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Cover Oregon Final Tech Meeting

Cover Oregon Final Tech Meeting

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Published by Statesman Journal
Cover Oregon
Technology Recommendation

Presented by
ALEX PETTIT, Ph.D., ACTING CHIEF INFORMATION OFFICER

April 24, 2014
Cover Oregon
Technology Recommendation

Presented by
ALEX PETTIT, Ph.D., ACTING CHIEF INFORMATION OFFICER

April 24, 2014

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Published by: Statesman Journal on Apr 24, 2014
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01/26/2015

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TECHNOLOGY RECOMMENDATION

ALEX PETTIT, Ph.D., ACTING CHIEF INFORMATION OFFICER
APRIL 24, 2014

Meeting Agenda: 4/24/2014
1. Review Technology Committee Objectives & Recommendation Guidelines 2. Recap of Process and Results through last meeting 3. Update on Fixing Current Technology / New Vendor option 4. Update on Utilizing Federal Technology option 5. Final Analysis, Discussion & Recommendation

2

OBJECTIVES
• Recommend to the Board of Directors the best technology option for enrollment, renewal, and change of circumstance to support the 2015 open enrollment beginning 11/15/2014 • Document recommendation with a final report • Assumptions: Enrollment, renewal, and change of circumstance for individuals is to be made available online within Cover Oregon’s current budget coupled with the lowest possible risk by or before November 15, 2014

3

RECOMMENDATION GUIDELINES
• Risk – Must provide the highest level of certainty for seamless individual enrollment, renewal and change of circumstance • Schedule – Thoroughly tested and operationalized prior to November 15, 2014 • Cost – Must be delivered within available resources

4

RECAP OF PROGRESS
1. Initial Meeting: March 11 - Articulate problem scope and constraints 2. Workshop Meeting: March 13 - Further description of problem 3. Workshop Meeting: March 18 - Articulation of solutions and limitations 4. Workshop Meeting: March 21 - Go forward plan proposed and detailed 5. Preliminary recommendation Meeting: March 27 - Go forward plan reviewed and approved 6. Status Monitoring Meeting: March 31 – Dual Approach
5

INITIAL SOLUTION ALTERNATIVES
Stay the Course 1
Keep the Technology Keep the Vendor

2

Keep the Technology Select a New Vendor

New Direction
New Product Solution New Service Solution

Federal Technology

3

Transfer SBM

Exeter

4

5

SaaS SHOP

Direct to Carrier

8
Enrollment

Individual & Shop

Partnership

Hybrid

9

10

6

7

Exchange Lite

6

NARROWED FROM 10 TO 3 FOR FURTHER REVIEW
• State System Transfer: Transfer functioning technology from another state, in whole or in part • Fix current technology – use new vendor • Utilize federal exchange technology

7

STATE SYSTEM TRANSFER KEY FINDINGS
• Utilize known working technology core to start • Avoid pitfalls and address issues proactively by leveraging experience of other state • A gap analysis is necessary to identify differences in business functions, business processes, and technology architectures

• Requires additional expertise and capacity
• Development of SHOP functionality will need to be addressed

• Some carrier interfaces would need to be developed
• Need to respond to evolving federal requirements
8

STATE SYSTEM TRANSFER OPTION ELIMINATED

• Risk: Has not been successfully done to date • Schedule: Infrastructure procurement and configuration would need to be completed before modifications to the application could begin • Cost: Maryland: $45MM, plus infrastructure

9

OUR PRELIMINARY RECOMMENDATION: DUAL APPROACH • Fix Current Technology / New Vendor: fix current technology and use a systems integrator
• Simultaneously develop a plan to utilize the federal exchange technology and execute if milestones are missed

10

FIX CURRENT TECHNOLOGY/ NEW VENDOR

11

KEY FINDINGS
 Maintain no wrong door vision for Oregonians to access services
 Infrastructure & technology is in place and enrollments are occurring (with a large manual effort)  State of code and complexity of architecture pose significant challenges to stabilize what is currently developed

