The OpenHBX development roadmap for 2016-2017 is organized into development master projects that will extend and enhance functionality of Enroll Application, Health Information Exchange Application and supporting infrastructure. The following are representative examples of major projects within each roadmap grouping:

Open Source B2B Gateway

This project is designed to address mission-critical dependencies that currently exist in the form of proprietary applications such as the Oracle DB, SOA Suite and B2B Gateway applications, which are currently hosted in the District of Columbia’s data center.

When launched in 2017, the new open source solution for Electronic Data Integration transactions (EDI) and a new, open source B2B gateway, will eliminate performance risks by hosting the B2B Gateway in the Amazon cloud, and will subsequently save the DCHBX millions of dollars in the coming years by eliminating costly proprietary software maintenance and licensing fees.

One Big SHOP

The primary focus of One Big SHOP is to transition thousands of employer groups to renew coverage through DC Health Link. This includes working with brokers and data exchanges with carriers to ensure transition and renewal are seamless to the employers and their employees. This also includes carrier-specific EDI customizations including the addition of detailed SEP and termination reason codes.

Financial Management Tools

The OpenHBX development roadmap for 2016-2017 includes a comprehensive suite of financial management tools that enhance and extend core mission technology systems, and deliver significant value to the DCHBX. The financial management tool set includes:

  • General Ledger (GL) support, double-entry accounting and record-keeping tools

  • Premium billing and payment capabilities include premium allocation, employer billing, carrier remittance, journaling, invoices, statements, generation of EDI 820s, and comprehensive internal controls and transaction tracking capabilities

  • Ability for authorized DCHBX administrative personnel to manage transactions between the DCHBX bank and a third-party premium aggregator, and track remittances to carriers

  • Self-Service billing inquiries & payment functions will enable small business employers subscribed to the system to establish one-time and recurring payments, import invoices and statements into their account as well as view their account status, amount due and other details online. This functionality will also provide brokers with the ability to access client invoices (past and present)

  • Integration of aggregated billing for medical, dental, and other plans across carriers into the Enroll Application will provide employer groups with consolidated billing invoices

  • Invoice functionality also extends to generating payment confirmations, reminders and other financial notices

  • Advanced Employer/Employee COBRA functionality

QHP Integration

The QHP Integration project focuses primarily on the Individual Marketplace. Projects include:

  • Extended functionality for caseworkers and DCHBX staff which includes the ability to make needed updates to APTC/CSR and manage Special Enrollment Period (SEP) requests and enrollment transactions

  • Enhanced outstanding verifications dashboard and functionality for DCHBX staff to review Fed Hub responses and consumer documentation submitted to establish and verify lawful presence. Project includes a consumer-facing dashboard that enables consumers to upload documentation and track their verification status

  • Benefit purchase shopping cart which will provide users with an Amazon-like commercial shopping experience.

HBX Core Reporting and Documentation

This project will establish a library of data-driven, core-mission reports and dashboards for the DCHBX. Statistical analyses will be conducted to identify quality attributes for the Exchange, establish baselines and determine metrics for reporting Key Performance Indicators (KPI). KPIs will form the basis of a DCHBX 'Vital Signs' report and corresponding set of online dashboards for use by DCHBX management, EDI Operations, and directors of SHOP, Individual and Plan Management marketplaces. This project will provide the following benefits:

  • Development of a series of online core-mission reports
  • Report generation using current and historical data
  • Ability for DCHBX leadership to monitor key performance indicators (KPI) for better informed decision making
  • Plan Benefits watch – enables regulators and policy teams to monitor issuer compliance with plan benefit offerings
  • Data-driven approach enables identification of trends in plan benefits and rates

UI and Consumer Decision Support Tools

We continue to focus on enhancing web-page features and usability as well as adding additional consumer decision support tools. Plan Match (powered by Consumers’ CHECKBOOK) helps DC Health Link individual market customers estimate annual out of pocket costs and see plans that cover particular doctors. We just recently deployed a new prescription drug look up feature that enables customers using Plan Match to include their prescription medication in the plan comparison. We beta tested Plan Match on our congressional customers last year and are looking forward to rolling out this tool to all of SHOP customers in 2017.

Our on-going user interface project is led by a senior-level user interface expert who we were recently able to transition from a consulting role to an HBX employee. This transition was important to us because we intend to invest in continuous user interface improvements. Our user interface work is grounded in data generated through in-person moderated user interface testing, customer and broker feedback, and feedback from stakeholders.