Maine co-op gets loan from ACA-based federal program.

There is a report this week that a non-profit group in Lewiston has received a $62 million loan as part of the ACA-defined program for setting up health insurance co-ops. The CEO, Kevin Lewis, comes from ten years at Maine Primary Care Association, an industry group of care providers focused on the "health care safety net". The cynical eye might see this as health care providers putting their heads together to figure out how to deal with the uninsured who show up at their doors. They have an ambitious schedule of developing their offerings and supporting infrastructure by 2014.

It should be noted that this doesn't seem to be a HIX, per se, but just a non-profit insurance company that will get subsidies for it's qualifying participants' premiums. Basically a private sector replacement of Dirigo Choice.

Enterprise Vendors

This is supposed to be a blog about technology so I think I'll take a quick survey (by no means comprehensive). As we get futher along we'll look at some of the technical specifications put forth by the government but for today let's see what's on the ground. With hundreds of millions of dollars in play, it is no surprise that many large and medium software vendors are putting forth their take on Heath Insurance Exchange software.

Oracle

Building around it's SOA infrastructure now called Fusion Middleware, Oracle is a little light on details around what they will provide out of the box but they stick with their industry best practice architecture of including a rules engine to go with their ESB. Their professional services group is usually pretty adept at fitting their technology stack into enterprise problem spaces, but the story has been a bit muddled since their Sun merger/acquisition. They do have a high-profile customer in this space of Oregon, one of the earliest and most enthusiastic states in the HIX field.

Microsoft

Redmond is always happy to throw things against the wall to see what sticks and woe be to those left holding the bag handed to them just months before by wild-eyed "technology evangelists". In this case, it seems they are at least leveraging the mature/venerable Biztalk platform they seem somewhat committed to, packaged with a CRM product that will really need to be shoe-horned to fit into the space in question here. While they do have some partners with expertise within this space that comes with challenges of it's own. For instance, the recent acquisition of Extend Health calls into question the availability some of the technology and industry expertise that partner brought to the table with it's Medicaid Exchange tool suite. At the end of the day, Microsoft's big play in the health care field, HealthVault, is on life support (see: throw things against the wall and see what sticks) and really is only tangentially relevant to the HIX space.

eHealth

From the health insurance industry-specific vendors we find set of tools that speak to a more ground-up approach rather than the top-down vision presented by the enterprise vendors. eHealth provides tools for health insurance carriers, agents and brokers to be able to collaborate on quoting, acquisition and servicing of group and individual business. Since a HIX conceptually is just a competitive bidding market place (similar to what plays out today in agencies and brokerages) with an additional layer of medicaid integration, tax credit calculation and reporting capabilities (amongst others) they seem well positioned to at least participate in the process. Many of their capabilities are "cloud-based" SaaS (Software as a Service) which does usually support rapid adoption and flexibility at the cost of vendor lock-in. The bottom line is that there is no complete solution here but some of the major components needed for carrier integration are.

In the next post we'll pick apart some of the technical specs being published by the feds.