Cover Oregon Technology Recommendation

Objectives
• Recommend to the Board of Directors the technology solution that will be used to support the 2015 open enrollment beginning 11/15/2014
• Document recommendation within a report for use by the Board of Directors • Note: Any change in technology solution will necessitate a discussion with CCIIO

2

Participants
• Participants
– – – – – – – – – – – – – – – –

• Meeting Assistance

Liz Baxter, Board – Tom McKivor, Point B, subject Teri Andrews, Board matter expert George Brown, M.D., Board – Jeff Burpo, Point B, record Robin Richardson, Moda keeping, report writer Sue Hansen, Moda Erick Doolen, PacificSource – Matt Lane, Point B, facilitator John Kenagy, Legacy Bruce Wilkinson, Providence Chris Blanton, BridgeSpan Aaron Patnode, Kaiser Alex Pettit, CIO, State of Oregon Tina Edlund, OHA Greg VanPelt, OHLC Bruce Goldberg, M.D., Cover Oregon Aaron Karjala, Cover Oregon Triz dela Rosa, Cover Oregon

3

Approach
• Referenced consultant report and other information as inputs

• First round: Validate reduced alternatives
• Final recommendation:
– Seek consensus to identify recommendation – Voting techniques as needed

• Leverage evaluation criteria for analysis • Document group decisions not individual inputs
4

Reviewed Technology Current Status
• Architecture • Functional Capabilities
• Defects • Gaps and future roadmap
5

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

Solution Feature Summary
Stay Course Same Vendor Functional Capability1 Global UI Account Management Eligibility Stay Course New Transfer SaaS Vendor SBM Exeter SHOP Fed DTC Tech DTC Exchange Ind & Enrollment Lite SHOP Fed Fed Tech Tech Partner Hybrid

1

2

3

4

5

6

7

8

9

10

2 0 1 4

Plan Management Plan Selection & Enrollment Anonymous Browse Provider Search Find Assistance from Community Partner or Agent Foundational Capability Case Management Document Management Business Analytics and Reporting External Interfaces

2 0 1 5
1 2

Financial Management Functional Capability Renewals Change of Circumstance SHOP

C

C

C

C C

C C

All 2014 functionality is associated with the Individual portal product A number of alternatives will continue to require CO functionality to be considered a complete solution

Feature Scoring

Supported by CO Exchange2

Complete

Partial

Unavailable

7

Narrowed to 3 Alternatives
• #2, Keep the technology, new vendor • #9, Federal partnership
• #3, State Transfer SBM

8

Pro / Con Factor Definitions
Factor
Alignment to Oregon needs Impact to the State of Oregon Customer functional fit

Definition
Degree to which the solution fits the State of Oregon needs Cost and disruption issues impacting State of Oregon based on solution Solution has all functional factors that Oregon customers require

Impact to Carriers Impact to Community Partners & Agents
Cost Product performance Timeline fit for November 2014 Disruption; business continuity impact

Cost and disruption issues impacting carriers based on solution Satisfaction, cost and disruption issues impacting CPAs based on solution
Sunk solution costs, solution implementation costs, solution future costs, organizational changeover costs Success of the solution in the exchange marketplace Ability to have solution ready to deploy by 11/15/2014 Business disruption & continuity issues caused by solution implementation
9

Pro / Con: #2 Keep the technology / new vendor
Factor
Alignment to Oregon needs • • Impact to the State of Oregon • • • Customer functional fit Impact to Carriers Impact to CPA •

Pro
Exchange was designed based on Oregon policy, law and ability to shape decision making to meet Oregon’s needs Included full integration among variety of programs such as Medicaid, QHP Fewer unknown risks than a new solution Maintain integration to sister programs within Oregon which facilitates enrollment in Medicaid Ability to use Agents can boost enrollments (5,000+ to date) Current technology allows Community Partners / Agents and Individuals to use the site Carriers could have greater input into requirements Agents have custom functionality within Cover Oregon portal •

Con

Need for expertise and capacity to finish and manage an Oregon specific exchange

Non operational SHOP

• •

• •

Deployment of interfaces have been slow Frustrated partners due to implementation issues

10

Pro / Con: #2 Keep the technology / new vendor, cont.
Factor
Cost (a more robust cost analysis to follow) Product performance • • • •

