TECHNOLOGY RECOMMENDATIONALEX PETTIT, Ph.D., ACTING CHIEF INFORMATION OFFICER

APRIL 24, 2014

Meeting Agenda: 4/24/2014

1. Review Technology Committee Objectives & Recommendation Guidelines

2. Recap of Process and Results through last meeting

3. Update on Fixing Current Technology / New Vendor option

4. Update on Utilizing Federal Technology option

5. Final Analysis, Discussion & Recommendation

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OBJECTIVES

• Recommend to the Board of Directors the best technology option for enrollment, renewal, and change of circumstance to support the 2015 open enrollment beginning 11/15/2014

• Document recommendation with a final report

• Assumptions: Enrollment, renewal, and change of circumstance for individuals is to be made available online within Cover Oregon’s current budget coupled with the lowest possible risk by or before November 15, 2014

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RECOMMENDATION GUIDELINES

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• Risk – Must provide the highest level of

certainty for seamless individual enrollment,

renewal and change of circumstance

• Schedule – Thoroughly tested and

operationalized prior to November 15, 2014

• Cost – Must be delivered within available

resources

RECAP OF PROGRESS

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1. Initial Meeting: March 11 - Articulate problem scope and

constraints

2. Workshop Meeting: March 13 - Further description of

problem

3. Workshop Meeting: March 18 - Articulation of solutions

and limitations

4. Workshop Meeting: March 21 - Go forward plan

proposed and detailed

5. Preliminary recommendation Meeting: March 27 - Go

forward plan reviewed and approved

6. Status Monitoring Meeting: March 31 – Dual Approach

INITIAL SOLUTION ALTERNATIVES

ExeterTransfer

SBM

New ProductSolution

Direct to Carrier

SaaS SHOP

New Service

Solution

EnrollmentExchange

Lite

New Direction

Keep the TechnologySelect a New Vendor

Stay the Course

Keep the TechnologyKeep the Vendor

1 2

3 4 5

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Individual & Shop

Federal Technology

Hybrid

8 10Partnership

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NARROWED FROM 10 TO 3 FOR FURTHER

REVIEW

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• State System Transfer: Transfer

functioning technology from another state,

in whole or in part

• Fix current technology – use new vendor

• Utilize federal exchange technology

STATE SYSTEM TRANSFER KEY FINDINGS

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• Utilize known working technology core to start

• Avoid pitfalls and address issues proactively by

leveraging experience of other state

• A gap analysis is necessary to identify differences in

business functions, business processes, and technology

architectures

• Requires additional expertise and capacity

• Development of SHOP functionality will need to be

addressed

• Some carrier interfaces would need to be developed

• Need to respond to evolving federal requirements

STATE SYSTEM TRANSFER OPTION ELIMINATED

• Risk: Has not been successfully done to date

• Schedule: Infrastructure procurement and configuration would need to be completed before modifications to the application could begin

• Cost: Maryland: $45MM, plus infrastructure

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OUR PRELIMINARY RECOMMENDATION:

DUAL APPROACH

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• Fix Current Technology / New Vendor: fix

current technology and use a systems

integrator

• Simultaneously develop a plan to utilize the

federal exchange technology and execute if

milestones are missed

FIX CURRENT TECHNOLOGY/

NEW VENDOR

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KEY FINDINGS

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Maintain no wrong door vision for Oregonians to access

services

Infrastructure & technology is in place and enrollments

are occurring (with a large manual effort)

State of code and complexity of architecture pose

significant challenges to stabilize what is currently

developed

Development of functionality including renewal and

change of circumstance is not complete

Federal requirements continue to evolve

FIX TECH/NEW VENDOR MILESTONES1. Product roadmap focus on ACA requirements (4/4/2014)

2. Sole source procurement approved (4/4/2014)

3. Function gap completed and reasonable (4/11/2014)

4. CO governance structure built & operational (4/11/2014)

5. CO program management in place (4/30/2014)

6. CO attrition is managed (4/30/2014)

7. System Integrator contract is complete (4/30/2014)

8. 2015 Open Enrollment functionality requirements complete (5/30/2014)

9. 2015 Open Enrollment functional design complete (5/30/2014)

10. 2015 Open Enrollment technical design complete (5/30/2014)

11. 2015 Open Enrollment development on-track (6/15/2014)

12. Final go/no-go decision (6/30/2014)

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DELOITTE ASSESSMENT

• Stabilization of current software and development of renewal capability is all that can be achieved by November 15, 2014

• Change of circumstance would not be completed until November 2015

• Total effort is estimated to exceed 390,000 hours, @ $200/hr ≈ $78MM to complete

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FIX CURRENT TECHNOLOGY/NEW VENDOR

REVIEW

• Risk: Aggressive timeline introduces substantial risk into project plan with little margin for error

• Schedule: Not all functionality can be completed by November 15, 2014

• Cost: This option exceeds available resources

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UTILIZE FEDERAL TECHNOLOGY

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KEY FINDINGS

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• Requires CO to maintain operations for 2014 events

• Provides individual enrollment, renewal, and change of

circumstance by the November 15, 2014 deadline

• Provides for QHP eligibility, plan shopping and enrollment

• 11 of 16 Oregon carriers already have interfaces with FFM

• Medicaid eligibility can be moved to OHA; requires no further

development from Cover Oregon but significant work from OHA

• Migration of existing enrollments to federal system TBD

• Loss of full integration of Medicaid and QHP

• Agents would need to be certified by the FFM

DELOITTE ASSESSMENT

• Migration to federal technology for QHP eligibility and enrollment expenses - $4 – 6MM

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Medicaid eligibility determination

• Transfer Medicaid eligibility determination back to OHA

• OHA retains:– Medicaid portal and call center

– Medicaid consumer outreach and education

– Medicaid determinations, enrollments, redeterminations and appeals

• Utilize cross-agency project team, rely on one system integrator for both entities

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Cost Estimate to Transfer Medicaid Eligibility to OHA

• Key assumptions:

– Some of Oregon’s current technology can be adapted

– Costs are eligible for 90%-10% federal match

• Cost estimate to complete transfer is within available resources

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POTENTIAL STATE EXCHANGE

UTILIZING FEDERAL TECHNOLOGY

• High-level approach defined– Use the federal technology for QHP Eligibility and Enrollment,

including portal and call center

– Oregon retains:• front-end customer outreach

• education

• initial QHP management and

• some QHP oversight

• On-going costs/budget to be determined

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UTILIZE FEDERAL TECHNOLOGY REVIEW

• Risk: Enrollment, renewal, and change of circumstance functionality are currently available, lowest risk option

• Schedule: All functionality will be available before November 2014

• Cost: Estimates are within available resources

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OBJECTIVES/RECOMMENDATION

• Recommend to the Board of Directors the best technology option for enrollment, renewal, and change of circumstance to support the 2015 open enrollment beginning 11/15/2014

• Document recommendation with a final report

• Assumptions: Enrollment, renewal, and change of circumstance for individuals is to be made available online within Cover Oregon’s current budget coupled with the lowest possible risk by or before November 15, 2014

• Milestones to fix current technology were not met

• We received more information on utilizing the Federal Technology

Based upon Risk, Schedule, and Cost, we recommend moving forward with the Federal Exchange for QHP and leverage our current investment to support Medicaid in OHA

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