Sarah Iselin, Optum to present responsible off-the-shelf and Federally Facilitated Marketplace solutions to Health Connector Board this week
BOSTON – Monday, May 5, 2014: State and Optum officials, led by Special Assistant to the Governor for Project Delivery Sarah Iselin and Optum Chief Information Officer John Santelli, will outline to the Health Connector Board of Directors on Thursday a plan to stand up a functioning Health Insurance Exchange (HIX) for Fall 2014 Open Enrollment. The dual-track strategy will include both a successful off-the-shelf solution and the Federally Facilitated Marketplace (FFM), and aims to ensure the Commonwealth continues to expand access to affordable, quality health insurance through the Affordable Care Act (ACA).
“Thursday will mark an important milestone for our turnaround project,” Iselin said. “We will be moving from planning to implementation, and we have developed a well-informed and pragmatic plan to guide us. I’ve said all along that no option on the table would be perfect, and the dual track certainly has its benefits and its challenges. It does, however, solve for two realities: we need a reliable website to help people during the next open enrollment period, and we need to be in a position to achieve a fully integrated system in 2015.”
“Based on our assessment of the Health Connector Exchange, we agree that the dual-track strategy is the optimal approach for the state to take at this point,” said John Santelli, Chief Information Officer of Optum. “We look forward to continuing to work closely with the state to improve the consumer experience and extend high-quality, affordable health coverage to as many Massachusetts residents as possible.”
The dual track plan, which will be detailed in full at Thursday’s Health Connector Board of Director’s meeting (9 AM, One Ashburton Place, 21st Floor, Boston), calls for concurrent implementation of an off-the-shelf solution and the FFM, while also ensuring the programs that make Massachusetts a national leader in health care access, affordability and choice remain intact. This includes the State Wrap program, which through additional state premium assistance helps makes health insurance more affordable for tens of thousands of residents. The plan also seeks new carrier accommodations to reduce the business and operational burdens associated with migrating to an external Exchange.
The Commonwealth and Optum had been considering rebuilding the current system, or using parts or all of an existing state Exchange or the federal Exchange. They determined that the off-the-shelf software – hCentive – powering Exchanges in Colorado, Kentucky and elsewhere has the best potential to fit the Commonwealth’s short- and long-term needs.
Through the hCentive solution, residents will be able to go online and apply for unsubsidized or subsidized insurance, learn what level of subsidy might be available and select a plan. The launch of an hCentive-based system will provide the end-to-end functionality required to support an ACA-compliant Marketplace, and will include minimal customization in vital areas such as State Wrap and billing. Over time, additional functionality can be added to improve the user experience and achieve the state’s long term vision for integrated eligibility.
The hCentive implementation will be pursued alongside connecting to the federal Marketplace, Healthcare.gov. The FFM provides a viable IT platform and it can be leveraged for one year if hCentive migration takes longer than expected. It does, however, require significant consumer and carrier adjustments. A number of Massachusetts-specific health reform design features will need to be reconciled with federal Marketplace operations, including supporting State Wrap, working on plan management operations with carriers and designing an appropriate billing interface (unlike many states, the Massachusetts Exchange handles billing and payment between members and carriers). State leaders have initiated discussions with CMS and Massachusetts insurers about how to develop the best accommodation strategy for the state’s health plans. The state plans to collaborate closely with CMS, health plans, consumer advocates and other stakeholders in the development of the implementation plan.
In recent months, the Commonwealth brought in Iselin as Special Assistant to the Governor to be the single point of accountability for HIX project management, and added Optum, the firm responsible for helping to fix Healthcare.gov, as an IT advisor. Additionally, the Commonwealth’s Information Technology Department is playing a more strategic and supervisory role for the HIX project, and already has increased project management capacity to steer the project’s implementation. During the first ACA open enrollment period, the Commonwealth enrolled more than 271,000 people into subsidized coverage and nearly 33,000 into unsubsidized plans.
As disclosed upon her appointment in February, Iselin took a four-month unpaid leave from her position at Blue Cross Blue Shield. She will return to BCBS in early June. In addition to presenting the dual track plan this week and completing the development of a state and Optum management structure to support the different work streams associated with both paths, Iselin will be responsible for handing her duties off to Maydad Cohen, currently Governor Patrick’s Deputy Chief of Staff for Cabinet Affairs.
Cohen, a labor attorney who most recently served as Chief of Staff at the Executive Office of Labor and Workforce Development, will succeed Iselin at a natural juncture for the project – planning to implementation. Optum and the same executive steering committee that supported and reported to Iselin will report to Cohen in his capacity as Special Assistant to the Governor for Project Delivery (Executive Steering Committee members: ITD CIO Bill Oates, ANF Secretary Glen Shor, HHS Secretary John Polanowicz, Health Connector Executive Director Jean Yang and MassHealth Director Kristin Thorn).