The District of Columbia Health Benefit Exchange Authority (DCHBX) is a state-based marketplace serving the District’s individuals, families, small businesses, and Members of Congress and designated congressional staff. DC was the last state to begin building its IT system, signing the IT systems integrator contract in January 2013. On Oct 1, 2013 DCHBX was one of four states to open on time and stay open. We opened for business serving individuals, families, and small business customers. In addition to customer portals (“DC Health Link”), we had a portal for brokers and assisters as well as case workers. The U.S. Office of Personnel Management designated us as the source for coverage for members of Congress and their designated staff, including field offices. President Obama enrolled in coverage through DC Health Link. Since Oct 1, 2013 we have had nearly a quarter of a million people come through DC Health Link – individual marketplace, SHOP, and Medicaid eligibility determinations. Since 2013 we have had a partnership with the DC Chamber of Commerce, the Greater Washington Hispanic Chamber of Commerce, and the Restaurant Association Metropolitan Washington.

Since opening for business Oct 1, 2013, DC Health Link SHOP has served more than 36,000 employees and dependents. By June 2017, we expect to cover over 4,000 small businesses with some 80,000 employees. DC Health Link offers full choice to employers and employees, and has done so since we opened for business. An employer can choose to offer all plans from all carriers in a metal level, all plans and all metal levels from one carrier, or one plan from one carrier. Approximately two-thirds of small businesses offer choice to their workers. For plan year 2016, DC Health Link offers 136 small group QHPs from Aetna, United, Kaiser, and CareFirst Blue Cross Blue Shield. Employers set contributions and can budget and control costs, while offering full choice of comprehensive products. In March 2016, we added dental coverage for SHOP employers.

The DCHBX team behind DC Health Link has a proven track record of success. Our IT team is directed by Suzanne Peck, who ensured our successful launch in 2013 and led the transformation from COTS products to open source state-of-the-art sustainable software and infrastructure. Having both private and public sector experience (Honeywell, METRO, DC Government Chief Technology Officer), Suzanne has a long history of success and is widely credited for moving DC from “worst to first” during her 8 years as DC CIO. DCHBX’s IT team includes people who have been in the private sector and in government and are part of the growing and nationally recognized DC tech corridor.

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The team includes tech wizzes who are entrepreneurs with successful start-ups and have experience in Fortune 500 companies and successful large IT companies including AOL, McAfee/Intel, JP Morgan, Thompsen Reuters, Revolution Health (Leonsis company), Best Buy, Amazon Web Services, Accenture, Bloomberg, GE, World Bank, Sallie Mae, Price Waterhouse Coopers and others. Our business team includes former federal and state senior level officials and our SHOP is headed by a former broker from a large agency with extensive insurance and ERISA employee benefits experience.

In 2015, we completely overhauled our SHOP platform. In addition to moving to a cloud-based, open source code approach, we made multiple improvements based on feedback from customers and brokers, as well as our own experience. A few examples include:

  • Reduced from 26 screens to 6 screens employee shopping, account set up, and plan selection.

  • Reduced from 22 screens to 5 screens employer application.

  • Streamlined plan offerings and contributions setup to occur all on one page for easier ability to make modifications to options and see the impact automatically reflected in the cost estimate on the same page.

  • Ability to upload roster of eligible employees, including new hires and terminations, through simplified spreadsheet at any time (i.e. during the initial employer application process as well as at any time throughout the plan year).

  • On-demand premium billing report available to employers (and brokers) at any time throughout the plan year showing all enrolled employees, their plan information, premiums, and contribution breakdown. Report is available as a downloadable spreadsheet for import into payroll systems.

  • Renewal plan year application is automatically created as a copy of the current plan year with all of the current plan year options pre-selected. This feature enables employers keeping their same options for the next plan year to click just one button and then to complete the entire renewal employer and employee process. Employees have the option to shop for plans during the renewal open enrollment period, but are not required to take action - employees who take no action by the end of the renewal open enrollment period are automatically re-enrolled in the same or comparable plan for the next plan year.

  • Features allow brokers to do everything for employers and employees.

  • Deployed a new portal for general agents and third-party administrators.

  • DC Health Link was built to work on smart devices, which makes it even easier for employers to offer health insurance.

We have also added decision support tools for employers and employees:

  • A single doctor directory for all SHOP products (in English and Spanish).

  • An estimator for employers to help employers decide what to offer based on their budget. This feature was designed by a DC Health Link small business customer.

