I had the opportunity to chat with Proteus Duxbury, the CTO of our Connect for Health Colorado (the Colorado health insurance marketplace) just after the start of open enrollment this year (a very busy time for CTOs of state health insurance exchanges). We are headed for a very exciting time here in Colorado. A lot of innovation will be headed our way around health, wealth and wellness in Colorado, and a central part of that is the Colorado health insurance marketplace. We are fortunate to have some great minds working to come up with new solutions and applying appropriate technologies to payment reform and populations health.
LK: Proteus, tell us a little bit about your background and how you came to be CTO of Connect for Health Colorado.
PD: I was a consultant for an international management consulting firm PA Consulting, operating across a broad spectrum of areas including IT strategy, program management, and enterprise architecture. Primarily for healthcare clients. Over that time, I worked for large payer, provider and life science organizations so had the opportunity to gain a holistic view across the industry of some of the important health care emerging trends and how they can be supported by new technology.
LK: It sounds like you have a good background then to see, and potentially bring together, a lot of different data types into this more holistic view and create a pretty different perspective of the health care industry.
PD: Yes, for example, I’ve helped small regional hospitals implement EHR, and worked with the largest pharmaceutical company in the world to integrate a new clinical/real-world data hub. So I’ve been exposed across the entire end-to-end spectrum.
LK: And you were also at Catholic Health Initiatives (CHI), headquartered here in Denver.
PD: I was director of IT for their virtual health services group, owning all technology for a division within CHI, which was promoting the use of telehealth, telepharmacy and telepsychiatry to provide care remotely, in rural areas, and developing new ways to engage consumers in actively managing their health. To help keep them out of the ER and reduce readmissions. That gave me an in-depth appreciation of consumer health care needs. I started this new role here at Connect for Health Colorado in January where I am heading up all technology initiatives. I’m responsible for providing a stable and robust platform for people to enroll and engage with us, reduce technology spend for our sustainability goals and protect the security or our data and technology assets.
LK: It strikes me that you have a really great background then in consumer-focused care, do you see your role with the Colorado Exchange as an extension of that? Certainly it’s a consumer-focused site, but how do you see this extending further into the healthcare value chain and providing better value care, better outcomes at lower cost?
PD: I think the health care provider has a central role of ownership around the introduction of new digital platforms for engagement. But I’m beginning to think that with the introduction of the health insurance exchanges, Connect for Health Colorado is starting to have a bigger role in developing relationships with a large set of consumers that have not had health insurance before or those who need extra help in navigating this complex market. These are quite often high-risk populations and consumers that we can really help to shepherd through the complex health care decisions they have to make on a daily basis. That includes selecting the right plan, helping to manage their health care and ensuring they are not surprised with unplanned high co-pays and deductibles. So, yes, I think it’s a natural progression for an entity like the exchange to be a trusted healthcare partner and be more involved in digital engagement.
LK: So let’s talk a bit about establishing that trust. Colorado has been ranked as one of the top rollouts of the state exchanges. All-in-all, things went pretty smoothly here and now you’ve just gone into open enrollment. What’s the secret to the success here?
PD: It’s a lot of things really: leadership, a solid technology product, and a hard-working set of partners. The exchange really had an excellent leader in (former Connect for Health Colorado CEO) Patty Fontneau. She and her management team were empowered to be agile and make decisions quickly. They were really successful in creating a vision and uniting a small team of highly-focused experts to get this deployed very quickly. Also, very early on there was a decision made to invest in a packaged solution called hCentive that turned out to be a very robust platform that we were able to implement in just 15 months. We also had a great partner in CGI who were very flexible in meeting our needs and working as a collaborative partner, pulling out all the stops to deliver at 110% in order for us to go live on time.
LK: And how many different plans are available on the exchange right now, I recall it’s over 100.
PD: Yes, there are 176 plans available right now.
LK: Through how many different insurers?
LK: So that’s a lot of complexity, integrating with a wide variety of information sources. Did those come prepackaged at all or how did that all come together?
PD: That’s the work that CGI did, they took the hCentive platform and used middleware to integrate it with our best of breed systems including CRM, financial management, noticing and external partners, like OIT, Healthcare policy and the division of insurance. None of this was 100% prepackaged and it took great collaboration with CGI to build out this architecture.
LK: Let’s talk about CRM as a basis for this kind of platform, do you see this kind of CRM becoming the basis for a communication management system between people and their care?
PD: We use a packaged Oracle CRM system that’s in the cloud and it’s pretty rich, but it’s very transactional. In order to really outreach and engage with consumers, particularly with Millennial consumers, who will comprise more than 50% of the market in the next 10 years, we need to look to innovative digital tools that we won’t get from a traditional CRM solution. For example the new mobile app tool that Deloitte has built for HCPF. It’s not just for displaying static information, but is exposing key interactive functionality from their benefits management system and makes it available in a really intuitive way. As an initial step, we’ll want to look at providing that kind of access.
LK: So it really will be more like a platform for innovation and outreach?
LK: You and I are participated in a panel recently on “Transparent Consumer Markets in Health Care” at the Colorado Capital Conference. Of course, that’s one of the driver’s for exchanges, to promote transparency, but long term, how do you see the role of the exchange in making healthcare more transparent and help people plan and make better decisions around health care?
PD: As an exchange, transparency is built into our mission and vision statement. Part of our mission is to increase affordability and choice. Our core purpose is to help people be healthier and secure, including financial security.
Transparency for us is critical and needed if you’re going to have true engagement because our consumers often make suboptimal choices when selecting plans. People tend to take shortcuts, or they’ll assume the one at the top of the list is the right one or assume the Gold one is the right one for them. We have a need to educate users very quickly and help them make trade-offs. Choice and information overload does happen very quickly, in about 10 seconds in newly-introduced choice dimensions. We need to provide transparent information about plans, carriers and the providers that are within those plans and cost and quality.
The cost dimension is critical because what a lot of newly-insured people don’t understand, and even what people who have had insurance their whole lives don’t always understand is all of the hidden costs. We know that these hidden costs are increasing dramatically. I referenced the Deloitte study of $672 billion dollars in hidden costs that are in the market. So, as much transparency as we can provide to help people make good decisions, it enables them to make the right health decisions, and financially they’ll be better off if they select the right plan, that has the right balance between out of pocket costs, deductibles, and premiums. And they can only make those decisions effectively if they have the right information on what it’s really going to cost them. That’s why we’re looking to partners like The Center for Improving Health Value, or CIVHC, and the all-payer claims database here in Colorado.
The next challenge will be how we implement the quality information and provider, carrier and plan consumer ratings to provide something that is not overly complex. The more transparency and tools you provide, the quickly it can become complex visually and people can get overloaded, so we need to find the best way to do that, but also provide as much information as possible.
And one final point, we’re doing this because the insurance marketplace is definitely changing with the prevalence of HSAs coming with high deductibles, and companies moving from defined benefit to defined contribution. More than ever before, consumers are having to make their own healthcare benefit decisions, and so what we do is going to affect not just their health, but their finances as well. Those are two core parts of our mission, and I think we’re in a good place to help people navigate those decisions because we are motivated only by our mission. We’re not financially motivated. I think that’s unique and powerful in addition to our unique focus on people who live in Colorado.
Stay tuned for Part II of my Interview with with Proteus Duxbury, CTO of the Colorado Health Insurance Exchange, Connect for Health Colorado.