Lawmakers hold brief 'lessons learned' hearing on health care exchange
But despite huge state and federal investments in the exchange website and a call center to handle interactions with the public, the system still has significant problems.
Lawmakers on the House Health Care Committee heard testimony Friday from Shumlin administration officials who attempted to answer two questions: What problems remained, and what lessons the state can take forward before the Shumlin administration launches two, even larger IT projects and moves toward a universal health care system over the next several years.
The lesson period on Friday, however, was brief, and the extent to which the Shumlin administration is addressing ongoing problems with the exchange was only partially explored.
Rep. Mike Fisher, D-Lincoln, chair of House Health Care, put three Shumlin administration officials just 15 to 20 minutes each in the hot seat, and the question-and-answer period with lawmakers was abbreviated. In all, Fisher gave the hearing, which was supposed to be a recapitulation of a report from the consultant BerryDunn that was critical of the Shumlin administration's handling of the exchange, less than an hour.
The state's website, which was developed by the international conglomerate CGI, has had repeated failures since it was launched in October 2013. CGI has a contract deadline of July 2 for making it possible for businesses to sign up employees through the online exchange.
Special report: What went wrong with Vermont's health care exchange and why
As of last week, people are still unable to alter their coverage online to reflect changes such as a boost in income or a new dependent. There are 8,000 people waiting to make such changes. That group includes some who qualified for Medicaid.
"There is some level at which it continues to be a tripartisan embarrassment," said Rep. Chris Pearson, P-Burlington, after listening to Friday's testimony. "Here we are in mid-April and core functionality is not working."
For those Vermonters, the experience with the exchange has likely been unpleasant. To fix any errors in their application or coverage, they must go through Vermont Health Connect's call center, where wait times reached as high as 50 minutes in December.
Though the wait times have dropped precipitously, the call center is still receiving more than 2,000 calls per day post-open enrollment.
Mark Larson, commissioner of the Department of Vermont Health Access, told lawmakers he did not have specific information on how quickly the manual changes were being made by department employees.
"I would love to come back with more specific information, because there's multiple steps to the process," Larson said, "But at this point we are not seeing the pace we'd like to see."
Larson told lawmakers CGI won't have the "change of circumstance" functionality in place for another two months.
The problems that have plagued Vermont Health Connect throughout the year were initially expected to be fleeting.
In the late summer last year, as the Oct. 1, 2013, federal launch date loomed, the Vermont Health Connect project management team knew they were well behind schedule. With an immovable deadline, they decided to cut back on the functionality of the website.
Though many design elements and technical glitches were ironed out in the first weeks and months after the launch, the state chose to delay larger components of the project, such as the acceptance of online payments, change of circumstance requests and the ability for small businesses to accept coverage requests from employees.
Meanwhile, thousands of Vermonters attempted to use the system, and many, in frustration, went to navigators for help.
Online payments are now an option, but the system for processing payments is still slow. Vermont Health Connect is currently processing 10 percent, or roughly 3,000, of the first month premium payments that have been received to this point.
Vermont's contract with CGI, the tech-firm building the website, didn't spell out how to manage the completion of those elements, and months passed as Miller and others worked behind the scenes to negotiate an amended contract that formalizes when the remaining work must be completed.
The state has paid CGI $51 million of the $84 million in its contract. The amendment didn't change the total dollar amount the firm will receive.
The Health Care committee spent little time Friday discussing the contents of an outside consultant's report on the pitfalls of the Vermont Health Connect in the hour of testimony they heard.
No one brought up BerryDunn's indictment of the political culture within the Vermont Health Connect project team that the report said "does not encourage questioning, conflict, or engaged problem solving, and inexperienced leadership does not know when to raise issues above them."
Miller said the report's findings were consistent with his experience since arriving in January to help complete the project.
He has focused on the need for better project governance and oversight. IT implementation practices must be improved as the state begins to build the IT infrastructure that will underpin a universal health care system, Miller said.
Vermont is also about to start building a new Medicaid reimbursement system and a streamlined eligibility program for the Agency of Human Services. Together, the two systems are expected to cost more than $200 million.
"Those are significant projects that will extend core functionality over the next couple years," Miller said.
The Agency of Human Services project management office is gearing up to oversee those projects, and a working group is examining BerryDunn's report on Vermont Health Connect, Miller said.
The state is looking to fill 17 limited service positions for work on the projects. Miller said the state had hoped to "lift and drop" experienced personnel from Vermont Health Connect into the new positions, but ongoing work on the exchange hasn't allowed that to happen.
Vermont Health Connect itself has 10 unfilled positions in an office of 50 current employees.
"We are carrying those projects as high risk projects simply because of timing and resources," Miller said.
The key to avoiding the missteps of Vermont Health Connect will be making sure the state has the right personnel in place and managing the project's scope, he said.
Managing the project's scope will mean separating needs from wants, Miller said, and making sure the people who help to formulate health care policy understand the limitations of the technology systems being built.
VERMONT HEALTH CONNECT BY THE NUMBERS
More than 6,000 of the 28,000 Vermonters who are paying commercial premiums through Vermont Health Connect are having some sort of issue with their coverage related to the website's inadequacies.
More than half of the Vermonters who purchased commercial insurance through the exchange have qualified for a subsidy - though some may struggle to afford their coverage.
About 87,000 people have enrolled in coverage offered through Vermont Health Connect - including the new Medicaid enrollees. Nearly 40 percent are employees of small businesses who were enrolled in insurance plans directly by insurers. The Shumlin administration announced direct enrollment last fall as part of an ongoing contingency plan when it became clear small businesses would not be able to use the website to enroll workers in Vermont Health Connect.
Vermont has transitioned all but 2,000 of the 51,000 people formerly on VHAP and Catamount onto Medicaid or subsidized commercial insurance, according to figures presented to lawmakers by the Department of Vermont Health Access.
The remaining 2,000 found coverage elsewhere, are still working to sign up or will be joining the ranks of the uninsured.
In addition, there are roughly 23,000 Vermonters who qualified for Medicaid as a result of the federal expansion of that program.
There is no way to tell how many of Vermont's roughly 40,000 uninsured are now covered, or if their ranks have grown. The Shumlin administration didn't require enrollees in Vermont Health Connect to check off a box declaring whether they were insured or uninsured.
Editor's note: Anne Galloway contributed to this report.
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