Flaw in health care exchange makes it tedious to change information

The number of people having difficulty completing their enrollment in Vermont Health Connect is dropping, but the problems are taking longer to solve, state officials say.

About 2,500 people who sought to have coverage effective Jan. 1 remain stuck in the enrollment process.

The main culprit in the delay is that the “change of circumstance” function — if a user needs to update their information — is still not functional and must be done manually.

Mark Larson, commissioner of the Department of Vermont Health Access

Mark Larson, commissioner of the Department of Vermont Health Access

As people progress through the exchange toward enrollment, it becomes more time consuming to enter those changes manually, said Mark Larson, commissioner of the Department of Vermont Health Access.

That’s because there is no option for users to change their information online and make it accessible to the insurance companies or the entity that processes invoices.

If someone who has picked a plan but has yet to make a payment, or be enrolled in that plan, needs to make a change, then it only needs to be changed in the state’s system, Larson said.

However, once that person has made a payment or been enrolled in their coverage, that same change has to be made manually in the invoicing contractor’s system and the insurers’ system, which drags out the process, he said.

“Many of the people who are having a difficult time now are doing so because of a change of circumstance,” he said.

Digitizing that process and making it automatic across the entities who handle that information is his department’s top priority, Larson said.

Trinka Kerr, Vermont’s health care advocate, said her office is hearing complaints.

“It used to be when we contacted the state, and said, ‘Oh, here’s a mistake,’ it could be corrected in an hour,” she said. “Now it’s like days or weeks for things to be fixed.”

Her office has seen a 30 percent increase in calls last month over January 2013, according to figures provided by Kerr.

“We’re being overwhelmed now,” she said, “The system appears to be so clunky, that even when everybody knows what’s supposed to be happening for the individual, it’s really hard to fix it.”

VHC update

Last month, the administration allowed the two insurers in the exchange to directly sign up small businesses through March 31. Individuals who wish to be covered on April 1 should sign up through Vermont Health Connect by March 15.

The extension for small employers gave the state greater ability to focus its attention on individuals who need to sign up for exchange coverage by that time.

There are more than 24,000 Vermonters who picked a plan using the exchange website seeking individual plans effective Jan. 1, according to figures presented to lawmakers late last week by the Department of Vermont Health Access. Roughly half of those individuals qualified for Medicaid.

Of the more than 12,000 who picked a Vermont Health Connect plan and didn’t qualify for Medicaid, more than 10,000 are fully enrolled in 2014 health care coverage.

That leaves more than 2,500 people seeking coverage effective Jan. 1 on Vermont Health Connect who are still mired in the process.

By the administration’s own estimate, there are roughly 4,500 individuals mandated to have coverage through Vermont Health Connect who have yet to begin the enrollment process.

Kerr said she’s concerned about what will happen this month when a contingent of newcomers start at square one.

“I really thought the state would be farther along at this point,” she said.

Kerr listed other problems people are experiencing with the exchange, such as denials or incorrect subsidies due to eligibility mistakes, incorrect start dates for coverage and difficulty switching or dropping plans when someone is enrolled inappropriately.

Refugees continue to be denied exchange coverage due to lack of citizenship, she added.

“It’s much harder now to untangle what the problem is,” she said, adding that sometimes a person has several problems with their application or coverage, and it can be hard to identify what’s gumming up the works.

“It’s really frustrating for the consumer,” Kerr said.

Morgan TrueMorgan True

Comments

  1. roger tubby :

    It’s hard to imagine that none of the individuals conceiving this system, building the requirements documents, holding design reviews, watching the phased implementation couldn’t have seen this coming. Weren’t there stakeholders (VT taxpayer reps) overseeing this?

    Really – there was no one on the staff/consultants who had the b@lls to out call this type of missing functionality? Almost anyone having worked for a while in IT would have questioned this.

    Is it possible that voices were stifled? That potential nay-sayers were told to be quiet or else? If many of the staffers working on this project were uncomfortable with their employment status, then they might not have wanted to rock the boat.

    Could we clarify who were the contractors and contracting offices on this? Is it CGI, again?

  2. Craig Powers :

    This website is a dog.

  3. Funny how our leaders adopted all this before the ACA was even brought to legislation. No one had even read the bill and no one understood what it would entail. Yet, [t]hey all ran to it with eyes wide shut. Now that we’ve spent millions on it, what happens if and when it fails, and it should fail before it does permanent damage to our already fragile economy.

  4. Ron Pulcer :

    As far as a given State’s healthcare exchange communicating with multiple insurance company’s IT systems (only 2 insurers in Vermont), it seems like the process could have been handled update transaction via an output XML file / transmission from State IT system to any given insurance company IT system.

    The XML file format could have been standardized, as long as it contained all the necessary pieces of data. It should have been setup such that it is the responsibility of the insurance companies, to read in XML data updates into their own systems.

    The insurance companies have their own set of IT systems, either built in-house, or via another 3rd party IT contractor. The insurance companies know their own data and systems better than anyone else. So why is it the State of Vermont’s responsibility to import the data into insurance company systems?

    The responsibility of State to provide updates should have simply been to send XML formatted data to insurance companies. If an insurance company wanted to play on the Exchange, then they would have to develop the process to import the updated data into their own systems. In other words, the insurance companies should have been on the hook to share in the IT development costs, in order to feed into their own proprietary systems and databases.

    It’s hard to know exactly what is going on between these systems. But conceptually, XML data format was invented in part to deal with sharing data across disparate IT systems.

    I don’t think it is the State of Vermont’s responsibility (or their IT contractor) to actually update the other systems. They should just deliver the data in the agreed-upon data format.

    Of course, this suggestion is probably “water under the bridge” at this point.

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