Demystifying Health Insurance Exchanges

Obamacare’s new health insurance exchanges are scheduled to open for business Oct. 1. But a recent survey shows that nearly 80 percent of those who stand to benefit have no idea what an exchange is or how to get the health insurance subsidies they will offer.


That’s where the private nonprofit Enroll America comes in. The group, which has strong ties to the Obama administration, has been using more than 100 staff and about 3,000 volunteers to go door-to-door and to stage community events this summer to inform people about the opportunities for health care coverage on the exchanges.


Its president, Anne Filipic, announced Monday that the group would focus most of its effort on 10 states with the largest number of uninsured and the lowest level of state-funded outreach: Arizona, Florida, Georgia, Illinois, Michigan, New Jersey, North Carolina, Ohio, Pennsylvania and Texas. All but Illinois have Republican governors.


California was left off of the list even though it has the most uninsured residents and among the highest percentage of uninsured population in the country at 20 percent. But with more than $600 million expected in state and nonprofit funding to support outreach efforts locally, Filipic said her group chose to support California’s efforts rather than launch its own.


“Our focus,” she said, “is on states that do not have a robust infusion of resources.” In the remaining 40 states, the group’s regional directors will be working without staff to support state-led and other local efforts.


When the exchanges open, anyone who does not already have employer-sponsored insurance will be able to comparison shop for coverage and find out whether they qualify for federal subsidies to help pay for their policies. Visitors to federally funded websites and call centers will also find out whether they qualify for Medicaid or the Children’s Health Insurance Program, and they’ll be able to sign up for that coverage immediately. Policies purchased on the exchange will take effect Jan. 1, 2014.


Enroll America stressed that it is not helping people sign up for insurance but informing them of their options. In the 10 target states, Filipic said the goal is to recruit and train volunteers and work with existing organizations, such as schools, churches, community health centers and other groups to build an infrastructure that will spread the word on Obamacare starting now.


The Obama administration is scheduled to announce Thursday how it will dole out $54 million in federal money to hire so-called “navigators” who will help people actually sign up.


This article was originally published by Stateline. Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.

App Helps Victims Report Sexual Assault Anonymously in D.C.

A new app launched last week in Washington, D.C., assists victims of sexual assault, domestic and dating violence. Users can report incidents anonymously and find other helpful resources.


The free app, called ASK DC (short for Assault. Services. Knowledge.) is a joint effort between Mayor Vincent Gray’s Office of Victim Services and nonprofit organization Men Can Stop Rape. Once downloaded, users can access 33 assault-response resources including medical, law enforcement, 24-hour support hotlines and more in the D.C. area.


The app is part of a larger, districtwide initiative that includes a website and training materials intended to help raise community awareness about sexual assault and dating violence.


“The ASK DC app is not just for assault victims,” according to a statement from Men Can Stop Rape. “The bystander tools and resources provided can be used by anyone to direct a friend, family member or a colleague who may have experienced sexual assault to the help they need.”


Melissa Hook, director of the Office of Victim Services, said men are also encouraged to download the app in the event they are a bystander in a crime like sexual assault.


Since the app allows victims direct access to medical attention, they can get properly examined before reporting the assault to the police, Hook said. Providing multiple resources through the app connects victims to numerous response and support options, even if they don’t report the assault right away.


“The practical details are sometimes the biggest barriers in the middle of the night when someone’s traumatized,” Hook said.


To reach beyond English speakers, the app offers services in English, Spanish, French, Amharic, American Sign Language, and more than 20 different Asian languages. Legal assistance is available for immigrant victims, and the app connects those visiting from abroad to their home country’s embassy or consulate in the U.S.


But before the app was available across the District of Columbia, a similar app was launched on a smaller scale.


ASK DC was modeled after U ASK DC, which was released last year across Washington D.C.’s college and university campuses, mainly to help women report sexual assault and violence. Hook said D.C.-area colleges were seeing a spike in the number of assaults and needed a more coordinated response.


