HIX Success Could Generate Add-On Revenue for CT

To fix its "deeply flawed" website, the Maryland Health Benefit Exchange is turning to Access Health CT. Now CT officials are mulling offering similar services to other state exchanges—for a fee.

Officials at the Maryland Health Benefit Exchange have been grappling with a problem-plagued website and are planning to retool their existing platform with software code from the Access Health CT, the Connecticut health insurance exchange.

"Our goal is to have the Connecticut upgrade complete and fully installed before the [next] open enrollment in the fall," Joshua Sharfstein, secretary of the Maryland Department of Health and Mental Hygiene, said Friday. He called the Connecticut exchange's website "well-designed and successful."

"Our main focus has been on the technology," Sharfstein said of top Maryland officials associated with the state's exchange, which surpassed its 260,000 resident target for 2014 enrollment.

In a memo to the Maryland exchange's board of directors dated March 31, state officials including Sharfstein recommend using the Connecticut exchange's website code with "only minor retrofitting for branding, notices, interfaces (including with carriers and with the Medicaid system), and to accommodate Maryland-specific rules."

Sharfstein, state IT Secretary Isabel FitzGerald and Carolyn Quattrocki, acting director of the Maryland Health Benefit Exchange, note in the memo that the state's existing HIX website "has improved dramatically since December." But acknowledge that a rebuild is necessary: "Despite these efforts to improve the system, it remains deeply flawed."

Adopting the Connecticut code is a superior solution to the two other options Maryland officials considered, they wrote. Using the federal government's exchange website code "does not adequately support our business model or Medicaid," the Maryland officials wrote. And "remediating the existing architecture" was deemed too expensive and "would take over 12 months and cost more than $66 million."

'New Revenue Stream'
The website code the Connecticut exchange is being provided to Maryland at no charge because Access Health CT is a quasi-public agency that is not yet authorized to charge for HIX-related goods and services. Jason Madrak, chief marketing officer at Access Health CT, said last week in a phone interview that handing over the website code is the least ambitious of three lines of HIX business his colleagues are considering to offer other states.

"Code is code," he said of the gratis deal with Maryland, one of the first major upgrade agreements between public exchanges since they were launched under the Patient Protection and Affordable Care Act last fall.

"There is some expertise that is valuable, and we would be open to providing that to them," Madrak added of assistance to the Maryland exchange. "Now that they have the code, the ball is in their court."

Madrak called providing the code an example of "exchange-in-a-box" HIX services. Under that scenario, there would be "little involvement on our part." In contrast, a full suite of HIX administration services would require hands-on involvement. A third option would be a level of services somewhere in between.

"We are actively trying to turn this into a business operation," he said, adding Access Health CT officials want to offer "valuable services to other exchanges to literally generate a new revenue stream."

Madrak said there would be some "administrative issues to work through" before the Connecticut exchange could start charging for HIX services. A key issue is deciding on a form of payment, Madrak said. A couple of options under consideration are a consultancy fee and monthly "member" fee.

Access Health CT, which is widely viewed as one of the strongest public exchanges in the country, has a strategic edge over most of the other exchanges, Madrak said. "We are able to take more of a leadership position because we were stable in our enrollment period, and now we can be forward thinking."

As they look to the future, Connecticut officials see an opportunity to play a large part in a regional HIX mix. "The country probably doesn't need 50 individual exchanges," Madrak said.