IT Infrastructure and Health Care Exchanges

A new report released by the University of Massachusetts Medical School (UMMS) and the National Academy of Social Insurance (NASI) details the opportunities and challenges that states face as they work to develop the IT infrastructure needed to implement health insurance exchanges under the Affordable Care Act (ACA).

The Center for Consumer Information & Insurance Oversight (CCIIO), part of the Centers for Medicare & Medicaid Services (CMS) within the Department of Health & Human Services (HHS), provided significant funding to “Early Innovator” states to jumpstart and share technology developments with other states. Three states — Oregon, Maryland, and New York — and a group of New England states led by Massachusetts are using this funding to develop IT components for Exchanges and for modernizing Medicaid/CHIP eligibility systems.

The authors of the report conducted interviews with policy and technology leaders from the Early Innovator states and other states that have made significant progress in designing and developing Exchanges and/or in modernizing Medicaid and CHIP eligibility systems, and discovered five key themes:

  1. Agreeing upon a common vision, strategy, and realistic plan for information technology development is essential for meeting fast-approaching implementation deadlines;
  2. Determining a state’s information technology approach requires a careful assessment of internal and external resources;
  3. Navigating policy and technology integration between an Exchange and a state’s Medicaid and CHIP programs is a complicated and pressing challenge;
  4. Leveraging federal resources, reusing technologies developed by other states and federal agencies, and participating in multi-state collaboratives may accelerate development and help minimize operational costs;and
  5. In order to meet deadlines, Exchange implementation efforts must proceed apace, despite federal and state policy, technology, and political uncertainties.

The authors describe the IT opportunities and challenges presented by the ACA as well as each theme mentioned above in more detail. You can read the full report here.

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