As digital technologies advance, health insurance exchanges are increasingly moving away from on-premises infrastructures and adopting cloud computing practices, presenting agencies with an important choice: implement a hybrid solution – with elements of both on-premises and cloud computing – or move fully into the cloud.
The Hybrid Model for Health Insurance Exchanges
Hybrid models have been applauded for how they act as a bridge between on-premises and cloud solutions, allowing agencies to preserve select aspects of legacy systems while adjusting to key elements of cloud computing. Hybrid models also leverage strengths of both: some of the scalability and flexibility of cloud computing and some of the autonomy and control of on-premises models. Additionally, by offering gradual change, hybrid models often evoke less resistance among staff and require fewer up-front resources.
However, the dual nature of hybrid models also comes with downsides. Using both on-premises and cloud systems increases the inherent complexity in integrating those systems. As the risk footprint expands to cover both system types and their interconnection, this also introduces additional security risks, which compounds system complexity, equates to higher costs for the agency, and increases the likelihood that additional developments and adoptions will be needed over time. In our experience, this also tends to limit the scalability otherwise available with cloud solutions.
Fully Cloud-Based Health Insurance Exchanges
Fully cloud-based solutions, where all components operate on the cloud (e.g., infrastructure, storage, and applications) present a simpler approach. Benefits of this approach include:
- Unparalleled Scalability: Cloud solutions offer instant and almost unlimited scalability to handle both planned and unplanned fluctuations in demand, from events like Open Enrollment to public health emergencies. When polled, the majority of health care systems that switched to cloud computing experienced improved scalability and agility.
- Real-Time Data Processing and Interoperability: Cloud computing has also been shown to offer improved data shareability and system interoperability, with real-time processing for fast eligibility results and enrollments, easy integrations with external systems, and no on-premises systems to create bottlenecks.
- Enhanced Security: While security concerns are cited as one of the most common hesitations to fully cloud-based solutions, research indicates that fully-cloud based models may actually provide more comprehensive security than on-premises or hybrid models. Cloud providers typically have access to more advanced security measures than state agencies, and cloud services are continually updated to offer leading-edge security with little cost or effort to agency clients.
- Long-Term Reliability and Cost Savings: Cloud providers also generally implement robust infrastructures with a high degree of redundancy and multiple availability zones to ensure high uptimes. Cloud providers also offer excellent incident support, regular system upgrades, and ongoing innovations to keep systems relevant, reliable, and secure. These services are commonly provided at no additional cost to clients, further reducing the amount of agency resources required for long-term system success.
How AWS Supports Full Cloud Integration for Health Insurance Exchanges
GetInsured has been operating state-based exchange (SBE) platforms fully on the cloud since 2014 and currently uses Amazon Web Services (AWS) for its cloud infrastructure. With “the most proven operational experience of any cloud provider,” AWS has been used by government and health and human services agencies and businesses across the country, from the U.S. Department of Treasury and Department of Homeland Security to companies like Merck and Moderna.
AWS GovCloud is a security- and compliance-focused cloud solution that is specifically designed for government operations involving sensitive information. AWS GovCloud features geographically separate cloud regions, restricts access to the United States, and has extensive security, identity, and compliance features, including FedRAMP and NIST 800-53 alignment, SOC certification, and a multitude of HIPAA eligible services. Using AWS GovCloud, GetInsured has offered exchanges secure, easy integrations with third-party systems – including CMS and Federal Data Services Hub (FDSH), health care providers, insurers, and state agencies – facilitating enhanced communication and service quality. We have also adapted the advanced analytics, AI, and machine learning tools offered by AWS and other partners to provide exchanges with improved fraud detection, real-time visibility into operations, and cost monitoring tools.
Fully Cloud-Based vs. Hybrid: Why Make the Shift?
While the hybrid model has played an important role in the shift to cloud computing, it is perhaps best understood as an intermediary step rather than a final destination. Transitioning to a fully cloud-based solution may require more change effort and investment up front, but in the long term, this approach presents a more streamlined, future-proof, and cost-effective solution – one that eliminates the complexities of maintaining two data systems and requires fewer agency resources over time.
Case Study: Nevada Health Link Cloud-Based Exchange Success Story
The history of Nevada Health Link illustrates the benefits of adopting a fully cloud-based exchange solution. In 2013, Nevada began a contract for a custom-built on-premises solution that featured considerable defects and ultimately failed to meet enrollment targets. By 2015, Nevada transitioned back to HealthCare.gov, but the federal platform’s gradual two-year transition to primarily cloud-based operations led to rising costs that were quickly no longer practical for Nevada. So, in 2018, after a competitive procurement process, Nevada partnered with GetInsured for a fully cloud-based exchange. This shift to cloud computing led to the successful adoption of ground-breaking AI technology, steadily increasing consumer enrollments that surpass target goals, and cost savings for the Nevada Exchange of approximately $18.9 million through 2023.
Addressing Common Concerns about Going Fully Cloud-Based
Today, one of the biggest hurdles to adopting fully cloud-based solutions is a lack of administrative and public support. Even though interviewed experts agree that cloud-based solutions are often more secure than on-premises or hybrid solutions, security concerns remain one of the most common reasons for this lack of support. As one expert remarks, “CC [cloud computing] is safe. The problem is how to make people believe that.”
Many agencies also report concerns about having the knowledge and expertise needed to transition to a fully cloud-based solution, but agencies don’t need to do this alone. GetInsured has proven experience helping states across the country successfully navigate this transition, and we would be honored to help your agency do the same. We know the importance of cultivating staff, partner, and public support during times of change and have in-depth communications plans in place to help agencies do just that.
The Future of Health Insurance Exchanges in the Cloud
Cloud-based solutions currently make up 40% of the global health insurance exchange IT market – more than either on-premises (31%) or hybrid solutions (29%) – and market forecasts predict that the central role of cloud computing is here to stay. Forecasts also predict that the market value of all three types (on-premises, hybrid, and cloud) will nearly double by 2032, with fully cloud solutions anticipated to reach a value of $4.2 billion.
As we look to the long-term future of exchange operations, the value of fully cloud-based solutions only grows. Their nearly unlimited scalability and flexibility make cloud solutions particularly adaptable to future changes and demands, and their enhanced data sharing and interoperability are more than promising for the future of No Wrong Door initiatives. Furthermore, the ongoing innovation observed among cloud providers means that services never stop advancing. Some of the current innovations being developed by cloud providers include advanced AI for personalized health recommendations, telemedicine integration, and blockchain for secure data sharing.
As security and interagency communication become increasingly important, fully cloud-based solutions are poised to become the gold standard for health insurance exchanges – providing greater agility, cost savings, and customer satisfaction. While shifting to a fully cloud-based exchange may seem daunting, GetInsured is ready to help agencies through this transition.
Read more about our cloud-based SaaS exchange solution or get in touch with us to discuss how our solutions can be tailored to the needs of your agency.
