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State leverages a unified data model to ensure everyone is using a single version of truth

In response to the Affordable Care Act passed by Congress in 2009, a state-based health exchange made the decision to develop and deploy their own Marketplace to provide health insurance to everyone living in the state.

During the development and deployment of this exchange, Archetype worked along side the state to design an integrated reporting and analytics platform.

Problem

When the work started in 2013, the concept of a State-based Health Exchange or Marketplace was brand new to everyone. While the Federal government worked to clarify the framework, process and state requirements, states scrambled to stand up their Exchange and start measuring the impact.

Archetype played a key role in reviewing the requirements provided by CMS (Centers for Medicare and Medicaid Services) and worked to define a data model to begin reporting on the success criteria.

In parallel to the development of the Exchange platform, which leveraged multiple software products from multiple vendors, Archetype developed an integrated data model that provided end-to-end transparency on applications, enrollment and plan effectuation. Later this same data support supported period outputs for both CMS and IRS.

Solution

Archetype developed an integrated reporting and analytics platform that

  • provides real-time analysis of enrollment and plan effectuation,
  • identifies issues in the process that may prevent effective coverage for one or more citizens,
  • and provides timely reports to the State, insurance carriers and Federal agencies, including IRS and CMS.

Archetype’s familiarity with data flow and integrations of the Exchange and proactive approach to identifying and proactively communicating expected issues resulted in the State asking Archetype to lead a Data Integrity Team. That Data Integrity team worked alongside both the operational team and call center to proactively identify root cause issues and potential resolutions. The integrated data model also served as a data mart to merge and reconcile state reporting.

Archetype prepared all Federal submissions on behalf of the State. This state has been recognized by the Government Accountability Office as the only State-based Marketplace to completely satisfy all Federal submission requirements.

Result

Leveraging the work in this state, Archetype now offers HIXANALYTICS as a packaged solution for other State-Based Marketplaces.

HIXANALYTICS provides 12 subject matter areas with over 500 metrics and over 80 reports. These reports cover

  • Eligibility
  • Enrollment
  • Appeals
  • Service tickets
  • Operational Dashboards
  • and many Federal submissions.

Because they all leverage a unified data model, the State can be sure everyone is using a single version of truth. HIXANALYTICS is available in both an on-premise and cloud configuration and leverages state-of-art data visualization capabilities.