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Pct under 5 seconds Pct under 10 seconds Day 10

11 NYSOH Visits - Life to Date 400, , , , , , ,000 50,000 0 Total Visits (includes repeat) Unique Visitors - Total 11

12 NYSOH Page Views - Life to Date 1,400,000 1,200,000 1,000, , , , ,000 0 Total Page Views (includes repeat) Unique Page Views 12

13 NYSOH System to System Data Exchanges: Context & Overall Flows through April 2014 NYOSH System to System Data Exchanges Context and Overall Flows (through April, 2014) Raw Risk Data NY DFS (Insurance Dept.) RTC#4342 Final Risk Data NY-HX Customer RTC#4343 Customer Support Tasks Maximus Customer Support Encounters (Future) Encounters Database Encounters NY SFS RTC#4326 Financial Reports Journals Enrollment Medicaid, CHIP RTC#4315, 4316, 4314: 834's DOH emedny 837 Medicaid Claims QHP Data NY OMH NY Tax & Finance NY Dept. of Labor NY Dept. of Civil Service NY DOCCS RTC#4328 Incarceration Data RTC#4310: Wage Verification, RTC#4311 EIN (SHOP) RTC4312: New Hire Db RTC#4308: Unemployment Benefits RTC#4325: NYSHIP (MEC) RTC#4313: Incarceration Status State Plan and Provider Data NY Exchange Enrollments RTC4322: 834's RTC4321: PARIS data RTC#4324: CIN Assignment RTC#4323: Web Services CBIC (NY OTDA) RTC#4337, 4338: 834's RTC4340: Reports RTC#4342 Bank Reconciliation To emedny Bank WMS Upstate (NY OTDA) WMS Downstate (NY OTDA) Federal Data Services Hub (FDSH) RTC#4331: Verify SSN, Citizenship, Incarceration, Title II Benefits (H3) RTC#4329: Identity Proofing (Experian) (H1) EDITS (HRA) RTC#4334: Verify ESI MEC (H31) RTC#4332 Verify Household Income, RTC#4333 Prior APTC Status (IRS) NYC HRA 820 Medicaid, CHIP Premium Remittance Medicaid Premiums Managed Care IRS/Treasury RTC#4317: Provider Network Data (Enhanced PNDS) DOH RTC#4319: Death Match RTC#4318: Quality Data (Enhanced QARR) CHIP Enrollment KIDS (Sunset in TBD) RTC#4335: Verify non-esi MEC (H31) RTC#4330: Verify Lawful Presence (DHS) (H4) RTC#4336: Quarterly Eligibility Verification (H31Batch) Tax Credit, CSR Payments Remittances SERFF (NAIC) RTC#4341 QHP Data RTC#4344, 4345, 4346: 834's 4347: 820's RTC#4349: Group Enrollment QHP Submission and Plan Data Enrollments and Premiums Issuers 13

14 Conclusions/Lessons Learned o Embedding the NYSOH within the Department of Health allowed the exchange to be implemented effectively by leveraging existing resources and systems. o A single IT vendor and back office vendor ensured clear lines of accountability and ensured needed expertise was available for the project. o We started early which helped ensure we had time to develop and test the solution. 14

15 Conclusions/Lessons Learned (continued) o We still have a long way to go. Additional functionality will be deployed in the months to come. o Overall, NYS is very pleased with ACA implementation to date. 15