The mayor’s office reported that prior to the launch of U ASK DC, sexual assaults on campuses had been greatly under-reported. The success of U ASK DC later incentivized the mayor’s office to expand the project districtwide with the launch of ASK DC.


ASK DC can be downloaded for BlackBerry, iOS and Android devices.

Virtual 3-D Desktop Targets Medicine, Education

Some organizations are looking to a new form of virtual reality to conduct research, educate students and accomplish medical tasks.

Take the Bullis Charter School, a kindergarten through junior-high school in Los Altos, Calif., which is building a fabrication lab (FabLab) that will use technology complete with  a pair of 3-D glasses, a stylus and software integration — along with 3-D printers —  to allow students to create things in the 3-D space, and then materialize their creations once they’re complete.

Developed by a company called zSpace, the new product allows its users greater immersion in their work, while facilitating a work environment more in tune with the 3-D world people are used to. The leap from 2-D to high-resolution 3-D on a person’s desktop is so dramatic and beneficial, said Chief Technology Officer David Chavez, that this technology will eventually become a standard part of a computing work environment.

Bullis Charter’s Superintendent and Principal Wanny Hersey said via email that such technology supports the school’s mission of individualized learning. The school provides a wide variety classes and programs, from things like Lego robotics to guitar, and this FabLab, she said, was a natural extension of the school’s mission to provide opportunities for their students to pursue their passions and discover new areas of interest.

At a cost of about $60,000 for equipment — which includes the zSpace system — the FabLab will give students a head start toward a career in IT or engineering, if that’s what they want, Hersey said.

“Students will now have the opportunity to use the latest technologies to create and test a prototype for their solution, in a process that mirrors what takes place here in the Silicon Valley,” she said, adding that traditional education models have not provided students with such opportunities, and the Bullis FabLab is an opportunity to provide their students an opportunity to learn by doing, while providing a model for other educational institutions to see what’s possible.

And across the country in New  York, the Touro College of Osteopathic Medicine also is deploying a virtual lab using the system — which costs  about $4,000 —  that will allow students to perform autopsies on virtual cadavers.

“It’s going to make a lot of people a lot more productive. There’s no question about it,” Chavez said. “Our vision is to give this to everybody. And there’s no doubt in my mind it’s going to happen. It’s that significant.”

Any applications that involve imaging, he said, such as CT scans or MRI, would benefit tremendously by entering a 3-D interface.

As seen in the video below, the system works in a fashion somewhat similar to what Tony Stark uses in Iron Man to virtually build and perfect his suits — but perhaps a very, very early iteration. People use a stylus to pull objects out of screens into the air in front of them, rotate objects and perform various other spatial tasks, and sometimes share the vision with another user wearing their own pair of 3-D glasses, as the system is designed for collaboration both locally and remotely.

What using the technology is like is difficult to explain, Chavez said. “I tell people, ‘You’re not going to believe this.’ It’s the coolest thing I’ve ever worked on. I’ve been making things in Silicon Valley for almost 30 years now, and this is the most exciting. I’ve never seen anything elicit such reaction from people. … It’s almost impossible to set people’s expectations too high.”

And the benefits in the educational and medical field are tremendous, Chavez said.

“They think students will be more immersed,” he said, noting that students will spend more time because, in the case of the Touro College of Osteopathic Medicine,  virtual cadavers have many advantages over a real cadaver.  “If you make make a mistake,” Chavez said, “you just put it back.”

Just as with any virtual system, the zSpace 3-D system allows for functions like adding or removing layers to an image, turning it or undoing a mistake — only everything is in 3-D.

Additionally, the zSpace system provides users with 1920 x 1080 resolution as they sit at a desk and use a stylus, whereas traditional virtual reality uses a “cave” that the user must physically walk into while wearing a headset and pointing a device at the walls, he said. The ability to sit at a desk provides comfort and precision, while making collaboration much easier, he added.

