The head of Vermont’s health care reform effort says he does not believe one of the basic functions of the state’s online health care exchange will be fixed in time for the open enrollment period for insurance this fall.
Thousands of people are unable to fix mistakes or change their coverage online through Vermont Health Connect, and Lawrence Miller, the head of health care reform, says the state needs to put contingencies in place.
The state will continue to employ customer service representatives who will make the changes manually, instead of trying to connect the disparate IT systems required to automate changes, he told lawmakers at a legislative hearing Wednesday.
Miller said the federal Centers for Medicare and Medicaid Services’ requirement for states to automate change functions has “basic problems” and isn’t standard practice in the health insurance industry.
After testifying, Miller clarified that the state plans to complete the work that will allow users to make changes online, but he’s not sure that can happen before open enrollment starts Nov. 15.
“If we don’t have a good line of sight on when it might be done, then when does the contingency plan become the operating plan?” Miller said.
Miller did not have a good sense of what it might cost or how much manpower it would take to continue developing the change function and operate a contingency plan simultaneously, but he reiterated that “we definitely want to continue to pursue [automated changes].”
Miller said he expects the state will use the entire $171 million federal earmark for Vermont Health Connect. The most recent number from the state pegged spending at $72 million in June. Miller did not have an updated price tag for Vermont Health Connect.
New Hampshire, which elected to use the federal healthcare.gov website, has spent about $8 million to implement the Affordable Care Act.
The state recently hired OptumInsights, a subsidiary of health insurance and IT giant United Healthcare, to review current practices and help erase the mounting backlog of changes that need to be made.
The $5.7 million contract asks the contractor to eliminate the backlog by Aug. 1, a deadline Miller said would likely be missed – in part because new people continue to trickle in to the system with a similar error rate to those who signed up for insurance through the exchange last year and earlier this year.
Optum has more than 100 people working in an overflow call center and was instrumental in developing a process to expedite changes that could hinder someone’s access to coverage. The contract also charges Optum with reviewing the work of other contractors, such as CGI, Exeter and Maximus, which operates the main call center.
Vermont Health Connect recently hired an operations manager, David Martini, who previously worked for the Department of Financial Regulation, Miller said.
Martini will report directly to Mark Larson, commissioner of the Department of Vermont Health Access, who was absent from Wednesday’s hearing. Larson was participating in a regularly scheduled review of Vermont Health Connect with CMS officials, Miller said.
Martini has a “strong operations” background, and will allow Lindsey Tucker, deputy commissioner in charge of Vermont Health Connect, to focus on the programmatic and policy side of the exchange, he said.
To this point, Tucker had been “stuck trying to do both,” he added.
Miller rejected the notion that Vermont Health Connect needs a change in leadership, and said if he thought that was the case he would raise those concerns with Gov. Peter Shumlin.
Any shake-up in personnel at the commissioner or deputy commissioner level would be done by the governor, he said.