With the national election over there’s an expectation for greater bipartisanship between Republicans and Democrats, but in terms of programs with potential for cooperation, the Affordable Care Act (ACA) is one of the least likely. The ACA has been a significant point of contention between the parties, and despite the President’s reelection and therefore, the mandate to pursue ACA, it seems the conflict may continue, particularly around implementing a Health Insurance Exchange (HIX) website portal in each state. Luckily, open source may be the answer to overcoming some of the conflict.
Response to developing state-based HIXs has been mixed. At the time of writing, 14 states had passed legislation to pursue building their own HIXs, nine declared they would use a federally-facilitated Exchange, and nearly 30 states had yet to declare their intentions, according to the Center on Budget and Policy Priorities.
But whether the states build their own or rely on the federal government to create a HIX, time is in short supply. By October 1, 2013, Exchanges must be ready for constituents to select health plans that will begin coverage January 1, 2014. The pressure is on, and the question is: How can states build these Exchanges in time and without overspending?
The answer is open source software (OSS) and open source-style collaborative development.
Free, effective and abundantly available, open source will be crucial to not only meeting schedule and budget goals, but also providing consumer-friendly, informative and effective HIXs. According to Ohloh.net, there are over half a million open source projects and billions of lines of proven open source code at-the-ready for developers. Rather than reinventing the wheel, using existing open source can save time and money (developers can use existing, proven code, rather than writing it all from scratch), while allowing states to spend these precious months focusing on creating friendly, usable platforms, rather than coding everything from scratch.
As Forrester Principal Analyst Jeffrey Hammond states: “Open source is a ‘silver bullet’ that allows simultaneous improvement along all three dimensions of the software ‘iron triangle’ of cost, schedule, features.” In other words, using open source may be the perfect response to the challenge of implementing ACA or any other health care overhaul.
For a “real world” example, think of HIXs like e-marketplaces, bringing buyers and sellers together – an Amazon.com of health insurance options. And what does Amazon rely on? Open source, of course. As does eBay, and nearly every other e-commerce site. It is open source that allows these companies to innovate – to provide successful, timely, user-friendly portals giving customers both the information and the services they need to make informed decisions. HIXs will be no different in this way, and as such, the development of these Exchanges should rely OSS.
Luckily, OSS is already pervasive within the US government, which has relied on open source for years because of these very benefits. From the Department of Defense to the Department of Energy, the Department of Veterans Affairs to NASA, open source already plays crucial role in government work. Extending the use of OSS to HIXs is a natural and important progression.
But can open source really enable both states and the federal government to keep the development of these Exchanges on schedule and on budget?
Yes, especially by increasing collaboration in development. It’s common practice, even amongst competitors, to work together to develop “the basics” of software platforms so organizations can spend time differentiating their products based on usability and features, and not waste time developing standard platforms. In the automotive industry, for example, BMW, Jaguar, Volvo, Nissan, GM, Honda and others are all working together through the GENIVI Alliance to develop a standard in-vehicle infotainment platform they can all use. Same holds true for financial services, in which J.P. Morgan, Bank of America, NYSE Technologies and others collaborate on the OpenMAMA project, not to mention OSEHRA for electronic health records and Polarsys in aerospace.
The opportunity for collaboration among HIXs, be they state or federally-based, is the same. And in contrast to the examples above, the HIXs would not compete with each other, which further eliminates potential resistance to collaboration. Using open source and collaborating on common code components used in infrastructure and, in particular, data architecture and business logic, can have a marked impact on shortening the development cycle and decreasing development and maintenance costs.
Some states have confirmed that the reason they opted to pursue a federal HIX is because of the expense feared from developing a state Exchange. Relying on open source and collaboration can help allay this fear. A recent report from IntelliCap estimated that an organization with 100-developers could save an estimated $4-5 million over five years simply by strategically using and managing open source. Imagine that level of savings over the entire HIX development process; with thousands of developers using already-existing code, the savings could be tremendous.
In terms of timing, the good news is that, thanks to Massachusetts, we know these Exchanges can be built both quickly and well by relying on open source. In fact, the Massachusetts Commonwealth Health Insurance Connector Authority, the Robert Wood Johnson Foundation and the Blue Cross Blue Shield of Massachusetts Foundation issued Building an Effective Health Insurance Exchange Website, a report which included a designated set of tools the Commonwealth’s Information Technology Division recommended, including a mix of open source and third-party tools. And in a recent whitepaper from Dell, Health Insurance Exchanges: Improving Care in Your State, the company asserted that the “Affordable Care Act provides an important opportunity for states to take advantage of the most current technologies [including] open-source applications… where technology can truly play a transformative role.”
I wholeheartedly echo the importance open source and collaborative development can play in establishing user-friendly, informative HIXs that serve as both plan brokers and customer support tools.
Sure, creating HIXs in every state in less than one year is a tough assignment, but we did it here in Massachusetts in 2006 with just a year’s timeframe, and I’m confident that with some hard work and a lot of OSS and collaboration, Americans in every state will be able to utilize similar systems to our Health Connector. Regardless of party affiliation, I think we can all agree that saving time and money, while simultaneously developing top-notch systems for all constituents, is a win.
Tim Yeaton joined Black Duck Software in February of 2009, and brings over 30 years of software and technology management experience to his role as President, CEO and Director.
