National HIX launch can learn from RI experience

The Oct. 1 launch of the new health insurance exchanges has been met with a range of technical glitches across the country. Angela Sherwin, program director of the Brown University executive master of healthcare leadership program and former employee involved in Rhode Island's insuranc exchange, spoke with Clinical Innovation + Technology about the situation.

The glitches were minimal given the launch of a national, state by state effort, Sherwin said. In most cases, those building the federal exchanges were tasked with substantial IT builds within nine months. During her days working on the Rhode Island implementation, “all of the experts kept saying the kind of IT initiative and business process transformation you’re undergoing usually takes three to five years. So, for anything to be pulled off in nine months is a miracle, I think.”

The tight timeline was due to many states not having their technology vendor on board and ready to go until late 2012 or early 2013. But, they all worked toward the Oct. 1 deadline at a “lightning pace.”

States will go through a continuous improvement process, she says. “With every new application, we’ll learn something new about the system.”

The new exchanges can learn from those who came first, however. For example, the Rhode Island implementation proved the importance of small businesses in this effort, Sherwin said. "Throughout the nation and even the feds have narrowed their focus to individuals and families and pushed off implementation of small businesses to later. Rhode Island, however, made a strategic choice to put a lot of resources and emphasis on small businesses at the beginning. I observed anecdotally that the small business community really appreciated that."

Rhode Island also has taken an innovative approach to consumer information and data availability, Sherwin said. “There’s a lot of excitement and energy around making sure that the goal and the mission and the purpose of Rhode Island’s exchange isn’t just about connecting people for coverage. It’s about transforming the healthcare landscape and leveraging the data that’s collected as part of the process, leveraging human capital, investment in the exchange to really think about how we can change the payment and delivery system.” Improving access to coverage leads to access to care which leads to improved outcomes, she said.

Looking ahead, the exchanges have the potential to connect and engage insurance companies in more meaningful dialogue that directly impacts consumers, Sherwin said. With ongoing debates about the rising costs of care and who is responsible for those increases, “the exchange can serve as a table to facilitate that dialogue in a way that other entities can’t as well.”

Insurance exchanges are becoming a routine part of business, Sherwin said. “It’s going to take a while before the exchange concept becomes normalized and not threatening. In Rhode Island, I think the tone and tenor is pretty close already.”

Meanwhile, the current government shutdown won’t have any impact on exchanges in the short term, Sherwin predicted. The funds that support exchanges aren’t impacted by the current budget process. In the long term, however, “everything is up for grabs but, both politically and practically, the answer is no, the shutdown won’t impact exchanges.” The mandate attached to all federal funding required that the exchanges be self-sustaining by 2015 anyway so they won’t need federal money.

Sherwin said she is excited about the exchange launch. “I think we’ve seen a great first week. I look forward to the enrollments coming in over the next few months and the good stories about how this policy changed my life that I think we’ll see next spring.”