Shumlin administration expects ‘smooth sailing’ for open enrollment

MONTPELIER — A state official overseeing Vermont Health Connect said he expects mostly “smooth sailing” when Vermonters begin renewing health care plans on a newly automated system Nov. 1.

Chief of Health Care Reform Lawrence Miller informed lawmakers in a memo sent Monday that the state’s online health insurance marketplace is primed to begin automated policy renewals during the open enrollment period that begins on Sunday and ends Jan. 31. The memo is part of a monthly report to lawmakers about progress on the exchange.

Lawrence Miller

Lawrence Miller

According to Miller’s memo, the administration confirmed on Oct. 19 that outstanding defects in software had been addressed successfully. In addition, the administration received formal approval on Oct. 20 from the federal Centers for Medicare and Medicaid Services, which oversees state exchanges, to utilize direct enrollment through the website for small businesses in 2016. And on Oct. 21 new software was deployed that will allow the automated renewal process to work, Miller said.

“In short, it was a busy week and a week that bolstered my optimism that the difference between last year’s open enrollment and this year’s will be night and day,” Miller wrote in the memo to several legislative committees.

In March, the governor promised the so-called change-of-circumstance function would be operational by the end of May. The function allows for automated changes to a user’s account when they have a life event, including marriage or the birth of a child. The administration declared victory earlier this year, but making life changes to a user’s account is still performed by Vermont Health Connect employees and not the end user.

Shumlin also promised an automated renewal process for enrollees would be in place by Oct. 1. The governor claimed victory earlier this month on the second benchmark, but the real test of the function will begin on Sunday when the open enrollment period begins.

Shumlin’s promised benchmarks followed a host of missed deadlines and technological setbacks since the exchange launched in October 2013. The exchange, created under the federal Affordable Care Act, has never performed as expected and has been a source of frustration for customers, the administration and lawmakers.

Shumlin said in March that failure to meet the benchmarks would result in the state transitioning to an exchange run by the federal government, or perhaps a state-federal hybrid model. The administration created contingency plans, as required by the Legislature, in the even that the state’s contractor, Optum, could not deliver the necessary technological upgrades.

“Earlier this year we mapped out a “Plan A” renewal plan based on allowing Vermonters to use self-service plan selection during open enrollment, with the option of easily renewing online, by phone, by paper, or by doing nothing and simply allowing their current health plan to roll into a new coverage year. We also prepared a contingency plan which consisted of a major staff augmentation to manually process over 20,000 applications,” Miller wrote in his memo. “I am pleased to report that we are following Plan A.”

However, Miller also warned that the system may not be perfect and some users might experience hiccups.

“To be clear, we don’t expect 100% smooth sailing. We expect that there will be cases that can’t be processed until customers provide more information; that call volume spikes will occasionally result in higher than average wait times; that there will always be some number of transmissions to the carriers’ and payment processor’s systems that result in error,” he said.VTHealthConnect

Still, “smooth sailing will be the rule and not the exception,” according to Miller.

The two insurance carriers that offer plans on the exchange — Blue Cross Blue Shield of Vermont and MVP Health Care — have participated in cumbersome manual workarounds as the website lacked functionality. There are reasons to be encouraged now, according to Cory Gustafson, director of government and public relations at BCBS.

“The stuff that we’ve seen has been encouraging. We are definitely expecting a better enrollment period this year for 1016 plans,” he said. “The true test really is when we see smooth integration with all the different vendors.”

Gustafson said whether or not the system is finally able to perform as it was designed to is “something we can’t know until renewal opens on Nov. 1.”

Similarly, Susan Gretkowski, senior government affairs strategist for MVP, said the carrier has tested its own processes with the state and they are ready. However, much is unknown about the extensive processes the state has with other entities to complete the automated renewal process.

“From what we are able to see, MVP Health Care is cautiously optimistic about the 2016 open enrollment process. We have successfully tested the transaction files that we have received from Vermont Health Connect and believe those transactions can be successfully processed,” Gretkowski said. “However, at this time we are unsure if VHC has all the functionality to capture transactions online and successfully send them to insurers. That functionality is an internal VHC/Optum process that is not able to be viewed or tested by MVP.”

Shumlin spokesman Scott Coriell said the governor is planning to hold a news conference Thursday to update the media and the public on progress.

Read Miller’s memo below:

Leave a Reply

Your email address will not be published. Required fields are marked *