Staggered launch could help Md. 'kick the tires' of its new health exchange website

A day after Maryland committed to a gradual launch of its health exchange, state officials are still working out some key details — including where the opening day sign-up will be held — but experts say it could be a way to avoid a repeat of last year's botched rollout.

Several health experts said the approach that limits enrollment in the first few days could allow Maryland to "kick the tires" on its new website.


"It's a controlled way to open enrollment," said Karen Pollitz, senior fellow at the Kaiser Family Foundation. "They can work with a controlled number of people for the first couple of days to see how this works in practice. I'm assuming there is some plan at the end of the day when people gather in a room and compare notes and say we need to fix this or that."

But Leni Preston, chair of the Maryland Women's Coalition for Health Care Reform, said she feared that a staggered approach might confuse consumers.


"My basic concern is the challenge of communicating this to the public," she said. "The national media is all going to be talking about open enrollment beginning Nov. 15. And that won't really be the case in Maryland."

Maryland plans to offer consumers the chance to browse plans, but not buy them, a week before open enrollment. Then, on opening day, there will be one enrollment fair where consumers can buy plans. On day two, consumers can enroll through the exchange call center, on day three they can go to a so-called "navigator" group for help signing up and on day four, the website will open to everyone.

Dr. Joshua M. Sharfstein, Maryland's health secretary and exchange board chair, said there will be a major information campaign, including social and print media. And this year, the exchange is also working to better staff call centers from the start to answer questions.

There will be 300 people in the exchange call centers, about the same number eventually employed last year, and hiring has begun. There will be an office for complex cases. The exchange also is contracting again with navigator groups across the state to help consumers.

Officials say they are still working out details about where the state's sole enrollment fair will be held on opening day and how many workers will staff it.

Other states have said they are taking steps to make the enrollment process go more smoothly, though it doesn't appear any are going to the same lengths as Maryland to stagger their website's launch.

Some states had similar challenges on opening day last year, but no other is rebuilding its site. Maryland ditched its technology and adopted software written for Connecticut's exchange. Other states fixed their sites, and Nevada and Oregon chose to go to the federal exchange.

But even in states that had more successful sign-ups, such as California, officials are mindful of early challenges of enrolling so many people.

A spokesman for California's exchange said the state plans to allow current enrollees the opportunity to renew in October, ahead of the open enrollment that begins nationally Nov. 15. The federal exchange, used by 36 states, will automatically renew enrollees who do nothing.

"I would not be surprised if we hear some more kinds of announcement from other marketplaces," said Sabrina Corlette, senior research fellow and project director in the Center on Health Insurance Reforms at the Georgetown University Health Policy Institute.

"They are taking a good hard look at the calendar and the capacity and some are saying, 'Oh, boy, we may need to look at more creative approaches here,'" she said.

The gradual launch model was not based on another state's plan but on general technology "best practices," Isabel FitzGerald, the state's secretary of information technology, told the Maryland health exchange board this week.


Pollitz said the Kaiser foundation employs a "soft opening" when they do a complicated survey about health reform. Officials often discover that a question is interpreted differently than they expected, and when they know early they have a chance to make corrections.

Consumer advocates are mostly optimistic the plan will work.

Vincent DeMarco, who heads the Maryland Citizens' Health Initiative, said it is a "smart approach to do this. This way, it allows us to take time and make it work right."

He particularly liked that Maryland has changed its system to allow people to browse plans ahead of open enrollment without an account. He said it was a mistake not to allow that last year, since creating an account was the main bottleneck in the system that prevented consumers from seeing their options.

Lawmakers, even those critical of last year's launch, said they are willing to give the soft opening a chance.

Sen. David R. Brinkley, a Frederick County Republican and frequent critic of the exchange's failures, said he was more concerned that state officials create a workable system and are able to enroll people.

"The issue is, can they meet the deadline and volume?" Brinkley said. "Perhaps this is one way to try to get the system from crashing. It's creative, and it's trying to filter people into it. As long as they can get to the deadlines and the end result, I think it's more important that they get it right."

Rep. John Delaney, a Maryland Democrat, said, "I haven't seen enough technical details to fully evaluate the current rollout plan, but I'm encouraged that they're already making adjustments ahead of schedule. Hopefully, we can avoid the problems that Marylanders experienced last time."

Baltimore Sun reporter Erin Cox contributed to this article.

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