Established under the Affordable Care Act (ACA) of 2010, a Health Insurance Exchange (HIX) is an online marketplace that allows consumers to compare individual health insurance plans from different providers to find the best fit and rate. The Maryland Health Benefit Exchange (MHBE), an independent state government unit that provides health coverage to Maryland residents, set out to create its own private HIX platform — a project that earned MHBE a CIO 100 Award in IT Excellence.
The main goal of MHBE’s HIX project was to “provide a better and engaging customer experience for existing customers and identify new avenues to target and enroll the uninsured population amidst a tightly regulated marketplace with limited resources earmarked for innovation in State systems,” says Venkat R. Koshanam, CIO of Maryland Health Benefit Exchange.
Here’s how they did it.
Developing a scalable industry-ready solution
Koshanam partnered with MHBE’s executive director and senior leadership team to develop its HIX platform with an eye toward not only getting more people insured and helping customers understand their benefits but also to provide better support.
These days customers expect mobile platforms and easier access to customer service in every industry, including healthcare. But strict compliance regulations and laws create unique challenges for healthcare organizations.
“Despite the independent agency status enjoyed by the MHBE, revamping integrated government systems pose inherent challenges like adaptability to technological changes, system ownership, compliance, governance, and operational accountability,” says Koshanam.
Other private HIX platforms have struggled when they couldn’t be continually enhanced, so Koshanam and his team sought to knit adaptability into its platform from the outset. Doing so would help MHBE “respond to the growth-landscape of the retail segment of the market” and keep up with the need for continual growth and improvement.
MHBE then brought together operations, marketing and IT to establish business needs, landing on the need for a digital API, integrated mobile platform and a marketing portal ripe with analytics to enable the marketing team to target specific groups and connect directly with customers.
In developing its HIX platform, MHBE took an agile approach, involving stakeholders in daily standups, hands-on working sessions and regular status updates directly from the CIO. It was important to keep everyone involved since they all had a say in the final product.
“During the initiation phase of the project, teams across functional areas defined the vision and scope of the platform and IT developed a highly scalable digital API based architecture including the metrics framework required by the business,” he says.
One of the biggest hurdles to instituting organizational change is getting leadership on board with a singular vision. MHBE’s HIX team was lucky in that everyone agreed that the goal was to improve customer engagement, while encouraging new customers to enroll in the Health Benefit Exchange. Together, the business and IT sides were then able to build a solution that was realistic for IT but also supported this goal.
“The IT team created a solution architecture based on the business vision and strategy and engaged with the business team from the inception of the project to set the direction of the project and system features,” says Koshanam.
To demonstrate ROI and show early results, MHBE established a “well-defined structure for project delivery” that depended on strong relationships with stakeholders, “prioritizing core initiatives” and implementing the project through multiple releases.
MHBE also relies on a metrics framework that enables the organization to continually monitor the platform’s value and engagement.
“As an example, we now see 65 percent of our customer traffic coming via mobile devices. We see record traffic of more than 5,000 concurrent users on our systems when we send out push notifications to customers, which is 10 times our usual peak traffic. We have also seen customers downloading our mobile app more than 350,000 times, check their notices and messages over 2.5 million times, see their enrollment information 5 million times, showing heavy, and active usage of the platform for health exchange solution,” he says.
Taking a more holistic approach to mobile development
Ultimately, all of MHBE’s hard work paid off — the first phase of the project went live after six months and was completely launched in 18 months after just four releases. Koshanam attributes the project’s success to strong leadership, noting that he felt it was his responsibility to “instill confidence” in fellow leaders and his IT team.
He also attributes the project’s success to sufficient budget allocation, embracing agile, hiring a strong team with the “right skills to develop and execute” this big of a project, efficient procurement and use of technology and human resources, rallying leadership support to ensure all solutions met regulatory and compliance requirements.
If his team were to do this project again, they’d take a more holistic approach that addressed a mobile strategy from the start, Koshanam says, and he would advise other organizations to do the same.
“The mobile channel is an extremely important consumer channel that we cannot ignore for consumer-focused platforms, so it is best to keep it in mind right from the outset,” he says.
Overall, the project was a successful in increasing user-engagement and enrollment in “historically lower-enrolling segments,” and Koshanam also noted an improvement in customer service and engagement including reduced call center volume (30%), abandoned calls (67%) and call wait time (90%).
“This innovative project has transformed our consumer experience and empowered the business with a best in class platform for individual health insurance and benefits across public and private sector,” says Koshanam.