When Minnesota's new online health insurance marketplace, MNsure, opens for business on Oct. 1, ideally people without health insurance will begin to compare plans being sold on the site. After all, everyone will be required to have health insurance coverage in 2014 or have to pay a fine.
To pick a plan, Minnesotans who lack health insurance will only need to enter some information about themselves. The website will let them know if they qualify for federal funding to help pay for a plan. After perusing coverage options, they will make a pick and enroll.
That's the ideal scenario, but it may not be the reality, said Geoff Bartsh, vice president of public policy and government relations for Minnetonka-based Medica.
Because MNsure is a huge, $100 million-plus Internet technology undertaking that is being built in a very short timeframe, there are bound to be bumps in the road, Bartsh said.
With that in mind, insurance company officials already are trying to anticipate potential problems with the online marketplace.
"Are they going to be little bumps, or are they going to be big bumps?" Bartsch asked. "Are they things that require some adjustments in our back office or MNsure's back office for a short period of time? Or are they things that prevent the consumer from completing that [enrollment] scenario?"
Health plan executives worry about what the consumer will experience on MNsure and whether the underlying technology will work. For the insurers initially participating in the exchange, the stakes are high: The exchange could generate up to $1 billion in premium revenue depending on how many people enroll. Insurers will be selling their products on an unproven platform, and if something goes wrong, they worry consumers will blame them.
As a result, Medica and two other insurance companies planning to participate in MNsure say they're running through their "Plan Bs" if the exchange doesn't work properly on opening day.
Meanwhile, at MNsure headquarters in downtown St. Paul, exchange executive director April Todd-Malmlov said her staff is busy making sure things go as smoothly as possible on Oct. 1, and she's confident that they will.
Whatever hiccups occur probably won't be too obvious to the consumer, she said.
"Our main goal here is to make sure that people get the coverage they need," she said. "Will that maybe require some fixing of glitches and some work-arounds on the back end? Likely."
Donna Zimmerman, vice president of government and community relations at HealthPartners, is wondering what the buying experience will be like for customers who use MNsure, a central concern for insurers.
"It's a little difficult to know how that front-end process will work, because the health plans are essentially not involved in that," she said.
MNsure needs to be accurate and easy to use because, in many cases, it will be the first interaction customers have with the insurers participating in the exchange.
"Everyone is really focused on not interrupting that consumer experience," Bartsh said. "For us as a carrier, it's really important ... It's our brand."
But Bartsh said it's even more important that the website doesn't turn off new customers from the insurance-buying experience.
"We don't want that to be a bad experience out of the gate," Bartsh said. "We don't want to give people an excuse to continue to be uninsured."
Todd-Malmlov said consumers should be able to use the site successfully on Day 1. If there are problems, they likely won't harm the consumer experience.
With MNsure still under construction and under wraps, insurers aren't pointing to any specific trouble signs about the consumer experience. It's the uncertainty surrounding the project that has them fretting. But delays have slowed development of a key U.S. government system.
MNsure and all state exchanges have to access a trove of federal data to determine whether someone is eligible to receive federal subsidies to help buy a health plan or to enroll in a government program such as Medicaid. The connection point is known as the federal data "hub," because it provides information, some of it sensitive, kept by several different federal agencies, including the Internal Revenue Service and Department of Homeland Security.
A report from an internal government oversight agency earlier this month concluded that the system's security may not be fully tested before it's slated to go online Oct. 1.
The response from the agency in charge of the hub says security testing is "critical"; officials are fixing "security weaknesses discovered by an independent auditor"; and the hub will be ready to go on Oct. 1.
If not, it will cause problems in all 50 states, said Scott Keefer, vice president of policy and legislative affairs for Blue Cross and Blue Shield of Minnesota.
"The problem is, if you have one source of information, if there are challenges getting that off the ground, it's going to impact the whole system," added Keefer.
Todd-Malmlov said she is "cautiously confident" that the federal hub will be able to supply key information right away. Already, the state exchange has been able to tap federally held information about taxes and citizenship, she said.
Nevertheless, MNsure has backup plans.
"We have some contingencies in place so that if they don't work we do have a backup that could work during a short period of time until those services are up," she said.
Even if the hub is up and running, insurance companies say they're anticipating other possible glitches that may mean more work for them.
"Many of us have been very concerned about the potential - and I would say the likelihood - of manual effort in part of the exchange operation," Keefer said. "And with that manual effort comes quite a bit of expense from a health plan's standpoint."
That could be the case if MNsure can't transmit information about an applicant to the insurer. Then, the insurer would have to manually enter that information - an annoying, time-consuming, but relatively minor problem.
Todd-Malmlov said MNsure has successfully sent personal and financial information to the insurance carriers in testing. And soon, the insurers will be able to see what their plans look like on the MNsure site, she said.
But with just six weeks to go, there's still more testing the insurers would like to do.
A FOCUS ON CUSTOMER SERVICE
Blue Cross and Blue Shield, HealthPartners and Medica all say they want to make sure that MNsure's potential glitches have little impact on consumers. That's why all three companies say they are beefing up customer service.
At HealthPartners, financial counselors, sales representatives, customer service employees and even hospital staff are being trained so they will be able to help potential customers use MNsure, said Zimmerman of Health Partners.
But for all the anxiety MNsure's launch may be causing the insurance companies, Keefer of Blue Cross said the entire project is a step in the right direction.
"We think that health reform presents a tremendous opportunity to simplify the system - for consumers, for providers, for everybody," he said. "So getting through, making these IT changes, these investments, that's a key part of what we're trying to accomplish."