“It’s just the beginning,” he said. “It’s our first product. Some people say, ‘Wow! That’s really cheap for what you get’ and other people say it needs to be a lot lower [in price] for mass penetration.”

And, Chavez says, both of those things are true.

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Bio-Threat Early Warning System Gets Booster Shot

A statewide bio-surveillance system designed to provide early detection of potential health threats has received a $3 million grant from the U.S. Department of Homeland Security (DHS) to continue its research efforts.

Called the North Carolina Bio-Preparedness Collaborative (NCB-Prepared), the group was formed in 2010 through an initial $5 million grant from the DHS. The public-private partnership includes representatives from the University of North Carolina at Chapel Hill, North Carolina State University and SAS. The new funding will be used to expand the system and help determine how information from the collaborative can best be used by local, state and federal agencies.

The group’s detection system accumulates disparate data streams from a number of different sources. Those feeds include recent life-threatening disease cases from emergency medical services, reports about food production and information from animal and human clinical services. 

That data is combined and analyzed by NCB-Prepared members using the collective’s proprietary text analytics and analysis approaches. The group is then able to predict whether a particular health event is a sign of a pending disease epidemic or evidence of a terrorist release of a pathogen in the food, air or water supplies.

According to Charles Cairns, principal investigator with NCB-Prepared, the collective’s goal is to detect outbreaks quickly and get the data to decision-makers who can intervene and save lives. He views the system as a way to speed-up intervention efforts, as opposed to traditional disease surveillance methods that are centered on investigating a health event and its origins.

“One of the things we’re trying to do is literally detect things within hours or days,” Cairns said. “And we’re trying to recognize cases, classify them as a particular disease or health challenge, understand the change … over a particular geography or a particular time, and then be able to understand what’s going to happen next.”

The University of North Carolina’s Department of Emergency Medicine played an early critical role for the collective by taking a close look at emergency department data across the entire state. The department developed data standardization approaches including information collection forms and systems that were used statewide in the system’s beginning stages.

The NCB-Prepared team is made up of public- and private-sector medical, public health, technology, sociology and psychology experts. The group also includes emergency management officials and first responders.

Barbara Entwisle, vice chancellor for research at UNC Chapel Hill, called the collective and its system a “powerful tool” to stopping outbreaks before they become widespread public threats.

“This is one of those areas where, using data and new technologies, university researchers and our industry partners can make a real difference in peoples’ lives,” Entwisle said in a statement.

Early Returns

The system has already been successful in several cases. In 2011, the collective identified an outbreak of norovirus three months earlier than it was announced by public health officials. Cairns explained that his team used the bio-surveillance system to obtain data from pre-hospital providers, such as paramedics, and using the collective’s analytic approaches was able to determine the outbreak’s severity. The findings were made public at a meeting of the International Society for Disease Surveillance in 2011.

NCB-Prepared also was successful in determining the severity of last year’s flu outbreak in North Carolina. The collective evaluated a series of Internet search terms and emergency medical services records, and accurately predicted the severity of the 2012 flu season three months ahead of the Centers for Disease Control and Prevention’s public announcement.

According to Cairns, the group is effective because of the early access it has to data from an event where people cross paths with the health-care system.

“Our current approach is to really look at emergency health data, so we’re not looking for things that aren’t severe or aren’t life-threatening,” he said. “We’re really focused on that slice of data because we think that’s the best opportunity to intervene and save lives.”

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Virginia’s Identity Verification to Reduce Fraud and Increase Efficiency in Shared Services

A technology project that started with a focus on Medicaid will soon produce Virginia’s first enterprise shared service for e-government applications. Called the Commonwealth Authentication Service (CAS), the new system will offer a way for any Virginia agency to manage the identities of people who do business with state government online.

Virginia agencies already take advantage of shared services for internal functions like email, employee identity management and data storage, said state CIO Sam Nixon (pictured above). But CAS is breaking new ground. “This will be a shared service, state-of-the-art identity management that will be citizen facing.”

