WINOOSKI — Gov. Peter Shumlin and his health care reform team said Monday they have met a key deadline in implementing a core function to Vermont Health Connect and plan to continue improving the online health insurance marketplace through the fall.
“Having Vermont Health Connect work as it was designed to is the best possible outcome for Vermont. There’s no question that the biggest challenge that we’ve faced since we launched is change-of-circumstance,” Shumlin said at a news conference Monday. “We set a deadline of today … and I’m pleased to announce that this team behind me and some who aren’t here have delivered.”
Shumlin said the upgrade of the site to include change-of-circumstance, the ability for customers to have their personal information changed online, meets the first of two self-imposed deadlines he laid out in March as he faced mounting pressure about the exchange’s performance. The upgrade, which is still being phased in by the administration, will allow customer service representatives to make changes to consumers’ accounts in an automated way.
The process until Monday required staff to make manual changes to accounts and sometimes included more than 20 different people to complete the process, according to Cassandra Gekas, operations manager for the exchange. Now, staff will be able to condense what was up to a two hour total process — and because of backlogs could take months to complete — should take about 10 minutes and be reflected on users’ accounts at the next billing cycle.
“It means that we now have the capability, the tool, to be able to change your circumstance when things change for your insurance. And the outcome of that, as we get it up and running, will be a much smoother system that has been evading us since we launched,” Shumlin said.
Shumlin promised the change-of-circumstance function would be operational by the end of May. He also promised that an automated renewal process would be in place by Oct. 1. The state’s main contractor, Optum, will now turn its attention to the second milestone, Shumlin said.
The promises in March followed a host of missed deadlines and technological setbacks since the exchange launched. The exchange, created under the federal Affordable Care Act, has never performed as expected and been a source of frustration for customers, the administration and lawmakers.
Shumlin said in March that failing to meet the goals would result in the state transitioning to an exchange run by the federal government, or perhaps a state-federal hybrid model. Shumlin said Monday his administration would continue to work with Optum and the two insurance carriers — Blue Cross Blue Shield of Vermont and MVP Health Care — that offer plans on the exchange to improve the site.
“There is no better solution for Vermont than to have our website work. Full stop. If there were the ability to partner with other states or state to solve our problems, we would have done that already,” the governor said. “We have been … incredibly frustrated by getting to this point and the point we need to be at for enrollment Oct. 1. But the best outcome for Vermont is to have their own website work and that’s what I will continue to try to achieve.”
The change-of-circumstance function is only being partially unveiled, however. For now, customers will need to continue to call customer service staff or fill out an online form to request a change to their personal information. The ability for customers to make their own changes online will not be allowed until October, officials said.
House Speaker Shap Smith has said he wants to begin the transition away from Vermont Health Connect immediately this month if change-of-circumstance” is not ready. He said Monday, however, that it is “a little too early to put out the mission accomplished banner.”
“I think that we’re going to need to wait a couple days to see how everything unfolds completely and I’d like to talk to the carriers about their experience, but it looks like there’s reason to be cautiously optimistic,” Smith said. “I do want to reserve judgement to see how things work over the next week or so.”
Lawrence Miller, Shumlin’s chief of health care reform, noted it has been about a year since the state ditched its original contractor, CGI. Since then, Optum has made significant progress in completing the site, he said.
“It’s been a long and difficult process. I think today’s step, where we are, is the best indication, though, that we’ve had that the project has been turned around and is on a sound path to completion.”
Plenty of hurdles remain, however.
The state has a backlog of 10,200 requests from consumers who need to change their information. Gekas said a team of workers will be focused on addressing that backlog, while a separate team will focus on processing new requests. That work is expected to be slow in the coming weeks, however, as staff are trained and officials closely monitor transactions to ensure the system is working properly.
“We are confident that Vermonters are going to see changes more quickly and accurately,” she said. We’re doing right by Vermonters through this deployment and taking a phased in approach to training our staff.”
Don George, CEO of Blue Cross Blue Shield of Vermont, has been patient with the administration and implemented manual work around procedures because the site lacked core functions. He said at Monday’s news conference that it has “really been a source of not only frustration, but grave difficulty for those who must place reliance on Vermont Health Connect.”
“We really look forward to receiving the timely flow of information,” George said. “It’s really only through this flow of information and being able to automate all these life changes … that we’re going to be responsive to them the way we need to.”
The carriers have dealt with billing issues, too, as a result of the site not being able to communicate with its billing vendor and the insurance carriers. The state and the insurance carriers are now undergoing a process called reconciliation to square up billing discrepancies that currently amount to about $1.3 million, according to state officials.
George said it is still too soon to know how much BCBS and MVP, which has a much smaller customer base, are owed for the insurance products they’ve sold on the exchange in 2014.
“I would say that it’s in the millions of dollars. It’s not in the tens of millions of dollars, but neither is it in the hundreds of thousands of dollars,” he said.
The issue has caused some minor cash flow issues, according to George, but no major problems for the company.
“It’s preliminary for me to comment on my satisfaction with the reconciliation process because it’s still ongoing,” he said. “We’re not receiving the revenues that we should so we simply need to let the reconciliation process be complete and once it’s complete we’ll have an accurate picture of exactly what that revenue flow looks like.”
Meanwhile, the administration now must manage customers’ expectations with the change-of-circumstance function. Officials have decided to be “prudent, careful and responsible going forward.” That means updating the requested changes will still take some time until the state is confident the system is working as expected.
“The last thing we want to do after frustrating people for this much time is screw their case up in a new way,” Miller said.
“The good news is that we now have the technology able to change circumstance which should put an end to the huge frustrations that Vermonters have been feeling, generally, about trying to sign up for insurance. So, does it happen tomorrow? No. Like any big technology project we’ve got to learn how to use the system. Will it happen by Oct. 1? Yes,” Shumlin said.
Bob Daub, an official with Optum who attended Monday’s news conference, said deploying the change-of-circumstance function will allow for work to move forward on the next milestone — completing development on the ability for consumers to renew coverage online.
“We recognize that’s there’s quite a bit of work ahead and we look forward to continuing to support the state of Vermont, with their health insurance carriers in the state, to further enhance functionality for the system over the next several months,” he said.