IBM's Curam Social Program Management platform will verify Minnesotans' eligibility for healthcare coverage through the state's HIX.
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IBM has announced that its Curam Social Program Management platform will be used to verify the eligibility of approximately 1.2 million Minnesotans who are expected to apply for health coverage through the state's health insurance exchanges (HIX).
Earlier this month, Minnesota awarded Maximus a prime contract worth $41 million to create the state's new HIX website. IBM will work as a subcontractor to Maximus on the project.
Like many state health insurance exchanges in development across the country, Minnesota's will rely on several technology vendors. HIXes require a robust health IT infrastructure to support their secure websites where eligible customers and businesses can compare health plans and send and receive information electronically for application and verification of personal data. Established under the Patient Protection and Affordable Care Act, all state health insurance exchanges must be certified and fully operational by January 1, 2014.
Minnesota officials point out that they must achieve certification on the design and development of a Minnesota exchange by January 2013 or a federal HIX will be imposed on the state. Additionally, consumer and small business enrollment in the exchange is scheduled to begin by October 2013.
To meet these goals,
IBM will collaborate with two other subcontractors working on the project. These include Connecture, a Waukesha, WI.-based company that will provide technology to support the enrollment and health insurance sales function, and EngagePoint (formerly known as Consumer Health Technologies), a Ft. Lauderdale, Fla.-based firm that will provide its financial management module for billing, aggregation, and payment reconciliation.
"The success of our build will depend on managing the integration of multiple systems successfully. For example, the IT system will be the combination of existing software, along with [newly developed tools] for Minnesota's needs. The HIX will integrate with federal, state, and partner systems," Ben Hill, director of consumer outreach and community relations at Minnesota's Department of Commerce, said in an interview with InformationWeek Healthcare.
To help the process along, Minnesota's HIX will design information systems that identify individuals who qualify for tax credits, cost-sharing reductions, Medicaid, or the Children's Health Insurance Program (CHIP). The state exchange must also establish strong standards to protect and secure the privacy of personally identifiable information (PII) provided by the applicant.
Verifying personal information over a secure website can be a complex process, says Ernie Connon, IBM VP for health and human services industry solutions.
"The IBM Curam platform will evaluate the eligibility of Minnesotans applying for health coverage, and many individuals, certainly in the lower income brackets, will receive health coverage under the expansion of Medicaid," Connon said. "Some will receive tax credits, some will receive subsidies, and some will receive nothing at all. One of the biggest, most complex parts of this deployment is looking at eligibility and determining which categories these folks fall into and, as their income and assets change over time, how does that [affect their status] under the plan."
The Curam platform is used in more than 80 government agency projects around the world in health and human services, workforce services, and social security organizations. In the Minnesota HIX project, the technology will incorporate new income standards and manage the capture and storage of IRS income data.
According to Connon, IBM has bid on other HIX projects around the country using its Curam platform, and said because of the "political furor" that has surrounded the implementation of the Affordable Care Act, many states are working quietly on developing their exchanges.
"We have bid on other state insurance exchange projects and indeed we have won other states with some of our partners that are on the Minnesota project," Cannon said. "We expect in due course to be announcing a number of these projects soon."