Fire, aim, ready: Will states make the right investment in HIX IT?

By Bobbie Wilbur
08:40 AM

Health insurance exchanges (HIX) are gaining national interest and are the hot topic in today’s healthcare landscape. Federal law requires each state to have a health insurance exchange plan in place by January 1, 2013 and a functioning HIX in place by January 1, 2014 that enables individuals and small businesses to buy health coverage. The federal government will create an exchange for states that don't comply.

As a result, states are about to invest billions of dollars in IT technologies and services required to meet the Affordable Care Act Health Insurance Exchange mandates. Many states will be upgrading their eligibility and enrollment system using significant federal financial participation.

[See also: An inside look at Maine's MMIS implementation.]

Despite the fact that not all federal technical or process requirements have been nailed down – and many of the implementation guidelines have yet to be defined – states are issuing Requests for Information (RFIs) and Requests for Proposals (RFPs). They realize they cannot afford to hold off on their Health Insurance Exchange planning, design and implementation if they indeed wish to meet the ACA deadlines.

While states scramble to put plans and technology in place, IT vendors and system integrators across the country are vying to get their share of business. Vendors are responding to large, complex RFIs and RFPs making promises to meet the specified requirements. Often, these IT vendors are entering into new partnerships with other vendors to be able to meet the requirements set forth in the RFPs. Given full details about the federal requirements the states must comply with have yet been published, this sets up the potential for the state to make the wrong investment. This has major implications and could in fact hamper the overall success of ACA since states may find what they built will not fit their needs.

What should the feds do to make sure their money is spent wisely? What can states do to make sure they are buying right and have the flexibility to deal with what they don’t yet know? What should states do to hold their vendors accountable? What’s the best philosophy for crafting an RFP in a time when much is still unknown – yet time is of the essence?

[Related: PwC says states HIX 'flexibility creates complexity' for payers.]

With states making such huge investments – using funds from state and federal coffers - it is time for states to put their “buyer beware” hat on. It is advised that sates “see, touch, feel” before they buy. State buyers need actual hands on experience with the software they are buying - not just checklists from the vendor that saying their software will perform certain functions. States need third-party assistance to review and evaluate vendor claims versus reality. They need to ask for technical assistance when picking the ‘right’ vendor; and lastly, the buyers need to fully understand the level of ACA depth the project team members possess. Also, it is important to make sure the team proposed is indeed the team that will do the work.

With so much at stake, states, working with their federal partner, need to up their game and bring in the resources required to ensure that come 2014 their Health Insurance Exchanges will in fact be operational and able to deliver upon the ACA promise.


Bobbie Wilbur, Co-director, Social Interest Solutions has more than 25 years of experience in management and development of web-based technology solutions for county and state governments, including co-authoring Section 1561 of ACA, which addresses eligibility and enrollment standards for health insurance exchange IT systems.

Claudia Page leads policy, advocacy, and strategic operational activities at Social Interest Solutions. For over 20 years, Ms. Page has worked to improve public health and to reform health care access on both the operational and policy fronts. Ms. Page has authored language in both federal and state legislation, including Section 1561 of the Affordable Care Act.