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Establishing the Technology Infrastructure for Health Insurance Exchanges Under the Affordable Care Act: Initial Observations from the “Early Innovator” and Advanced Implementation States

By: Michael Tutty and Jay Himmelstein
Published: September 2012

Summary: One of the most effort-intensive activities required of states in order to be ready for the 2014 health insurance exchanges deadline is the development of information technology (IT) infrastructure. This report, by the University of Massachusetts Medical School (UMMS) and the National Academy of Social Insurance (NASI), provides a review of the issues that policymakers should consider as they plan to build and enhance their own state-based technology infrastructures. It provides guidance based on the experiences of states most advanced in their Affordable Care Act IT implementation. Based on interviews with policy and technology leaders, five themes and takeaways arose as guidelines:

  1. Agreeing upon a common vision, strategy, and plan for IT development is essential for meeting fast-approaching ACA deadlines;
  2. There is a great need for a careful assessment of a state’s internal and external IT resources;
  3. Integration of policy and technology between an Exchange and a state’s Medicaid program 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. Proceeding with development –  despite federal and state policy, technology, and political uncertainties – is necessary in order to meet aggressive federal implementation deadlines.

The report is a product of a NASI project funded by the Robert Wood Johnson Foundation to provide technical assistance to states developing health insurance exchanges. Related products include a toolkit offering legislative language for policymakers implementing Exchanges and issue briefs on Exchange governance, active purchasing, federally facilitated Exchangescoordination with Medicaid and plan management.