Oregon officials are pledging to avoid 2014s enrollment nightmare, which prevented the state-run HIX from fully launching online and led to the departure of six top officials connected to the exchange.
Deloitte Consulting was hired over the summer following the contractual debacle with Oracle, which triggered litigation, to help transition the initially conceived state-run exchange to Healthcare.gov and finish building the states Medicaid system.
Oregon is an outlier on top of an anomaly, observes Robert Booz, a health care industry analyst with Gartner. It was, I think by any measure, an unmitigated disaster. So the game plan now is just to make it a supported state-based marketplace, which basically means theyre going to use Healthcare.gov.
In 2014, Oregon became one of 36 states to use HealthCare.gov. While roughly 416,000 Oregonians enrolled in HIX coverage for 2014, another 202,000 residents, or 5% of the state population, are estimated to remain uninsured.
The lesson from Oregon is how not to attack a technology problem, according to John Sarich, VP of strategy at VUE Software, an insurance automation company. Oregon, like many other states, just really didnt define the scope of the project beyond building a website so people could access information, and thats where they started to break down he explains. Its probably a good post mortem into how large-scale IT projects are problematic.
Sarich says the sheer size, number of people involved and training level were a lot to digest, as was the decision to write everything from scratch or use third-party applications to do certain things, then determine how is it all going to plug and play together.
Booz fears the new arrangement may still create some potential disconnects and confuse consumers with three different websites. Cover Oregon, the official state exchange, will route visitors to Healthcare.gov. Both feature their own call centers, with the former handling general inquires and the latter managing enrollment issues. Theres also Oregon Health Care, which is the Medicaid plan.
Even if the technical difficulties are resolved, and it sounds like theyre well on their way to being resolved, you still have this multi-part equation, he explains.
Also see: State exchanges look ahead to 2015
There are essentially two elements to the ongoing saga in Oregon. One is an ability to navigate various pieces of technology and services, while the other isnt as straight forward. People can make lots of reasonable consumer-based decisions in an isolated way, Booz cautions. But once theyre a patient or a prospective patient, they lose that objectivity. So even if they are a good consumer with lots of tools at their disposal, they really are in a situation of uncharted territory when it comes to making decisions for themselves.
Sarich adds that too much attention was paid to the retail side and front-end of systems, as well as building websites and Web interfaces.
Tina Edlund, the state administrator in charge of overseeing the transition, recently told The Associated Press: Overall the project is on track, it's going well. She noted that 15 insurance carriers not only underwent end-to-end testing, but also uploaded their plan and cost-sharing information, as well as premium data, to HealthCare.gov.
Bruce Shutan is a Los Angeles-based freelance writer.
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