Health Exchange

Background Information: The Affordable Care Act (ACA) required states to either establish and operate a Health Insurance Exchange by 2014 or participate in the Federal Exchange. States had the flexibility to develop an Exchange that meets the needs of their citizens and using one of the following models offered by HHS:

  • State-based Exchange 
  • State Partnership Exchange
  • Federally-facilitated Exchange

Exchanges are designed to make buying health coverage easier and more affordable. A state’s Health Benefit Exchange allows state residents to compare health plans including rates, benefits, and quality among plans to help individuals and small employers find an insurance product that best suits their needs.
Our Customer, as an early innovator, was tasked with building a state-based exchange. A full spectrum of health insurance plans tailored to the specific needs of Exchange applicants are offered, ranging from Insurance Affordability Programs (IAPs), which include the Medicaid Managed Care (MMC), Essential Plan (EP), Children’s Health Insurance Program (CHIP) plans, Advanced Premium Tax Credit (APTC) and the Qualified Health Plans (QHP). 

The Obstacles:

  • Evolving Requirements.
  • Stipulated Timeline.
  • Interfacing with both Legacy as well as New Gen systems.
  • Large number of interfaces also under implementation simultaneously.

How GCOM Assisted: Highly skilled resources from GCOM participated in requirements gathering, design, implementation and support for the following six core Business Areas of HBM:

  • Eligibility and Enrollment – includes Individual EE and SHOP
  • Plan Management
  • Financial Management - Risk and Funds
  • Customer Service - Channels (Navigators, Brokers, Agents, Customer Service Reps)
  • Interfaces
  • Common Services
  • Oversight

Also orchestrated and architected core Infrastructure Services supporting HBM. These include:

  • Core Virtual Server Infrastructure
  • Virtual Storage Infrastructure
  • High Availability and Disaster Recovery Infrastructure
  • Install and maintain of all COTS products
  • Messaging Backbone
  • Federal and State Data Sources Integration
  • Performance Engineering
  • SLA metrics and reporting
  • Integration with State Entities 

End Results: Stepped into the 3rd year with 2+ million successful enrollments.


Click below to see details on our capabilities within this project scope: