Washington Healthplanfinder Facilitates Health Insurance Exchange

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1 Title: Washington Healthplanfinder Facilitates Health Insurance Exchange Category: Digital Government: Government to Citizen (G to C) Contact: Richard Onizuka Washington Health Benefit Exchange (360) OCIO Contact: Ben Vaught, Special Assistanct State: Washington Project Initiation: January 1, 2012 Project Completion: October, 2013

2 Executive Summary (one page) The Affordable Care Act required all states to implement a health insurance exchange by Oct. 1, 2013 through HealthCare.gov or a state-based model to comply with federal legislation. The Washington Health Benefit Exchange (Exchange) was created to deliver and manage Washington Healthplanfinder, a state-based exchange for residents for individuals, families and small business to find, compare and enroll in health coverage. The Exchange was established in 2011 as a public-private partnership with the mission of improving how residents secure health insurance through innovative solutions, an easy-to-use customer experience and by providing undeniable value to the healthcare community. With more than 125 employees, the Exchange works in close coordination with state agency partners including the Health Care Authority (Medicaid), Office of the Insurance Commissioner and the Department of Social and Health Services. The Exchange s IT department worked with the federal government, state legislature, supporting agencies and IT integrator Deloitte to determine policy requirements, solicit input from key stakeholders and identify business and technology requirements that would optimize the application for quality of content and ease of use. The Exchange then applied strong project management principles to guide the design and build of the application for the start of open enrollment. Washington Healthplanfinder is complemented by a Customer Support Center that supports 175 languages, 1,800 navigators and 2,000 insurance brokers. These individuals also help identify needed system improvements to enhance the customer experience. Ongoing system updates continue to strengthen the marketplace and address prioritized capabilities to boost the functionality of the application. The marketplace encourages competition by allowing consumers to compare health plans side-by-side. It improves access to coverage by integrating a seamless eligibility determination and enrollment process for both Qualified Health Plans and Washington Apple Health (Medicaid). The marketplace is anticipated to exert downward pressure on prices through free-market competition and innovation. Under tight timelines and changing federal guidance, the team designed and implemented one of the most successful state-based marketplaces in the nation, covering more than 1 million residents. Washington Healthplanfinder has revolutionized how the State of Washington provides improved access to comprehensive health coverage for its residents, reduced the rate of uncompensated care, empowered consumers to make informed decisions and streamlined the eligibility process for the public and the state.

3 Description of Business Problem and Solution The Affordable Care Act required all states to implement a health insurance exchange by Oct. 1, 2013 through HealthCare.gov or a state-based model to comply with federal legislation. The Exchange chose to provide residents with health coverage through a state-based exchange. The Exchange was created to deliver and manage Washington Healthplanfinder, a new marketplace for residents to find, compare and enroll in health coverage. The Exchange s IT department worked with the federal government, state legislature, supporting agencies and IT integrator Deloitte to determine policy requirements, solicit input from stakeholders and identify business and technology requirements to optimize the quality of content and ease of use. Because of its progress, the Washington Health Benefit Exchange was one of the first six states to receive conditional approval for its Exchange Blueprint from the Dept. of Health & Human Services on Oct. 10, 2012 more than one month before the original Nov. 16 federal deadline. The Exchange then applied strong project management principles to guide the design and build of the application. The application is much more than a website it is a complex eligibility portal for both Qualified Health Plans and Washington Apple Health (Medicaid) that is required to interact with federal and state data systems, all while providing a customer-friendly user interface to shop and enroll in health plans. It was developed on a three tier architecture (Web, Application, and Data), and deployed on Oracle, an industry leader in technology, products running on all three tiers/zones. The Oracle SOA architecture was also chosen to comply with the CMS requirement for MITA (Medicaid IT strategy) compliance. The system infrastructure was built over 175 servers that comprised all environments from Development through Production, including Disaster Recovery. The application itself was built over struts framework, adopting a model view controller (MVC) architecture and use of Hibernate for providing a framework on creating SQL queries to connect to the Database. The Exchange placed great emphasis on the security of the infrastructure and the application. The infrastructure was highly secured using redundant Firewall and IDS/IPS devices, while access to the Washington Healthplanfinder application was secured using Oracle security stack for highly secured user authentication and authorization. Data communication to the application was also encrypted (SSL). Furthermore, the application data was encrypted using the Transparent Data Encryption (TDE) available in the Oracle Database software for storing sensitive data including FTI. The Exchange also created a Data Management Plan to address security standards such as Personally Identifiable Information (PII), Protected Health Information (PHI), Internal Revenue Service (IRS), Federal Tax Information (FTI), Personally Identifiable Information (PII), and Payment Card Industry (PCI) data.

