Thought Leadership

Adding Value to CMS’ State Health Insurance Exchange: A Program Management Perspective


December 6, 2019

We met with Cognosante’s Theresa Roberts, Program Oversight Specialist/Project Manager and Ashley Daniel, Project Director to learn how our State Health Insurance Exchange Operational Oversight and Monitoring Support (SHIE OOMS) Program provides value to the Centers for Medicare and Medicaid Services (CMS).

1. Can you briefly describe how we go about managing this project?

We provide oversight and guidance for the SHIE OOMS program. We strive to provide coaching, and direction to the project team in relation to various issues, risks, activities, general management, and project approach. We also work closely with our subcontracting partners, Deloitte and Index Analytics, ensuring they have the tools necessary to succeed and so that we can work together, as one team, with united processes and communications both internal and external to CMS.

2. Could you briefly describe the SHIE OOMS project?

The State Health Insurance Exchange Operational Oversight and Monitoring Support or SHIE OOMS effort was awarded in June of this year. Since January 1, 2014, consumers and small businesses in every state (including the District of Columbia) have had access to obtain health and/or dental insurance coverage through Individual or Small Business Health Options Program (SHOP) Health Insurance Exchanges, operated by States through State-based Exchanges (SBEs), or operated by the Federal government through the Federally-facilitated Exchange (FFE). This contract focuses on the State Exchanges. The State Marketplace and Insurance Programs Group (SMIPG) falls under the CCIIO umbrella at CMS which oversees state compliance with the Exchange and with 1332 waivers. As states work to become and exchange, SMIPG provides ongoing technical assistance to meet the following CMS objectives:

  1. Maintain financially stable and competitive Exchanges
  2. Drive state innovation
  3. Promote program integrity

Cognosante provides implementation and ongoing oversight support of State Exchanges through the following:

  • Data collection, validation, and reporting on SBE & SBE-FP enrollment metrics
  • Oversight of the 1332 waiver grants for all states
  • Exchange transitions and technical or subject matter expertise

3. How are we providing value to CMS via this program? Are there any impressive results we’ve attained?

We are providing CMS with an organized approach to determine, validate, and report on open enrollment metrics for Medicaid, Child Health Plus, Qualified Health Plans (QHP), and Basic Health Plans (BHP). We are providing tools that the State Officers can utilize in facilitating the transition of states to an SBE/SBE-FP, which is streamlining and enhancing the process. We have supported at least 17 Open Enrollment Readiness Reviews, a benchmark period in which states report on results, strategies, and expected open enrollment performance and remaining preparation steps.

We collaborate with CMS regarding maintenance and oversight of the State-based Marketplace Annual Reporting Tool (SMART). The States Exchanges use SMART to provide CMS with required reporting data and will likely see a refresh in the next year or so. In anticipation of this, we are supporting SMIPG with an upgrade to the SMIPG SharePoint site set to go live later this month.

4. What, in your opinion, is the most rewarding part about this project?

There are several rewarding aspects to this project. We have an excellent team that is not only smart and skillful, but kind and willing to connect and share that knowledge or pitch in and support an overloaded team member. It’s rewarding to contribute to the success of states as they:

  1. Transition to become an Exchange
  2. Maintain existing Exchanges

Both scenarios are better supported by the introduction of efficient and effective processes. Whether you endorse the ideals surrounding ACA or not, it is important to utilize government resources wisely, which is what we’re accomplishing on the SHIE OOMS Program!