By Yvonne Gonzalez (contact)
Sunday, April 8, 2018 | 2 a.m.
CARSON CITY — The state’s health exchange under the Affordable Care Act is moving off the federal platform for signing up for insurance, relying on lessons learned in the past and in other states.
Vendors have until 2 p.m. April 13 to file proposals with the Silver State Health Exchange and must adhere to strict requirements. The goal is to avoid mistakes made the first time around, said Heather Korbulic, the exchange’s executive director.
“(Applicants) have to have at least one year of demonstrated and proven experience,” Korbulic said on March 30. “It’s a smaller pool when you start limiting things like that.”
Korbulic said only about a handful of companies have built successful platforms under the Affordable Care Act.
“We’re not looking to create new wheels,” Korbulic said. “You must have provided these services to other states, functionally.”
Virginia-based hCentive Inc., for example, has built software that as of 2016 had handled more than 10 million benefit requests across the country. HCentive lists healthcare.gov and exchanges in Colorado, Massachusetts and Arkansas among its clients. Korbulic said she’s spent about three years looking at the platforms run by other states, including Minnesota, Colorado, Idaho, Connecticut and Rhode Island.
The Interim Finance Committee recently approved $1 million for the design, development and implementation of its own platform.
“The build is going to be really small because we don’t have to do that much,” Korbulic said. “Essentially, these products exist. They’re going to have to configure it to interface with our Welfare and Supportive Services systems and to our carriers, but that’s very minimal.”
If the new platform is open by Nov. 1, 2019, for the 2020 plan year, as officials are aiming for, the exchange would save $6 million. The exchange, which uses its own revenue to operate, pays healthcare.gov $5.5 million, or about 1.5 percent of the premiums it collects. That figure will increase to $11 million by 2020.
Xerox had collected $12 million of a $75 million contract when the state fired the company in 2014 and moved onto the healthcare.gov platform.
Korbulic said Xerox ran into issues the first time around because it was attempting to create a one-stop shop for determining eligibility for both Medicaid and health insurance subsidies. When the system didn’t work, it created a bottleneck for consumers.
To avoid this in the future, Korbulic said, vendors have to be able to replicate the way the state’s Division of Welfare and Supportive Services communicates with Medicaid and healthcare.gov.
Currently, customers who visit the exchange website or the Division of Welfare and Supportive Services find a prescreening page that uses information like income to direct people to Medicaid or healthcare.gov. Consumers will see no changes to the process later this year, when open enrollment begins again.
“We’re not changing any processes, we’re not going to require one single eligibility system,” Korbulic siad. “It’ll be a pre-screener like you have right now.”
The exchange is also working on being able to migrate all of the healthcare.gov data into its own platform, such as consumers’ plans, premium cost and subsidy eligibility. Korbulic said this will help the exchange get rolling on its own platform for plan year 2020.
With its own platform, the exchange will be able to have real-time access to information that will help officials target advertising for those who need insurance but aren’t buying it, Korbulic said. This will help as the individual mandate, which taxed people who went uninsured, is eliminated effective in 2019.
“If we can have a better sense of who those consumers are that are going to potentially leave, then we can start targeting them with advertising and messaging and saying, you really are going to benefit from having this insurance,” Korbulic said.
The exchange could also accommodate more innovative plans, such as “Sprinklecare,” a Medicaid buy-in option that failed to become law last year.
Healthcare.gov also operates on servers rather than through a cloud like almost every other technology today, Korbulic said. Servers are expensive and need to constantly have the capacity to handle peak traffic, which only occurs during the 45-day open enrollment, Korbulic said. A cloud can increase or decrease as appropriate to save money, she said.
“It’s not going to be perfect,” Korbulic said. “There will be things that are bumps in the road, but what we’re hoping to have is all the healthcare.gov data migrated into our system.”