Governments are overwhelmed balancing consumer expectations, aging workforce, regulations, rapid technology change and fiscal deficits. This blog gathers a community of SMEs who discuss trends and outline how public sector organizations can leverage relevant best practices to drive their software-led transformation and build the future of technology – today!

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April 20, 2012

Revised ICD 10 Deadline - Time to Review Your Neutrality Strategy

With the CMS update on revised compliance date for ICD 10, State Medicaid departments get the much needed time to step up their ICD 10 compliance program and be ready by Oct 1, 2014. Broadly classified, each State may belong to one of the following categories based on their current state of remediation plan:

  1. Tracking to the plan of ICD 10 Go-Live by Oct 1, 2013
  2. Just started on ICD 10 and delayed by few months
  3. Procuring MMIS replacement and timing Go-Live of new ICD 10 compliant system by Oct 1, 2013


Most States would belong to the second category and additional time would help them complete their project tasks and be ready for Go-Live by Oct 1, 2014. States belonging to the first category can explore opportunity of dual support - ICD 9 and ICD 10, and Oct 1st 2014 can be a non-event. States that belong to the third category will be in a dilemma -  they will have to plan to either support ICD 10 on their current MMIS or support ICD 9 on new MMIS, which would mean the tasks and costs they hadn't anticipated, will have to be planned for, now.


Irrespective of the above categories, each State now gets additional time and they should take a step back and review their financial neutrality strategy. Especially, States that were planning to get compliant first and then leverage the advantages of ICD 10 should now re-prioritize and re-focus as they remediate their systems.

April 13, 2012

The Common Man's Exchange

Very mention of the word 'Exchange' in the United States is associated with Health reform and the PPACA act, and why not? This is probably one of the most discussed topics today! The Exchange which is supposed to make insurance purchase simple for the majority of uninsured & underinsured population has courted a lot of controversy and issues around implementation costs, self-sufficiency & sustainability, political conflicts, regulatory uncertainty etc.


While the act mandates that every individual needs to be insured by Jan 2014, the current scenario has confused the consumers as they grapple with basic questions - 'Should I purchase insurance right away from an existing agency or a private exchange? Or 'should I wait for the reform which claims to provide subsidies?' Something else that is troubling consumers is the confusion around release of such exchanges - every other State has its own conflicts with the federal government and is un-decided whether to set up an Exchange or not. Consumers are trying to understand -


  • What will happen to these Exchanges if and when there is a change in the government?
  • What will happen if a plan is discontinued in an Exchange due to non-conformance to federal standards and will the Exchange be able to provide an equivalent plan as replacement?
  • If and at all I have certain benefits from an insurance company due to loyalty to a certain plan even though I might be underinsured, is the switch to a new Exchange worth it?
  • Would I rather pay the fine than pay the big premium for my entire family?

As a consumer, what would interest me, should be the priority of every Exchange and every platform associated with it. The stakeholders responsible for designing these platforms should be able to resolve such issues quickly and make the process easy and seamless.


Every Exchange should be able to:

  • Tell consumers why they need insurance and what would be the benefits of buying insurance early
  • Explain why paying is not a preferred solution
  • Contract with payer partners to continue the "no-claims bonus" or other loyalty benefits
  • Simplify navigation and be User friendly - should make the process of insurance purchase as stress free and non-chaotic as possible
  • State facts clearly - be accountable & transparent

Most of the private exchanges look jazzy, carry a lot of fine-print and give an impression of being expensive. A successful exchange should address these and enable consumer to -

  • Choose suitable cover which does not have any hidden clauses and conditions
  • Choose a payer who would not hike rates unreasonably once the plan is purchased
  • Choose plans according to the quality of care the payer promises to provide 

Meeting the Cloud Imperative

While there have been many discussions around Cloud Computing, the adoption has been slow among public sector organizations. Despite plethora of information available around Cloud, State leaders still have differing viewpoints on how Cloud can help, how it can be compliant, how could security issues be addressed, which governance model would work best, how to identify and track outcomes and most importantly, how to procure these services quickly. Even the early adopters on cloud have started stumbling on what next after email migration. There is also a clear trend emerging that makes mobility and Cloud go hand in hand, thereby allowing applications to be less dependent on internal infrastructure and more universally accessible on a plethora of devices, where information can be accessed anytime and anywhere.


I recently served as a commissioner on Techamerica Foundation's State and Local Government Cloud Commission (SLG-CC) and helped publish the latest report- The Cloud Imperative: Better Collaboration, Better Service, Better Cost. The report analyzes these issues and outlines recommendations for State & Local governments to adopt and implement cloud technologies successfully.


We spoke to multiple stakeholders, researched and found that a successful cloud implementation demands a structured approach across dimensions such as infrastructure, people, processes and dollars. A typical implementation cycle spans 4 stages viz. Readiness assessment, Risk & Plan governance, Solution implementation and Operation, and transforms culture and processes. While cloud consumers don't deal directly with technology details, technical aspects around data governance, service model, service level, portability, privacy & security must be considered while planning for cloud roadmap and selection of a service provider. And, procurement can be accelerated by leveraging cloud-specific procurement models.


You can access the report here to know more about the technical, business and policy issues related to cloud adoption and learn about the program, project and operational best practices that will ensure a successful cloud implementation.

April 4, 2012

Navigators and their Role in Health Insurance Exchanges

Yes, consumers like online comparison, but buying health plans is more complex and invariably requires experts' assistance. Recent survey conducted in the State of Colorado revealed the importance of 'Navigators' in an Insurance Exchange. The study highlighted that people preferred a non-biased opinion/ suggestion/ guidance from the Navigators while choosing a health plan. And, in case they are eligible for State plans, they want Navigators to guide them to those relevant programs. These conclusions validate the importance of Navigators in building an effective exchange.

Until the concept of Exchange gets familiar, a majority of consumers will prefer live assistance. Thus, to build an effective exchange, we believe States should factor in the following elements to strengthen Navigators role -

  • Exchange portal for navigator functions that allows Navigators to work on behalf of the user
  • Compliance to HIPPA and Gramm-Leach-Bliley-Act (GLBA) in handling PHI and information sharing
  • Robust training/ product awareness program for Navigators
  • Transparent and well defined Navigator certification process
  • Navigator performance tracking & management
  • Incentives and payment mechanisms for Navigators
  • High Navigator availability - in real-time

There is often a question if the term Navigators can be interchangeably used for Brokers. Brokers have always been a part of the Health insurance industry and act as a liaison to create product awareness and enroll members. For long, Brokers have done a good job of representing the health insurers and representing the employers in negotiating a better plan. In the context of exchange, States are still examining the goals of a broker and the kind of guidelines they need to be subjected to, especially when it comes to State programs - Medicaid, CHIP and subsidy programs etc.

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