CAS got its start about two and a half years ago, as Virginia’s Department of Motor Vehicles (DMV) started making plans to buy a set of Oracle Corp. identity management tools.

“That’s quite a powerful suite to have for just one agency,” said David Burhop, the DMV’s deputy commissioner and CIO. As fortune would have it, though, another state department also needed those capabilities.

Virginia’s Department of Health and Human Resources (HHR) was gearing up to comply with the new federal health insurance law, which meant implementing new technology to manage its Medicaid programs and determine eligibility. That system required an identity management component — a system to ensure that when John Doe applied online for benefits, the government could trust that he actually was John Doe.

And officials at HHR didn’t just want their new eligibility system to work for Medicaid; they wanted to use it for a broad spectrum of programs dealing with health care, hunger, disabilities, child care and other issues.

Sharing the same back-end technology would let HHR’s agencies also share information, said William Hazel, Virginia’s secretary of health and human resources. “If someone’s applying for benefits in multiple programs, you don’t have to put the same data in multiple times.” Additionally, if they spent less time entering data, employees could operate more efficiently, he said. “That allows us to use our workforce to be more problem-solving for individuals and families and help hook them up with solutions for their particular needs.”

As the department began planning for its new identity management system, the DMV — the state’s identity management expert — became a natural partner.

HHR bought the enterprise service bus, rules engine and data management tools that the DMV had been planning to purchase, Hazel said. “We essentially gave them to our DMV and said, ‘OK, you develop it.’” So a team led by staff at the DMV got to work on CAS.

Money to purchase the tools and create CAS came largely from a pool of federal funds designed to help states develop the Medicaid Information Technology Architecture. In 2011, the U.S. Office of Management and Budget decided that when states used this funding to develop systems for their Medicaid programs, other state organizations could use those systems as well, as long as they paid a share of the operating costs. That opened the door for Virginia to stretch the benefits of CAS — and the costs of its ongoing operation — across multiple state organizations.

“It doesn’t make sense to the commonwealth to say only health agencies can use it,” said Aaron Mathes, Virginia’s deputy secretary of technology. “We want other agencies to be able to authenticate against the database and use the algorithms that we develop.”

Hazel agreed: “The goal is to create a tool for the commonwealth without having to have a separate tool in every agency.”

Although Virginia developed its Commonwealth Authentication Service (CAS) mainly to support citizen applications, state agencies also can use it to manage identities of employees from other jurisdictions who do business with the state.

An example is the Office of Comprehensive Services (OCS), a branch of Virginia’s Department of Social Services that supervises local governments in implementing services to at-risk youth. These services receive combined state and local funding.

Local governments use several online applications to report expenditures to the state for reimbursement. OCS needs assurance that the individual who logs on to submit such a report is authorized to do so, said OCS Executive Director Susan Cumbia Clare.

The current authentication system isn’t very sophisticated, Clare said. ”We’ve had issues with folks sharing logins or passwords. We [can’t] ensure that [those] who are logging in are actually the individuals who are authorized.” Better controls on who can submit and certify financial information will reduce the opportunity for fraud, she said.

The authentication service could also help OCS ensure that client information is only accessed by authorized individuals, Clare added.

Within CAS, authenticating local government employees will be the same as authenticating private citizens, said David Burhop, CIO of the Virginia DMV, which is leading CAS’ development. ”CAS isn’t written specifically for any one application or function. It’s an authentication engine that integrates with any agency application that can consume Web services and securely pass the required data back and forth.”

While CAS will determine whether a local government employee who presents herself online actually is who she says she is, it won’t determine whether that employee can view or use particular data, Burhop said. ”Access will still be the responsibility of the organization using CAS.”

So in the future, for example, if a Virginia resident uses an online portal to register to vote, the State Board of Elections might use the shared service to verify that citizen’s identity, Mathes said. “While the [State Board of Elections] may keep a completely separate database of registered voters, that registered voter is verified based off the Commonwealth Authentication Service.”