Pro
Lower ongoing, long-term costs of 2.5% charged to carriers versus 3.5% charged by Federal Ability to leverage sunk costs and assets into the future Eligibility determination is working along with shopping and plan selection Portal is enrolling customers through Agents Infrastructure and functionality is in place with enrollments occurring; no full implementation required Higher continuity with current technology •

Con
Higher initial one-time implementation costs than FFM alternative

• • • •

Missing re-enrollment, change of circumstances and SHOP Carrier interfaces not complete Usability testing needs to be expanded to include end users Ability to meet tight timeline will depend on outstanding gaps analysis and ability to institute governance and program management improvements Disruption due to new vendor onboarding and potential architectural changes

Timeline fit for November 2014 Disruption; business continuity impact

11

Pro / Con: #9 Federal Partnership
Factor
Alignment to Oregon needs • • •

Pro
Inability to make custom changes Has Individual QHP eligibility, plan shopping and enrollment Has predetermined carrier interfaces • • •

Con
Inability to make custom changes Must fit into predetermined solution Not an integrated solution for multiple State programs (short term) Minimal Agent functionality SHOP currently not deployed Lose ability to integrate with Medicaid Lose flexibility on exchange roadmap including integration to multiple State programs Unknown at this point Idaho consumers reported dissatisfaction dealing with Federal call center Need for data migration Full end-to-end testing cycle Some carriers would need to develop new interfaces (11 carriers have interfaces; 5 do not) Lesser match to Carrier technical needs, e.g., EDI versus web services CPA do not have client management functionality No ability to search for CPA’s

• •
Impact to State of Oregon Customer functional fit • • Has end to end Individual functionality Simplifies governance and decision making Has all basic functional needs for individual • •

• • • •

Impact to Carriers

Some carriers could leverage Federal interfaces already built

• •

Impact to CPA

None identified

• •

12

Pro / Con: #9 Federal Partnership, cont.
Factor
Cost (a more robust cost analysis to follow) Product performance For November Timeline fit for November 2014 Disruption; business continuity impact •

Pro
Lower one-time implementation cost • •

Con
3.5% charged to Carriers versus 2.5% for State of Oregon Decommissioning and transfer of assets costs No SHOP Idaho reported inadequate support from Federal call center Does not have redetermination circumstance capability None

• • •

Functional system for Individuals Has change of circumstance Pay redirect is available

• • • •

Shortest timeline of all alternatives

Unknown

Impact to CO and Medicaid business and technology; continuity impacted

13

Pro / Con: #3 State Transfer SBM
(e.g., Rhode Island)
Factor
Alignment to Oregon needs Impact to State of Oregon Customer functional fit •

Pro
Potential fit due to multiple state systems There are states with end-to-end functionality including SHOP • • • • • • Rhode Island example solution has necessary functional areas • • • •

Con
Need to complete gap analysis on alternatives Must implement new State solution Lose flexibility on exchange roadmap including integration to multiple State programs Need to reintegrate with Medicaid Need to complete gap fit with any other state solution No known state technology set up to transfer technical 100% solution fit to another state Need for data migration Full end-to-end testing cycle Need to modify all interfaces to fit new solution Must learn new application

Impact to Carriers Impact to CPA

• •

Other state systems have carrier functionality (if fit for Oregon) Unknown

• •

14

Pro / Con: #3 State Transfer SBM, cont.
Factor
Cost (a more robust cost analysis to follow) Product performance For November Timeline fit for November 2014 • • •

Pro
Similar costs for one-time implementation to “keep the technology” alternative May have proven architecture Functioning system in other states • • • • • • • • • • •

Con
More expensive one-time implementation costs than Federal option Disruption and continuity costs Limited set of solutions that can satisfy without significant modifications Unsure about SHOP based on state solution Unsure about re-enrollment and change of circumstance based on state solution Must confirm contract issues Must select new solution Must confirm new solution with CCIIO Unsure of technical ability to be used by Oregon Data transfer Carrier interfaces must be reintegrated CO would need to learn new system Search and selection of new solution Potential for parallel systems for a period of time

Unknown

Disruption; business continuity impact

• May be able to reduce number of manual work arounds based on solution

• • •

15

Next Steps
• Finalizing cost information
• Conducting functional gap analysis between FFM and Cover Oregon technical solutions • Validating Cover Oregon organizational success factors:
– – – – Governance Program Management Personnel needs New vendor contract requirements

• Gather further information for CCIIO
16

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