Private Sector Rides To Rescue Of - InformationWeek

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Healthcare // Policy & Regulation
03:20 PM

Private Sector Rides To Rescue Of

Handful of Web insurance brokers will start enrolling people in plans within a month, but backend coding problems could continue to delay completion of policy purchases.

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The private sector is riding to the rescue of, the troubled federally operated health insurance exchange. Five Web insurance brokers that signed a deal last Julywith the Centers for Medicare and Medicaid Services (CMS) are expected to start enrolling subsidy-eligible people in plans that participate in within the next month.

That should go a long way toward easing the pressure on the front end of, which has encountered significant technical problems in enabling people to sign up for plans. But less-publicized difficulties in sending enrollment data to insurance companies' backend systems could still delay the process for some time to come, a leading expert warns.

At an earnings conferencewith security analysts on Thursday, Gary Lauer, CEO of eHealth, which operates, one of the leading online insurance agencies, announced, "We continue to work with the federal government to launch enrollment capabilities for subsidy-eligible individuals in the 36 states where the federal government is operating an exchange. eHealth has received the necessary information for implementation of this capability from CMS … But we received this later than expected. We are currently in the process of operating and testing. Assuming the federal exchange is operable, we hope to be able to provide eHealth consumers access to subsidy-eligible plans during this open enrollment period in time for the Jan. 1, 2014 effective date of coverage."

[ Why is a mess? Read HealthCare.Gov Woes: Lack Of Testing. ]

In an interview with InformationWeek Healthcare, Sam Gibbs, president of government systems for eHealth, said that the company anticipates going live with that capability "within the next few weeks. A handful of other Web-based entities will be launching at some point. My guess is in the next month you'll see other companies begin to offer subsidy-eligible plans and do the subsidy calculations through the FFM [Federally Facilitated Marketplace], and we'll be one of those."

Besides the national Web insurance brokers who signed up with CMS last summer, Gibbs believes the agency is enlisting additional regional and statewide agencies to help enroll people in the federally run exchange.

A CMS spokesperson told InformationWeek, "We’re still signing agreements on a rolling basis with these parties and will have a more complete list to share soon."

Since Oct. 6, eHealth has been offering Affordable Care Act-qualified health plans to customers who are ineligible for government subsidies because of their income, Gibbs noted. These plans are being sold independently of the FFM and the state-run exchanges in 14 states. But they meet all of the qualifications for a plan that is offered on one of these exchanges, and the premiums charged to customers for a particular plan are the same whether they're available in an exchange or not.

To enroll people who are eligible for subsidies -- the vast majority of those interested in purchasing exchange plans -- eHealth and the other four brokers must connect to the CMS data hub to verify applicants' incomes and calculate the amount of subsidies they can receive. eHealth is still testing its ability to get that information and to link with other FFM systems. "We didn't get the test environment until Sept. 30," Gibbs explained.

When eHealth is ready to begin enrolling subsidy-eligible individuals in the FFM plans, it will do so on its own. "We'll do our own marketing to our own customer base, and if one of our customers wants a subsidy, we'll take them through our site and help them pick a plan," Gibbs said. "When they're ready to enroll, we'll send them to the federal exchange for enrollment completion, and then the exchange will send that enrollment to the carrier."

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Chuck Brooks
Chuck Brooks,
User Rank: Author
10/28/2013 | 11:28:50 PM
re: Private Sector Rides To Rescue Of
Ken really hit the nail on the head when he notes the private sector's critical role in government IT programs. This is especially true with healthcare where digitization, document management, and cybersecurity are always important elements in the process. Best commercial practices should be used as a metric more often when designing and implementing enterprise-wide programs in government.
David F. Carr
David F. Carr,
User Rank: Author
10/28/2013 | 11:47:46 PM
re: Private Sector Rides To Rescue Of
This is why smart web businesses have beta periods, to avoid treating the whole mass of customers as beta testers
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