In developing CAS, the DMV is using three levels of identity authentication assurance. Which level the system applies depends on the transaction a citizen needs to conduct.

A person who goes online simply to set up an account (Level 1) just has to provide information about him- or herself, including a name. “It could be Mickey Mouse; it could be anybody,” Burhop said. “They don’t do any verification there.”

But when a transaction requires two-way communication, CAS will verify the individual’s identity. It will obtain this Level 2 assurance by testing the person’s knowledge about information held by the DMV — asking him, for example, dynamic questions such as the make and model of his first car registered in Virginia. “We use that now for DMV, and it works quite well,” Burhop said.

Level 3 comes into play when a person transacts business on behalf of someone else — in a guardianship relationship, for example. At that level, CAS will use some form of two-factor authentication, such as a one-time password or a public key interface certificate.

Of course, not everyone holds a driver’s license: Probably 25 to 30 percent of Virginia residents aren’t in the DMV’s database, Burhop said. Non-drivers can obtain a state ID card from the DMV for $10. Residents who can’t or don’t want to buy that card can still apply for benefits or conduct other business with the state, Burhop said. But they’ll have to do it in person.

CAS is scheduled to start operating in October, when large numbers of Virginia residents become newly eligible to apply for Medicaid benefits under provisions of the Affordable Care Act. At that point, the Virginia Information Technologies Agency (VITA) will take over responsibility for CAS, providing it as a shared service.

In the long run, any Virginia state agency will be able to use CAS, in exchange for a fee. “VITA will develop a cost recovery model of some sort that will help defray the ongoing maintenance and operation cost of that service,” Nixon said. State officials are still working out how the service will be governed and how it will evolve.

Although other agencies have been asking about CAS, VITA isn’t soliciting new participants yet, Nixon said. “We’ve been holding them off somewhat, because we don’t want to distract from the initial and intended use by HHR, particularly since they’re paying for it.” Mechanisms to support other users on CAS will probably be in place by the first quarter of 2014, he said.

One potential mechanism is awaiting approval, though.* It’s an enhanced memorandum of understanding (E-MOU) that allows different agencies within Virginia to share data as needed for the operation of CAS. HHR developed the E-MOU, based on the federal Data Use and Reciprocal Support Agreement, first to allow data sharing among HHR, the DMV and VITA. The state’s attorney general has yet to approve the E-MOU, but once approved, any other agency can use CAS, Burhop said. “All they have to do is agree to it and sign it.”

Although VITA will operate CAS, the DMV will continue to maintain the data used to verify identities. Among other things, that puts new pressure on the department to keep its data current. “We will have to have real-time updates for anyone who comes in and gets an ID card or a driver’s license, especially those people specifically coming in so they can set up an account with the Commonwealth Authentication Service system,” Burhop said.

The advent of CAS could also earn the DMV a reputation as an agency concerned with more than drivers’ licenses and vehicle registrations. “It’s obvious that our mission is shifting to include not only public safety, but also identity management,” Burhop said.

As Virginia prepares to enjoy the benefits that CAS will provide, Nixon points out that these benefits are available in part because of the state’s centralized IT structure, including a single network to support all the executive agencies. “If we didn’t have that, and HHR was paying for that service by themselves and standing it up, it would be your typical siloed agency application that’s very difficult to share with anyone else.”

But with VITA operating the system on Virginia’s enterprise network, CAS can work as a cloudlike service available to all state agencies. “They will be able to avail themselves of that capability without having to make any kind of capital investment,” Nixon said. And HHR — the system’s original user — can enjoy its benefits without bearing the full cost for maintenance and operations, he said. “That will be shared with others. So everybody wins under that arrangement.”

*Editor’s note: the story was corrected to indicate that the E-MOU is still awaiting approval from the attorney general. The quote was corrected to attribute it to David Burhop.

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