With federal health care reform moving into implementation, technology plays a large role in streamlining the system. On Monday, IBM announced that its Curam solution will provide the technological platform for Minnesota's health insurance exchange.
Each state has an option to set up their own online exchange, or, if they decline, the federal government will provide one for them. In Minnesota, IBM will work as a subcontractor to Maximus, which is the prime contractor. Connecture is supporting the enrollment and health insurance sales functions, and EngagePoint, formerly Consumer Health Technologies, will provide financial management capabilities.
Solution for Healthcare Reform
IBM's Curam platform is based on technologies it acquired when it bought Curam Software in December 2011. The company has launched a Curam Social Program Management effort, which is designed to enable self-service, single-point access to social program delivery.
Within Social Program Management, a specific Curam Solution for Healthcare Reform provides what the company said is an "eligibility and case management solution that helps states address the Affordable Care Act requirements" with a central hub "for the array of systems and processes across the enterprise by delivering a common front-end for all eligibility and enrollment."
The platform provides functions and resources that have been designed specifically for health care reform.
These include a social program management data model which can also be used for other human services programs, a domain-specific eligibility and entitlement engine, expert-based out-of-the-box content that incorporates thousands of best-practice business processes and rules, and configurability features for adaptation to future changes. In addition, the platform provides business analytics and enterprise content management.
IBM Bidding for Other Exchanges
We asked Ernie Connon, IBM vice president for health and human services industry solutions, about the evolution of the Curam technology.
He said that Curam "had been around for about 20 years" when IBM acquired them. Curam, Connon said, had been building social services-oriented custom technology solutions for years, but about a dozen years ago decided "to productize these solutions" around the common requirements.
Connon said that, at this point, Curam's solutions have been deployed "to more than 80 agencies around the world," for such programs as income support, food stamps, or unemployment insurance.
In Minnesota's case, he said, the IBM platform will primarily be used for intake and eligibility determination, such as whether the user is eligible for coverage under the Medicaid expansion. Income level is, of course, a key determinant, and Connon said user-provided income and other information will be verified by the platform with IRS.
Connon said IBM has already been bidding "on a number of other state exchanges," although it wasn't ready to announce any of those awards yet. States have the option to customize their own exchange, he added, although "Minnesota has decided to minimize customization" so as to be ready for modifications in health care down the road.