 Development of functionality including renewal and change of circumstance is not complete
 Federal requirements continue to evolve
12

FIX TECH/NEW VENDOR MILESTONES
1. 2. 3. 4. 5. 6. 7. 8. Product roadmap focus on ACA requirements (4/4/2014) Sole source procurement approved (4/4/2014) Function gap completed and reasonable (4/11/2014) CO governance structure built & operational (4/11/2014) CO program management in place (4/30/2014) CO attrition is managed (4/30/2014) System Integrator contract is complete (4/30/2014) 2015 Open Enrollment functionality requirements complete (5/30/2014) 9. 2015 Open Enrollment functional design complete (5/30/2014) 10. 2015 Open Enrollment technical design complete (5/30/2014) 11. 2015 Open Enrollment development on-track (6/15/2014) 12. Final go/no-go decision (6/30/2014)
13

DELOITTE ASSESSMENT

• Stabilization of current software and development of renewal capability is all that can be achieved by November 15, 2014 • Change of circumstance would not be completed until November 2015 • Total effort is estimated to exceed 390,000 hours, @ $200/hr ≈ $78MM to complete

14

FIX CURRENT TECHNOLOGY/NEW VENDOR REVIEW

• Risk: Aggressive timeline introduces substantial risk into project plan with little margin for error • Schedule: Not all functionality can be completed by November 15, 2014 • Cost: This option exceeds available resources

15

UTILIZE FEDERAL TECHNOLOGY

16

KEY FINDINGS
• Requires CO to maintain operations for 2014 events
• Provides individual enrollment, renewal, and change of circumstance by the November 15, 2014 deadline • Provides for QHP eligibility, plan shopping and enrollment • 11 of 16 Oregon carriers already have interfaces with FFM • Medicaid eligibility can be moved to OHA; requires no further development from Cover Oregon but significant work from OHA

• Migration of existing enrollments to federal system TBD
• Loss of full integration of Medicaid and QHP • Agents would need to be certified by the FFM
17

DELOITTE ASSESSMENT

• Migration to federal technology for QHP eligibility and enrollment expenses - $4 – 6MM

18

Medicaid eligibility determination
• Transfer Medicaid eligibility determination back to OHA • OHA retains:
– Medicaid portal and call center – Medicaid consumer outreach and education – Medicaid determinations, enrollments, redeterminations and appeals

• Utilize cross-agency project team, rely on one system integrator for both entities

19

Cost Estimate to Transfer Medicaid Eligibility to OHA
• Key assumptions:
– Some of Oregon’s current technology can be adapted – Costs are eligible for 90%-10% federal match

• Cost estimate to complete transfer is within available resources

20

POTENTIAL STATE EXCHANGE UTILIZING FEDERAL TECHNOLOGY • High-level approach defined
– Use the federal technology for QHP Eligibility and Enrollment, including portal and call center – Oregon retains:
• • • • front-end customer outreach education initial QHP management and some QHP oversight

• On-going costs/budget to be determined

21

UTILIZE FEDERAL TECHNOLOGY REVIEW

• Risk: Enrollment, renewal, and change of circumstance functionality are currently available, lowest risk option • Schedule: All functionality will be available before November 2014 • Cost: Estimates are within available resources

22

OBJECTIVES/RECOMMENDATION
• • • Recommend to the Board of Directors the best technology option for enrollment, renewal, and change of circumstance to support the 2015 open enrollment beginning 11/15/2014 Document recommendation with a final report Assumptions: Enrollment, renewal, and change of circumstance for individuals is to be made available online within Cover Oregon’s current budget coupled with the lowest possible risk by or before November 15, 2014

• Milestones to fix current technology were not met • We received more information on utilizing the Federal Technology Based upon Risk, Schedule, and Cost, we recommend moving forward with the Federal Exchange for QHP and leverage our current investment to support Medicaid in OHA
23

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