New York's IT Readiness for Health Reform: A Gap Analysis

Health reform requires states to implement a "no wrong door" policy for accessing both public and private health insurance options and to establish health insurance exchanges as a one-stop shop venue to obtain coverage. Executing seamless eligibility and enrollment requires sophisticated information technology (IT) systems and infrastructure to receive, process, and transmit information between individuals, the exchange, employers, health plans, and Federal agencies. Robust, modern, and consumer-friendly IT systems will play a crucial role in the success of health reform.



A new report by Social Interest Solutions, conducted for NYSHealth, identifies the assets and deficits in New York State's IT readiness to implement health reform. The report finds that New York State has a strong technical architecture contained in its Medicaid claims system and powerful reporting and data analysis capability in its Medicaid Data Warehouse; both of these assets are highly leveraged in the State's Early Innovator approach. However, the IT inventory and assessment also identifies gaps, including the need to add a suitable front-end system that provides a "first-class customer experience," limitations in the State's Welfare Management System, and a need for functionality related to some commercial insurance offerings for individuals and small businesses. New York State will use its Early Innovator award from the Federal government to address these and other systems issues.



Access the entire report and appendices.