  • We are testing a consumer decision support tool called Plan Match – which is a tool that allows employees to see their total out-of-pocket costs by plan including deductibles, coinsurance, copays, and premiums. This tool allows employees to include their doctors in the search and includes a pharmacy look-up tool that enables customers to enter up to ten (10) prescriptions and see a list of health insurance plans covering the medication and how each is covered. Plan Match is powered by Consumers’ CHECKBOOK and has been a great tool in the individual marketplace for our customers. We anticipate deploying Plan Matchl for SHOP customers in 2017.   Although we have the best SHOP in the nation, it did not happen overnight. We learned many lessons. We initially used a commercial off-the-shelf (COTS) product to build our SHOP. After the initial build, we faced millions in annual licensing fees for COTS products. Change requests were hundreds of thousands and at times millions of dollars due to the complexity of changing hard-coded software. Similar to custom hard-coded traditional state eligibility and other state IT systems, product development cycles were 6 to 8 months. Deployments required the Marketplace to be off-line in maintenance, which meant customers could not use DC Health Link while the system was down.

We now use open source code and an Agile approach. Open source code means that we no longer have licensing fees. The Agile approach allows us to make fixes, corrections, changes, and enhancements quickly. We can change our code daily without down time in a cost-effective way. Code fixes/upgrades are done while the production environment is open. Customers do not experience system down time for software upgrades. Changes are cost-effective because it is no longer hard-coded and does not require months of development and testing of the entire code.

We believe that the combination of our SHOP platform and our business and customer service approach offers a best-in-the-nation experience to our small business customers and their employees. We have a proven trackrecord of success with our Congressional customers and with all size small businesses – micro and larger small businesses alike. We use customer feedback and broker feedback to drive website improvements and new features. We sign up 40 to 50 new businesses per month, on average, and a recent internal survey shows that 40% of small businesses did not offer health insurance coverage to their employees before purchasing it through DC Health Link.

DCHBX proposes to establish a collaborative state-to-state partnership with the Health Connector. This partnership will provide a fully-operational, Health ConnectorSHOP Marketplace that is ACA-compliant and configurable to meet the Health Connector’s needs. A collaborative, state-to-state partnership puts the Health Connector in complete control of its own highly-responsive, built-to-purpose system that is capable of rapid (hours, not days) deployment, and provides configuration options necessary to support the Health Connector policies and requirements. Like DCHBX, the Health Connector will own its asset. Open source software licensing assures that the Health Connector will maintain access to the software code. The Health Connector would also enjoy access to enhancements which have already been programmed into DCHBX’s 2016/2017 development roadmap.

First Generation HBX System

DC Health Link’s first generation system consisted of several Commercial Off-the-Shelf (COTS) applications. A large systems’ integrator was engaged to ensure these dissimilar systems would be able to communicate and function together transparently to our customers. DC Health Link opened for business on time October 1, 2013 for both SHOP and individual marketplace customers.

Not long after the system launched, it became apparent that the task of integrating dissimilar COTS applications, with all of their complexities and proprietary elements, was going to be much more challenging than had been anticipated. These experiences were not unique to DC Health Link. The story is very similar to many other state-based exchanges that launched using COTS systems. Integration delays, deployment issues, and lack of scalability are common issues our customers experienced due to limited design and infrastructure.

The issues faced by DC Health Link and it’s customers, when combined with significant annual licensing and maintenance fees, made it clear that the original solution would not be sustainable.

Built-to-Purpose HBX Technology

At the close of the second open enrollment season in February 2015, DC Health Link made the decision to begin replacing its COTS system with an open source application for both the Individual and SHOP marketplaces. This new system would need to be robust and completely configurable to accommodate future changes in the marketplace.

DC Health Link engaged Ideacrew, a local, highly innovative development team, to design, build and operate its core mission technology systems, including: benefit enrollment, plan shopping, premium billing, notices, analytics and reporting. The team now supports the DC Health Link enterprise with full-service technology, strategic planning, business analysis, architecture designs, system integrations, cloud engineering and operations (DevOps), software development, and systems testing.

During a seven-month period in 2015, working with DC Health Link’s Business stakeholders, the IdeaCrew team developed a new e-commerce web site for DC Health Link. They replaced the underperforming, legacy system with a high-performance, reliable, and scalable solution. The new system is comprised of two core components: 1) Enroll Application for employer benefit design, roster management and employee enrollment, and 2) EDI Application for Health Insurance Exchange (HIX). The new system launched on-schedule in October 2015 and helped DC Health Link achieve a highly-successful 2016 open enrollment season (view press release).

Using open source software and shifting data center operations to the commercial cloud, the new systems immediately reduced costs. Through elimination of expensive legacy system licenses, change orders, and recurring maintenance fees, the savings were massive.

Given 2015’s successful transition, DC Health Link uniquely understands how to set up and operate with Massachusetts’s Health Connector, a shared technology and operational services model for a next-generation small group health insurance marketplace.