The HIX market has undergone a facelift over the past year in some states where hopes are running high that a 2.0 reboot will be just what the doctor ordered.

While Oregon and Nevada folded their respective state-run exchanges in favor of Healthcare.gov, Maryland and Massachusetts paid a high price for replacing their technology contractors. The Bay State also toyed over the summer with a switch to the federally facilitated marketplace, but ended up correcting glitches to its own exchange – a fix that soared to $254 million from an estimated price-tag of $174 million.

Improvements seen in Nevada, Maryland and Massachusetts involved a “rip-and-replace scenario,” observes Robert Booz, a health care industry analyst with Gartner. “It’s not like they could learn from last year’s mistakes using the same applications and services. They had to basically start all over again.” He says high levels of support and hands-on assistance is still required in those states, where consumers will need to be patient with all the new technology.

Also see: ACA pits insurance giant against Md. co-op

Growing pains also have been reported in other markets. In Minnesota and California, for instance, officials are promising increased website capacity and extra call center staff, while Vermont scaled back its relationship with the state’s prime contractor.

A number of states have taken some heat for consumers making narrow network choices without fully realizing it, according to Don Garlitz, executive director of bswift Exchange Solutions, a key industry player. “Decision-support tools matter, and much of the build-from-scratch technology just didn’t get to where they needed to be quickly enough,” he says. “For a variety of reasons, I think states are realizing that it makes sense to engage a partner with experience with a software-as-a-service approach.”

Another key development is that Kevin Counihan, who used to helm the oft-praised Access Health CT, is now head of exchanges at the Centers for Medicare and Medicaid Services. Booz believes “he’s going to be more attuned to some of the issues going on at the state level because he’s got a very fundamental understanding of what it is to operate at a state exchange. So hopefully, he will be able to offer counsel, as well as oversight.”

Ironically enough, the current HIX enrollment could prove to be worse than the bumpy maiden voyage. “Last year there was a certain amount of excitement about the whole program and how it was going to do,” says John Sarich, vice president of strategy at VUE Software, an insurance automation company. “Now, there’s very little media attention, and I think a lot of people wish this problem would go away.”

He cites Vermont as an example of how even despite having manageable numbers of people with limited health plan choices in the online marketplace, the Green Mountain State’s struggles are telling about the level of complexity and expenses involved. Nevada also comes to mind. “That’s a manageable size to do something with from a technology standpoint,” Sarich says. “I think one of the issues is you don’t necessarily have a program that’s stable and static because it’s in a continual state of flux.”

Also see: Critical checkpoint approaches for HIX fix in Mass.

While the focus of states thus far has been squarely on individual-market solutions, closer attention toward the SHOP exchanges is expected in the years ahead. Garlitz notes that “the technology demand of a SHOP is quite different from the individual market, since it involves handling various ways of packaging plans that are chosen by the employer and visible to the consumer, and because employers require a certain level of benefit administration functionality that the individual market doesn’t.”

He believes small businesses can actually have a positive experience with SHOP “as long as key employer administrative tools are available, and the employee has an excellent consumer experience. But just listing plans with a radio button to select a plan isn’t going to cut it going forward.” Some of the most desirable tools have focused on plan selection or packaging, a customized defined contribution strategy, processing new hires and life-event changes, availability of reports and billing aids.

Bruce Shutan is a Los Angeles-based freelance writer.

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