It is exchange testing time

Deadline PPACA

By Allison Bell

June 18, 2013

Patient Protection and Affordable Care Act (PPACA) exchange builders who want to get the health insurance supermarkets running by the Oct. 1, 2013, deadline should be in what amounts to dress rehearsals.

Dan Maynard, president of Connecture, a company that has been setting up Web-based health insurance sales and shopping systems since 1997, gave that assessment during a recent interview.

Connecture has been developing sales systems for the exchanges for Maryland, Minnesota and the District of Columbia.

The Connecture team is still hard at work testing the systems and how they connect with other exchange systems, and dealing with gaps and other problems, but the development workload peaked about two months ago, Maynard said.

Now, Maynard said, at exchange programs that are on track to open on time, the main action is in the offices of the "system integrators" who are responsible for making sales, eligibility, administration and other systems work together smoothly.

"It's pretty intense in the system integration shops right now," Maynard said.

PPACA requires the U.S. Department of Health and Human Services (HHS) to work with state agencies to make exchanges available in all 50 states and the District of Columbia.

Some states are starting their own state-based exchanges, some are working with HHS to set up "partnership exchanges," and some are letting HHS to provide all exchange services for their residents through "federally facilitated exchanges" (FFEs).

Connecture has about 12 to 20 big, "enterprise" level projects in the pipeline at any given point, and many of those projects are about as big as a state exchange front-end development project, Maynard said.

One difference, however, is that the exchange front-end systems must fit together with many other big, new systems, Maynard said.

For typical projects, he said, Connecture simply must plug a new front-end system into existing systems.

The creators of some of the other new systems, such as the eligibility verification systems, are simply updating existing systems to fit in the new exchange environment, but creators of other systems, such as the billing and reconciliation systems, have to trod on less familiar ground, Maynard said.

The lack of ability to plug into legacy systems "creates a level of uncertainty that makes [the exchange work] unique," Maynard said.

But the level of systems knowledge at state and federal agencies is much better than it was three to six months ago, Maynard said.

"When there are gaps, certainly people are filling them," Maynard said. 

In the states Connecture serves, "it's been a very positive experience," Maynard said.

Because states understand how much time pressure they and vendors face, they have been good about trying to be realistic about the keeping the scope of their projects realistic and minimizing the number of requests for changes, he said.

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