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DC pivots for Rescue Plan’s health benefits changes

The Washington, D.C., Health Benefit Exchange Authority (DCHBX) pushed out new features that reduced users’ health insurance premiums just two weeks after President Joe Biden signed the American Rescue Plan of 2021.

To do it, DCHBX built on the modern IT infrastructure that it began putting in place in 2013 with IdeaCrew, a full-service IT company focused on health care, DCHBX Executive Director Mila Kofman said. The authority runs DC Health Link, the District’s state-based online health insurance marketplace established under the Affordable Care Act.

“Agile, cloud-based, open-sourced,” Kofman said about how the authority was able to move so quickly. “It’s very modular. We don’t have to deploy a whole new code, for instance, any time we do a new update,” she said. “In fact, we can do updates every day if we wanted to … and the [user], next time they log in, they see the new features.”

Nothing goes live without thorough testing, she added, and “being in the cloud allows us to really in a matter of minutes set up environments for testing…. In the old days, we had to wait several months to get an environment. Technology really matters.”

DCHBX and IdeaCrew began planning for the changes once they had a sense of Congress’ response to the American Rescue Plan, which Biden signed March 11. The law meant that anyone who received unemployment insurance in 2021 was eligible for premiums that are as low as $2 per month, Kofman said. Additionally, it expanded the number of people who qualify for lower premiums and how much coverage they qualify for.

On March 29, users who went to DC Health Link and provided income information instantly saw a lower premium, Kofman said. “What we were able to do very quickly,” she added. “Everyone whose income information we had, we automatically ran redeterminations for them so they didn’t have to do anything.”

Another IdeaCrew tool let DCHBX calculate the amount a person was eligible for as of Jan. 1 and apply it going forward, which also lowered premiums.

For the 100,000 people who use DCHBX, it has saved $36 million. For instance, some customers went from paying $357 for coverage to $3.76 for the same coverage.

“The fact that we were able to do that a couple of weeks after the bill was signed, it’s huge,” Kofman said. “Having good technology that works and can be changed quickly and efficiently in a cost-effective way is great, but the bottom line is it’s great because it’s the residents that benefit the most.”

IdeaCrew has helped DCHBX modernize its marketplace technology to fully integrate both individual and small-business portfolios. The platform’s open standards and the Amazon Web Services Government cloud created a system that increased enrollment from 20,000 to 100,000 and eliminated paper applications.

Initially for the marketplace, D.C. had hired an IT systems integrator, but when Kofman came onboard as the authority’s first employee in 2013 and began working with a big vendor, she realized that things would move too slowly and be too costly. What’s more, the initial system, which was data-center-based, required lengthy lead times to make even simple changes, she said. IdeaCrew came in and helped HBX move to the cloud, which saved the authority $2 million a year.

The company’s approach is two-pronged, IdeaCrew founder and CEO Dan Thomas said. “For an effective exchange, you need an e-commerce-style system facing the public so that it operates very quickly and can do high transactional throughput,” he said. That component, built for the enrollment process, must integrate with federal and state systems to determine certain requirements, such as someone’s lawful presence in the country. 

The second component is the communications and exchange with the insurance carriers. “As you can imagine, they’re going to be very interested in the dollars,” Thomas said. The carriers need to be able to correlate data on the funds collected with the enrollment information “so that they know that they are getting paid properly,” he said.

Since DCHBX opened for business, it has halved the uninsured rate in D.C. Now more than 96% of the population is insured, and the District ranks second for the lowest uninsured rate, behind Massachusetts. In fact, that state partnered in 2017 with DCHBX to allow the Massachusetts Health Connector to use a branch of DC Health Link’s online platform to improve offerings to small businesses and their employees while reducing the long-term operational costs for the small-business online system.

IdeaCrew’s model is transferrable to other states, Thomas said. Maine recently taped the company to help it transition from a federally facilitated exchange to its new state-based marketplace.

About the Author

Stephanie Kanowitz is a freelance writer based in northern Virginia.

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