Having worked through a state exchange ramp-up from vendor selection to the eventual invoicing and collection of premiums, it rings true that anyone attempting this needs to look at it like an entrepreneur involved in a technology startup. States that want to start now will at least be able to benefit from the experiences of those who have come before but looking at the process as that of a startup would still serve them well.
Objectives and requirements need to be defined up front and not as you go along. Staffing should match the expertise required to manage the project. All those participating in the project should believe in it and work to make it a success.
The biggest difference between a technology startup and an exchange startup has been money. I think it had a profound effect on the state exchanges. The Feds were providing the money – lots of it – for a project that hadn’t yet had its requirements defined. I am convinced that a private individual or a venture capital organization would have dealt with the funding very differently than did the Federal Government that seemed at time to provide a blank check to state exchanges.
Now we are facing even more money pouring into the process and a feeding frenzy as vendors step up, perfectly willing to fix another vendor’s code. When will the dollars stop? When will someone develop the technology can will bring reality to the dream.