Maryland looks to Connecticut as exchange model

Maryland will likely dump all or part of the state's health insurance exchange website and adopt Connecticut's system, a move that could make it the first state to abandon a dysfunctional site.

Officials with Maryland's exchange plan to turn to the "Connecticut solution," which was developed largely by Deloitte Consulting LLC and considered among the most successful in enrolling consumers in private health insurance under the Affordable Care Act, said two sources with knowledge of the situation.


Exchange officials insist that no decision has been made..

Connecticut's software is "on the table, among other options, but we've not made a final decision," said Carolyn Quattrocki, interim director of the Maryland Health Benefit Exchange.


"It's a multi-step process that we're undertaking," she said. "Then it becomes a recommendation to the board. The exchange board makes the final decision. We'll also need to work with our federal partners."

Many details remain to be worked out, and the plan could be derailed by logistics, costs or the federal government, which would likely be tapped to pay for the move, said the sources, who asked not to be named because discussions are continuing.

Maryland officials still need to decide how much of Connecticut's technology to use, how much of the existing architecture is salvageable and who would implement the changes. A big issue is how to enroll consumers in Medicaid, which Maryland now does through its exchange but Connecticut does not.

Officials in Connecticut declined to discuss any talks with other states, but they have been marketing such services to Maryland and others with potentially unfixable websites.

Leaders there said recently that they would have room to run one or two other states' sites wholesale on their servers out of their offices or provide guidance on how to hook up the technology. Connecticut also plans to integrate Medicaid enrollment into its exchange, called Access Health CT, but the timetable isn't clear.

So far, Connecticut, a much smaller state with fewer uninsured, has enrolled almost 57,500 in private health plans, compared with Maryland's enrollment of just over 38,000.

Maryland officials acknowledge a tight timeline to ramp up a new system. The current open enrollment ends March 31 and the next one begins in November.

They have outlined several options, such as moving to the federal site, fixing the existing site and adopting another state's technology.

Maryland's exchange — the Maryland Health Connection — crashed as soon as it launched on Oct. 1 and has been plagued by problems ever since.

Maryland's exchange officials brought in Optum/QSSI to assess options last December, and then the firm took over the site's management after the state terminated its relationship with its prime contractor, Noridian Healthcare Solutions.

The ultimate decision may be as complex as the website itself, one technology consultant said.

All of the technology developed by contractors for exchange websites is free for other states to adopt because it was paid for with federal dollars, but integrating the technology won't necessarily be simple or cheap, said Rick Howard, a research director at Gartner, an information technology research and advisory company.


Maryland has already reported that it expects to spend $261 million by 2015 on its exchange.

The state's website architecture Is far different from Connecticut's, so saving any portions of it could be tough, Howard said. But adopting Connecticut's system wholesale would require customization because Maryland has its own rules, consumer data and insurance companies, for example.

Maryland may be best off using the whole system and adopting new ways of doing business, he said.

"From a cost point of view, leveraging what's on the ground in Connecticut would probably pencil out as a lot less expensive than duplicating it in Maryland, which already has spent a lot of money," Howard said. "They could take Connecticut's work flows and processes to minimize customization."

Howard did say that even if Maryland is the first to dump it site in favor of another state's, it won't be the last. Fourteen states opted to run their own sites, leaving the rest on the federal site, which stumbled at first but now runs more smoothly.

He expected there would be a lot of consolidation of systems in the next three to five years, both among states with troubled systems and those who want to break off the federal site for something that better fits their needs.

Maryland lawmakers hadn't heard yet of specific plans to use Connecticut's system, but one in charge of a panel that oversees fixes to the exchange said Thursday that scraping the site in favor of Connecticut's model wouldn't be surprising.

"All indications are it's just a bad product," said Sen. Thomas "Mac" Middleton, a Democrat and co-chair of the legislative panel, about Maryland's site.

When Middleton first asked state officials about a backup plan, he said, they offered Connecticut as an option.

Baltimore Sun reporter Erin Cox contributed to this article.

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