Client Story

Pennie turns healthcare costs into savings

KPMG helped the Commonwealth of Pennsylvania assure quality when establishing its health insurance marketplace.

Robert Mitchell

Robert Mitchell

Principal, Advisory, Health & Government Solutions, KPMG US

+1 717-260-4658

James Yurko

James Yurko

Director Advisory, Health & Government Solutions, KPMG US

+1 717 260 4777

Christopher Burns

Christopher Burns

Director Advisory, Digital Lighthouse, KPMG US

+1 804-782-4293

Amiran Gelashvili

Amiran Gelashvili

Director Advisory, Health & Government Solutions, KPMG US

+1 212-954-4335

Client
Pennsylvania Health Insurance Exchange Authority
Sector
State and local government
Project
Technology implementation QA for health insurance marketplace
  • Client challenge
  • Key KPMG initiatives
  • Business impact
  • Why KPMG?

Client challenge

The Pennsylvania Health Insurance Exchange Authority, d/b/a PennieTM, is a state affiliated entity of the Commonwealth of Pennsylvania. It administers the Pennsylvania health insurance marketplace that enables eligible individuals to purchase private health insurance coverage as required under the federal Patient Protection and Affordable Care Act. Pennie was created to reduce premiums in the Commonwealth and better support the needs of customers purchasing health coverage.

When the Commonwealth of Pennsylvania decided to move from the federal health insurance marketplace to its own state-based marketplace, it only had one year to get ready to support more than 300,000 Pennsylvanians, making health insurance more accessible and affordable.

Quickly standing up the marketplace required the state to implement a new technology solution in time for the first day of open enrollment and provide the  flexibility in COVID-19 times to extend enrollment for 11 additional weeks. The Commonwealth was required to deploy quality assurance protocols to oversee adherence to federal and state policy requirements to operate their state-based marketplace.

Key KPMG initiatives

Known for our experience in helping establish state health insurance marketplaces in other states and for delivering high-quality projects to other large Pennsylvania government agencies, KPMG was asked to manage quality throughout the marketplace implementation.

In establishing a quality management office, we developed and implemented quality assurance processes centered around policy, operations, and technology and delivered a robust testing approach to review and validate the technology platform installed by an external systems integrator.

In helping Pennie get ready for open enrollment, we planned, prepared, and executed tasks covering 1,100 business scenarios and 1,500 test cases across four releases. We also leveraged robotic process automation to automate the inquiry ticket creation process that occurs when Pennie receives emails from external parties, including customers and brokers.

In addition to the quality management support, we were asked to independently verify and validate the system integration vendor’s testing of the Federal Data Services Hub (FDSH) interface and conduct a security assessment. We delivered a detailed gap assessment report that Pennie was able to submit to the Centers for Medicare and Medicaid Services for its review and approval. This approval was crucial as it granted Pennie the authority to operate as a state-based health insurance exchange and connect to the FDSH.

Business impact

By relying on the KPMG approach to quality, testing, automation, and user-friendly design, the Commonwealth of Pennsylvania has expanded access to quality health coverage for its citizens, easily transitioned from the federal marketplace, and connected more customers to the financial assistance for which they are eligible. As a result, Pennie:

  • increased new enrollment by 9.7 percent, raising total enrollment to nearly 338,000, including 75,000 new customers
  • handled over 5,000 emails in the first two months of operation, with the KPMG bot saving hundreds of hours of manual processing, allowing Pennie staff to focus on more value-added tasks
  • handled nearly 307,000 calls by the Pennie Call Center during the extended 11-week open enrollment, with an average wait time of just over two minutes.

Why KPMG?

When maturity and experience are critical

In the hectic environment of a time-compressed project scrutinized by the highest levels of state government, KPMG was a calming influence that could be relied upon to explain risks and issues, test thoroughly, and deliver the right technology solution.

A single team with deep strategic and technical experience

Our team combined a depth of knowledge across all facets of state based exchanges and federal health insurance regulations, enabling us to interpret the impact of federal statutes on the Pennie platform as it was being implemented. Our extensive quality assurance practice and automation development experience also helped ensure that the right solution was delivered, providing Pennsylvanians with a streamlined, user-friendly system.

I can say, without question, the Pennie/KPMG partnership is one of the reasons we were able to meet or exceed all business metrics in year one of operations. KPMG services are appreciated and always add value.
Duane McKee, CIO, Pennsylvania Health Insurance Exchange Authority