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GetInsured Wants To Be Cloud Provider To State Exchanges

Website provides cloud back-end for New Mexico health insurance exchange and software for California insurance marketplace, with hopes to expand.
With 36 states currently getting some or all of the online services to support their exchanges from the federal government, there likely will be a second wave of implementations at the state level, said Jordan Battani, managing director of a healthcare IT research group at the global consulting firm CSC called the Global Institute for Emerging Healthcare Practices. "One of the anomalies of the way this has unfolded is that many of the states you would reasonably expect to be more likely to want to control things close to home -- a lot of those states are in the federal exchange," she said.

That is, in many cases it's the right-leaning states that have wound up ceding control to the federal government by default because they opposed the entire concept of Obamacare and were trying to get it repealed. While that fight continues in today's budget battles in Congress and factors into a looming government shutdown, the law has withstood repeated legislative challenges and a review by the U.S. Supreme Court. If conservative states are ultimately forced to accept the introduction of the health insurance exchanges as a reality, "it's a pretty good bet those states would prefer local control and are likely to try to move to controlling their own exchange," Battani said.

Some of the momentum for that change will depend on how well or how poorly the federal exchange system manages to address the needs of all the states it serves, she said.

That's where Krishnan sees an opportunity. "The states that aren't doing anything by themselves are by default in the federal systems. But many of those states are at a point where they're realizing it would be much better to run these at a state level." For one thing, they often need to connect to other state systems, he said.

California is different because the state made an early commitment to produce a high-quality exchange for its citizens. GetInsured is less directly involved in the operations of that exchange, but it has been delivering software updates to meet the state's requirements.

What GetInsured offers is an online insurance shopping experience already integrated with the systems of major carriers and tested through experience with consumers. It is also one of a handful of private brokers who have agreements with the federal government to access the same federal data hub that states will use to determine eligibility for federal programs and tax subsidies. The California exchange uses the GetInsured software engine as a building block, but the shopping experience is different.

In addition to acting as a technology supplier to states, GetInsured will continue to grow its private exchange business, which should also see more opportunity, Krishnan said. Far from putting private exchanges out of business, Obamacare is changing the rules in ways that make it easier for them to do business, such as preventing insurers from denying coverage to consumers or inflating rates because of preexisting conditions.

Although GetInsured will be competing with government-operated exchanges on some level, it has the opportunity to sell the same insurance products at the same prices, under the same terms -- which will be good for business if it can at the same time offer a better consumer experience, he said. For a comparison, he suggests tax preparation, where a do-it-yourself model is available to all consumers, who can download forms from the IRS for free -- yet that leaves plenty of room for a "robust market" for tax preparation software and services.

Making the process of shopping for health insurance as simple as possible is challenging, he noted, and "while I don't want to say we're a generation ahead, we're a couple of laps ahead."

The federal government has tried to simplify things by grouping insurance plans into a set of tiers with standardized characteristics -- bronze, silver, gold, and platinum plans. Going back to the online flight booking analogy, this is a little like the first class, business class, and cabin distinctions that give consumers an idea of what they're paying for. "It's an extremely useful metaphor," Krishnan said, and anything to simplify the process is welcome. "We've found that health insurance is arguably the most complex consumer purchase there is." Yet it needs to be further personalized because consumers also want to know "whether a plan includes their kid's pediatrician and covers their Lipitor, not just whether it's gold or silver."

In a demo conducted by Akins Van Horne, GetInsured.com's user interface product leader, those metallic tier classifications weren't displayed terribly prominently in the company's own insurance marketplace, although they're shown on the detail screen for each plans and users can filter search results to show just the silver plans. Instead, the user experience revolves around a questionnaire that asks consumers for their family size and needs, along with details like how many medications they take, and tries to present the best matches for those requirements. "It's more in tune with their needs, as opposed to how the plans are structured," Horne said.

The version of the software GetInsured is delivering for New Mexico and plans to provide other states is not identical, although it builds on some of the same elements. One of the company's main challenges will be recruiting people to support a customized, private cloud environment for each state based on Java software, VMware virtualization, EMC storage, Cisco networking and Oracle databases in multiple clusters, with fail-over redundancy to a second data center. Midway through our conversation, Krishnan asked that any InformationWeek readers interested in lending their skills to that effort write to the Palo Alto-based company at [email protected]. If things play out the way he hopes, GetInsured will need your help.

Follow David F. Carr on Twitter @davidfcarr or Google+. His book Social Collaboration For Dummies is scheduled for release in October 2013.