Kevin Counihan, the CEO of , is walking through the 15th floor of a downtown Hartford office building that houses Connecticut鈥檚 health insurance marketplace. He passes the legal department, the IT folks and the consultants, then stops in front of three large, wall-mounted computer screens.
鈥淭hese are showing in real time activity on our website. So, for example, right now you鈥檙e looking at the number of concurrent users on the site,鈥� Counihan says. 鈥淪o you can see that there are 212 people in the process of applying for insurance on the site.鈥�
Those metrics, monitors and technology are just a part of what his agency is doing well. Connecticut is widely seen as one of the states that is . Its website works well, and it has already exceeded its first-year enrollment goals. Other states have noticed.
Access Health CT opened the first retail storefront for a state exchange in New Britain, Conn., in November 2013. (Photo by Jeff Cohen/WNPR)
鈥淲e were approached by several states who called us and said, 鈥榃ould you have any interest in franchising your exchange to us as a state?鈥� And so, as we thought about that, we began coming up with this concept of an Exchange In A Box,鈥� says Counihan.
Think of it as Obamacare a la carte. Need a better executive team? Let Counihan鈥檚 people run your show, for a fee. Need help managing your vendors? They can do that, too. His technology infrastructure is 鈥渟calable,鈥� he says, which means don鈥檛 rebuild your own website 鈥� let them do it. They can deliver a state-specific look and feel, too. Sales. Marketing. Legal. Why do it yourself, when Connecticut can do it for you?
鈥淢y only point to some of these other states is, why go through all that agita?鈥� says Counihan, referring to the aggravation involved. 鈥淲hy recreate a wheel somebody else already built?鈥� Counihan says, sounding every bit the salesman. And he is, because the effort could help Counihan bring new revenue into the exchange.
The question is, can it work? Consultant Rosemarie Day of worked with Counihan years ago when Massachusetts built its own health insurance system. She says the idea of an Exchange In A Box is intriguing, but it鈥檚 got to be nuanced, too.
鈥淚 think you can鈥檛 just cut and paste, if it works in Connecticut, boom,鈥� Day says. 鈥淒oing that kind of organ transplant and reconnecting things can take longer.鈥�
She cautions that it鈥檚 important to consider the complicated insurance markets in different states and their politics.
鈥淪tates that have embraced having their exchange have a fair amount of buy-in from their governor鈥檚 office, and the governors wanting to put their own stamp on what they鈥檙e doing for their constituents,鈥� says Day.
Ego plays a role, too. States that seem like they are running successful exchanges may still need help behind the scenes, she says.
鈥淭hey may not be publicizing all of this, but they鈥檙e trying to make sure that they get out of that fingers-in-a-dike mode into something that is sustainable,鈥� Day says. 鈥淚f [Connecticut] can help them do that, that would be tremendous.鈥�
NPR/KHN reached out to several states that have struggled to implement Obamacare. None confirmed contact with Connecticut, but Oregon said it is looking at technology alternatives should its vendor not deliver by the end of March, and Maryland officials said earlier this month that they are actively investigating their options. Just this week, the state fired its health care IT contractor and picked a new one.
Not everything is perfect in Connecticut. The state鈥檚 Spanish language enrollment website 鈥� with barely a month to go before open enrollment ends. Still, people who work for Counihan say Connecticut has a lot to offer.
鈥淭he second name of this city is the insurance capital of the world,鈥� says Jim Wadleigh, the chief information officer for Access Health CT. 鈥淎s you look at our entire leadership team, we come from the Cignas, the Aetnas, the Uniteds, the Healthnets, all those companies. That is probably what鈥檚 helped us be so successful. We understand health care.鈥�
They also understand timing. Counihan says states that need help getting ready for the next have a few weeks to decide how to proceed. But the clock, he says, is ticking.
This story is part of a collaboration among , and Kaiser Health News.