4 The Exchange set a high bar for testing the infrastructure and the capabilities of the application. It performed a series of functional and technical tests for that included Performance, vulnerability, and ADA compliance. Staff also conducted a successful Disaster Recovery Test prior to initial Go-Live, confirming a stable DR site to fail over in an event of a disaster should one occur. Upon launch in 2013, Washington Healthplanfinder offered extensive functionality including: Enabled Washington residents to securely shop for and enroll in participating health plans; Supported full eligibility determination and enrollment processes for an expanded Medicaid program; Supported full eligibility determination and enrollment processes for residents who are eligible for federal Premium Tax Credits (PTCs); Allowed small employers to establish exchange accounts through which employees can shop for and enroll in employer-sponsored coverage available on the exchange. Served all consumers with a cutting-edge, interactive, self-service-based web site, toll-free customer support center (to be built under a separate procurement), and other innovative customer support tools. Washington Healthplanfinder was also able to accommodate large volumes of traffic for expected high-peak times. The Exchange built a robust infrastructure that was able to support up to 7,500 concurrent user sessions at one point on March 31, the last day of the first open enrollment period. Significance to the Improvements of the Operation of Government Washington Healthplanfinder was designed to support a customer-friendly process for individuals and small businesses to shop, enroll and manage their health insurance. More residents than ever before can access affordable health care options through an online application that is compliant with federal- and state-level regulations. This online process results in flexibility for Washington government through the ability to leverage a self-service marketplace over manual enrollment, reducing Medicaid eligibility determinations from 45 days to 45 minutes. The online marketplace is complemented by a Customer Support Center that addresses customer questions in more than 175 languages, 1,800 navigators and 2,000 insurance brokers. At an investment of $70 million for the system, a recent CNBC report notes that the Washington Health Benefit Exchange was among the top three most financially efficient exchanges in the country (an average of $1,300 per QHP enrollee). The Exchange focused on increasing access to affordable plans, supporting a transparent insurance market to facilitate consumer choice and an efficient, accurate and customer-friendly eligibility determination process while enhancing plan competition.

5 Under tight timelines and changing federal guidance, the team designed and implemented one of the most successful state-based marketplaces in the nation, covering more than 1 million residents. Washington Healthplanfinder has revolutionized how the State of Washington provides improved access to comprehensive health coverage for its residents, reduced the rate of uncompensated care, empowered consumers to make informed decisions and streamlined the eligibility process for the public and the state. Specific success stories include: Kevin, Baker, Seattle, WA: Last fall, Kevin lost his health insurance when he lost his job. As a Type 1 diabetic, he needs daily insulin shots that amount to $600/month without health coverage. Though he soon found work at a local bakery, it didn t offer health benefits. He was afraid he d have to try to ration his insulin, which would be detrimental to his health. One of Kevin s coworkers signed up for a health plan on Washington Healthplanfinder, so Kevin visited the site too. He was able to find quality coverage for only $86/month that s less than his cell phone bill. Kort, Freelancer, Seattle, WA: Kort couldn t afford health coverage and without it for two years, hoping not to get sick. At one point he got walking pneumonia, which he left untreated until he cracked a rib from coughing so hard. The doctor s visit was so expensive he had to pay for it with his tax return. When the marketplace opened, Kort found a health plan and learned he qualified for tax credits to make the plan more affordable. Benefits of the Project (Financial and Non-Financial) With more than 1 million residents enrolled, Washington Healthplanfinder is recognized as one of the best exchanges nationwide. According to the Kaiser Family Foundation, this number represents approximately 33% of the eligible population. Other key accomplishments include: Streamlined Eligibility Determination: The system provides an instantaneous eligibility determination for QHPs and Medicaid. Previously, eligibility determinations for Medicaid took up to 45 days. Responsible Use of Funds: According to a recent CNBC report, the Exchange was among the top three most financially efficient exchanges in the country (an average of $1,300 per QHP enrollee). Generated Tax Credit Dollars for the State: The average cost of a health plan after a tax credit was about $100, with an average tax credit of $276. Residents accessed more than $34 million dollars in tax credits statewide. Allowed Young People to Easily Shop for Plans: 25% of enrollments in QHPs were young adults ages These individuals will contribute to a more sustainable insurance marketplace and risk pool. Allowed Residents to Locate In-Person Help: 43% of QHP enrollments were assisted by navigators or brokers that were able to assist consumers in many languages. The system allowed consumers to search and request partnerships with individuals who could assist them in their local community.

6 Washington Healthplanfinder boasts a robust infrastructure that support users as they shop and enroll in health insurance. Upon go-live, the marketplace: Enabled side-by-side comparisons of QHPs Supported eligibility and enrollment for Medicaid expansion and those eligible for tax credits Allowed small employers to offer their employees health coverage through exchange accounts Served consumers with a cutting-edge, interactive, self-service-based marketplace Conducted series of Stress Tests and Disaster Recovery Tests prior to initial Go- Live In addition, the Washington Health Benefit Exchange was one of the few state-based marketplaces that went live with an individual and small business marketplace and offered standalone dental plans on Oct. 1 (in both English and Spanish). Other unique characteristics include allowing residents to report changes in their individual status, the ability to browse for health plans without creating an account, features specific to American Indian/Alaskan Native enrollment, screen-sharing with customer support staff, complex billing and invoicing functionality, the renewal of existing Medicaid, and the ability to support MAGI Medicaid eligibility upon go-live. Exchange staff engaged navigators, partner agencies, community advocates, businesses, brokers, hospitals and tribal organizations to engage their networks, ensuring even the hardest to reach were involved in the conversation. The communications team also implemented an innovative marketing campaign and performed targeted outreach to specific populations. In the future, the Exchange will focus on performance and functional enhancements to address policy changes and improve the end-user experience. This will support the Exchange s goal to be the leading exchange in the country as the marketplace matures and supports greater efficiency and sustainability. The implementation of Washington Healthplanfinder was a tremendous effort; it required persistence, creativity, community engagement and the sheer will of countless public and private entities who partnered together to do something that has never been done before in American history. The new marketplace connected residents with more affordable health care options, enabling them to access services to help them lead healthier lives.