Private Payers News

How Health Insurance Exchange Database Handles Enrollment

To learn more about the MarkLogic database platform and how it manages consumer demand on the health insurance exchange, HealthPayerIntelligence.com spoke with Bill Fox.

By Vera Gruessner

- The health insurance exchange system set up through healthcare.gov needs to be a robust technological platform in order to manage the vast amount of information and high enrollment numbers associated with the insurance marketplace. The MarkLogic database is the enterprise platform used to manage the beneficiary data on the federal health insurance exchange. The MarkLogic database needs to be able to handle the ongoing rise in enrollment numbers, which have risen to 8.9 million individuals for the 2016 enrollment period.

Healthcare.gov Enterprise Database

To learn more about the capabilities of the MarkLogic database platform and how it manages consumer demand on the health insurance exchange, HealthPayerIntelligence.com spoke with Bill Fox, Vice President of Healthcare and Life Sciences at MarkLogic.

HealthPayerIntelligence.com: How does your company especially the MarkLogic database handle the high enrollment numbers and consumer demand associated with the federal health insurance exchange?

Bill Fox: “The technology was always developed from its inception 14 years ago to be an enterprise product, so there’s a number of pieces to that answer. One – the technology, unlike traditional relational technology, scales out and not up. That means as demand rises and volumes rise, you don’t have to buy a new, bigger, better box – you just add more capacity with affordable commodity hardware and keep building it out. It’s very easy to scale to demand.”

“One of the quotes from Henry Chao at CMS at the time, who brought this technology in, has said ‘the reason you use the MarkLogic database is not because you know what the demands are going to be, what the volumes are going to be, what your requirements are, and then you pick this perfect technology for it. It’s because projects like healthcare.gov, you really don’t know what the requirements are two years out or what the volumes are going to be or how many concurrent users there are going to be during a surge in enrollment – and that’s where MarkLogic is really strong.’ It’s because of its ability to scale out, ingest data in a schema agnostic way, and handle massive volume securely. MarkLogic is a transactional, operational database designed to not only analyze data for better insight, but operationalize it to use in day-to-day business operations.”

 “Across a lot of industries and projects whether it is BBC for the London Olympics or healthcare.gov, we handle these kind of volumes and these kind of surges very well.”

HealthPayerIntelligence.com: How are specific characteristics of the populations getting enrolled in coverage through the health insurance exchange affecting the management of the database?

Bill Fox: “This goes back to a webinar we recently did with the theme of change. Whatever the policy is, and the policy can change due to a new election and meaningful use variations, the technology has to be flexible enough to adapt to that change quickly and fluidly. The benefits that the enrollees are getting are extremely important, which is what the technology can deliver. Agility is essential for healthcare.gov and one of the reasons the MarkLogic database was brought into the project.”

“We have a number of people on the ground that work this every day. That’s really where the interaction is with CMS and all the other contractors that are involved in implementing the healthcare exchange. We make sure that we understand what’s coming up, what changes are taking place, what the policies are, what surges and volumes are expected, so that we’re always on point and ready to handle that. We want to never be in the way of this running smoothly and people getting their benefits.”

HealthPayerIntelligence.com: Do you think legal challenges from Congress could put an end to the federal exchange? Would a repeal of the Affordable Care Act completely destroy healthcare.gov or would it still be useful to some insurers and consumers?

Bill Fox: “To me, in the conversations that I have with executives all across the healthcare continuum including insurers, hospital systems, or clinicians, they’re more concerned with both the business and delivery of healthcare. They have business concerns like ensuring high quality care is delivered in a profitable manner.”

“I think they see the exchange as part of this ecosystem that exists now and the healthcare field will always have to adapt to changing policy and innovation. There’s always parts that some people don’t like, some people do, and some people think they need to change some aspects. It’s a huge piece of legislation. There’s always going to be tweaking and it can always get better.”

 HealthPayerIntelligence.com: What data security features does MarkLogic use to manage beneficiary records?

Bill Fox: “The headline is that the 8.0 version – the latest version of the MarkLogic database – has just received the common criteria standard. There’s only six databases in all that have that standard and we’re clearly the only new generation database that has that standard. We sit in a very select group of what you would call true secure enterprise databases that can be deployed in a secure environment whether that’s HIPAA and hi-tech or the financial services industry.”

“Whatever the particular security regulations are that you need to comply with in a given environment, because of the MarkLogic database being designed to be enterprise secure, we can be in that environment.”

“The security is very granular and all the data is indexed as it comes into the system. Security permissions can also be indexed along with that. Getting the common criteria certification is something we always seek to do for the database and now we have it for the latest version.”

“We get asked this sometimes: ‘Is your software HIPAA-compliant?’ Well, there’s no such thing as HIPAA-compliant software per se. There is software that is secure and can be deployed in a HIPAA-compliant environment. Having things like the common criteria certification, it’s very clear that ours can.”

“That’s one of the great features of the MarkLogic database. The customers that we sell to – these aren’t science experiments that they’re involved in – these are all mission-critical, operational type of implementations that we do whether it’s in banks, publishing, or healthcare. It’s crucial for them from the outset to know that these can be operational and the security is there.”

“That’s a major piece for us. You can have all the cool business accelerating features of the MarkLogic database, whether it’s bitemporality or schema-agnostic ingestion of data or the ability to handle unstructured data, while the enterprise features – the table stakes of operating within an environment like healthcare.gov – are all there.”

“The healthcare.gov challenge is the perfect example [of what MarkLogic can solve]. It deals with 37 states, every federal agency, and every commercial insurance company. They [all of these governments and companies] all had their own data schema. It was basically an impossible data problem. They were faced with this issue of needing to get this up and running but not being able to build it on a relational database.”

“They tried for a couple of years before they brought us in. Across industries, that’s really where we get brought in. There’s something mission critical or some regulatory compliance issue at a bank where we need to get this data integrated, need to be able to see it, and it needs to be secure and scale to the size of our enterprise – that’s where the MarkLogic database is strong.”