IT could be healthcare reform's highest hurdle

Politico reports that “IT could be reform's highest hurdle.”


Find the article, by J. Lester Feder, May 29, here: http://www.politico.com/news/stories/0512/76825.html.

While most followers of healthcare are awaiting the next big event – the Supreme Court ruling on the constitutionality of the Affordable Care Act, and in particular the survivability of the health insurance exchanges, Politico points out that even if they do survive the constitutional challenge, HIEs “could still be brought down by a much more mundane problem: information technology.”

It reports: “Even states that are solidly committed to pursuing an exchange are facing major logistical challenges in building the computer systems that will be able to handle enrollment when exchanges open for business in 2014.”

Here’s why: “the system that will actually connect people to the right coverage will have to “talk” to many other systems, and the systems don’t use a common language. This interoperability challenge extends to the federal level, where the US Department of Health and Human Services is responsible for a yet-to-be built federal “data hub,” that will combine tax information from HHS with the other information needed to establish that people are eligible for coverage. “Hardest of all” among the technology challenges is reportedly the Medicaid enrollment systems, remarkably: “many of which are not yet fully computerized.”

The report says that fewer than 20 states are moving forward to launch their own exchanges and that even for these, there is a concern “that the technology piece” will not be in place in time for them to open in 2014. The report cites experts who predict that “fewer than a dozen” states will be running full bore.

That shifts focus of the federal Department of Health and Human Services that is supposed to be in position to offer a “partnership” exchange for those states not ready or not willing to launch their own. “The need for real-time information creates a second problem for the exchanges. They have to build a way to integrate their system with the feds’ data repository — and that hasn’t even been built yet.”

HHS is overseeing the construction of its “data hub,” but technical specifications for transmitting data on the hub have not been worked out.

The report also cites a problem that there is “no standard format for private health insurers to give details on plan benefits and in-network providers to the exchange — key information an individual is going to want to know about a plan when enrolling in an exchange.”