Vermont’s state-based health insurance exchange relies on manual updates but is on the verge of basic functionality 20 months after launch, Gov. Peter Shumlin says.
Following the expiration of a self-imposed May 31 deadline, the Shumlin administration on Monday announced that the state’s technology contractor has accelerated the process for updating customer account information.
“We still have work to do to ensure the Vermont Health Connect system supports the level of customer service that Vermonters deserve, but today’s successful deployment is a major step in the right direction,” Shumlin said.
Before Optum completed the new upgrades, customers with changes such as marital status, birth of a child or even a recent move were unable get their insurance plans updated in a timely manner. While customer support reps continue to make changes manually as before, the governor said the process for updating information takes just 10 minutes, instead of hours, and will help resolve a backlog of some 10,200 customer requests.
Vermont Health Connect has been riddled with debilitating glitches since its failed launch in October 2013. To improve the exchange, specialists are working to automate data input so consumers might eventually be able to update their own plans online.
In March, Shumlin said Vermont may need to transition to the federal exchange if the change of circumstance functionality wasn’t fixed by May 31. A second deadline of Oct. 1 is set for automated processing of enrollments and renewals for 2016.
While the governor remains optimistic about VHC fixes, a 62-page report released in April by Vermont State Auditor Doug Hoffer cast doubt on the exchange’s viability.
According to the report, the exchange had a backlog of 7,256 unprocessed change-of-circumstance requests as of early March, along with 7,360 unprocessed renewals from customers in qualified health plans. Despite Monday’s upbeat announcement, the backlog continues to exist.
The report also outlined 70 separate security issues with VHC technology, saying “the state has known about 91 percent of those weaknesses for at least 13 months.”
In assessing the usefulness of past fixes, Hoffer says “gaps in VHC’s functionality have been patched by manual and time-consuming processes that have caused hardship to Vermonters.”
While Shumlin expected Optum would meet the May 31 target for repairs, Hoffer called the deadline “aggressive,” creating conflicting expectations about what constitutes progress.
“It’s nice that the governor has something to cheer about, but I don’t think this is any great news for Vermonters,” said Darcie Johnston, founder of Vermonters for Health Care Freedom.
“For every problem, there are 20 patches and workarounds,” she added.
Problems with VHC fall into two categories: technological and operational. The technology problems include security, system development, and governance and project management. Operational areas include premium payment processing, enrollment and change of circumstances.
Another noteworthy concern relates to the state’s relationship with Optum, the vendor chosen to provide IT services after CGI was fired in August. Vermont’s contract with Optum has yet to be extended into the fall open enrollment and renewal period. Without Optum’s services, the influx of new data could sink an already floundering ship.
Moreover, Vermont’s contract with Optum lists no provisions to hold the vendor accountable and offers no real way to measure vendor performance. The Hoffer report recommends that if the state continues working with Optum, the contracts should be amended to tie monetary consequences to performance.
The report said unreconciled data between state, vendor and insurer systems is another major problem. In some instances, customers have been charged several months premium payments at one time. Moreover, some payments have not been tracked properly, and account balances sometimes differ.
In particular, the report says Benaissance, another private vendor, is managing a $5 million state account that contains “misapplied, unallocated payments, as well as prepayments and overpayments.” Health officials may have difficulty determining what to do with this money.
All these flaws must be addressed before the open enrollment period in the fall.
“Optum must deliver the technology needed to enable a smooth 2016 enrollment and renewal process,” a statement from the Shumlin administration said.
While Shumlin remains “cautiously optimistic” the online exchange will work by fall, the administration is instructing Vermonters whose status has changed to call the customer support center or fill out a change report form, as also noted on the exchange website.
These customers should not expect immediate results, however. A statement from the governor’s news release says while new functionality “will decrease the amount of time it takes customer service staff to process changes,” the ability to see updates reflected within a one- to two-invoice period is not expected until October 1.
Date: June 2, 2015