Failing Healthcare Exchanges Need Better Decisions

Managers of struggling state healthcare exchanges have much to learn from successful states; Progress Corticon would be a decision in the right direction.

Today’s Supreme Court ruling on Obamacare removed a measure of uncertainty surrounding the healthcare legislation, enabling states to proceed with plans to improve failing exchanges. As news reports have well documented, there are many failed health exchanges littering the landscape. Wasted time and lost dollars totaling in the hundreds of millions, combine with compromised web systems that fail to deliver the efficiency, cost savings and healthcare access promised to patients. As a doctor, and someone immersed in technology every day, I see this as a tragedy that could have been easily averted.

Common Crises in State Healthcare Exchanges

Articles about Maryland, Oregon, Nevada and more recently Hawaii's failed state-based health exchanges describe many common challenges that have to date, not been sufficiently addressed. Chief among the complaints is faulty technology that prevented those wanting to enroll from doing so. Regardless of where you stand on the topic in general, I think we can all agree that technology should work.

How States Have Survived ACA Obstacles

So what have the successful exchanges done to avert the problems experienced in so many states? Simple: they made better technology decisions. Successful IT leaders have anticipated the fluid nature of the federal healthcare laws, plan changes, regulations and state policies, and have built systems capable of changing in near real-time. This involved choosing technology capable of making better automated decisions as the systems scaled.

One key component of agile technology is a business rules engine (BRE) used to automate decision-making logic, such as the rules inherent in complex regulations and policies. By separating the decision logic from the code, a new world of agility opens. Implementing complicated rules changes is extraordinarily difficult to manage using traditional programming techniques, especially as the rules grow in volume. It could take weeks or months to implement a single change, during which time, other changes have been introduced. It’s a never ending quagmire and is impossible to stay ahead. The right BRE helps organizations keep pace with the inevitable changing requirements.

Business Rules Engine to the Rescue

By using the right BRE, organizations can build systems that scale to handle thousands of business rules and millions of transactions per day―all with the ability to make changes in minutes rather than months. This type of agility has enabled states using BREs to thrive where others failed.  Equally important, the right BRE technology helps to share rules across applications―and even organizations.

We’re proud that 26 states now use Progress® Corticon® to manage their business rules and deliver more responsive service to citizens. Corticon has come to the rescue for some of the recent failed health insurance exchange initiatives mentioned above. With Corticon, these states can easily transfer and reuse business rules successfully implemented in other states.  This enables them to get up and running in a fraction of the time (and with a fraction of the cost and risk) of alternative solutions.

Many states are still considering whether to build a state-based exchange.  We encourage them to take a look at Progress Corticon and the many states leveraging this powerful BRE technology as a part of their successful exchange. This webinar about our work with the Pennsylvania Department of Human Services is a great illustration of the power of a top-notch business rules engine like Corticon.