Optum makes progress, but smooth open enrollment still in question

The fact that consumers have been unable to make changes to their personal information or health care coverage through Vermont Health Connect has been routinely cited as the exchange website’s biggest flaw.

But state officials released a report from tech firm Optum on Thursday that identifies something called “834 errors” as the greatest threat to a smoothly functioning website.

Form 834 is an electronic file that transmits a customer’s information from Vermont Health Connect to the insurance carrier. It’s how the changes to an application eventually are made.

The errors are increasing the number of consumers who are ending up in the change of circumstance backlog, according to Kyle McDowell, Optum’s vice president of operations and transformation.

The company was hired in June to help eliminate that backlog, and is now in contract negotiations with the state to take over from CGI as the primary vendor to complete Vermont Health Connect.

There are roughly 900 cases that have 834 errors, and Optum’s top priority is resolving those issues and finding a technological fix to prevent them from happening.

There are roughly 7,000 Vermonters still awaiting a change of circumstance, down from a high of more than 14,000 earlier in the summer. An additional 4,000 are having billing issues, according to the report.

Problems persist for Medicaid beneficiaries who will eventually need to use Vermont Health Connect to renew coverage, but the federal government has given Vermont temporary permission to suspend renewals — thereby reinstating anyone who lost coverage. Officials do not know how long the grace period will last, but said they believe they’ve found a workaround. New Medicaid patients in the upcoming enrollment period will rely on that temporary fix.

State officials say they understand that for consumers who are awaiting changes or having problems with billing, the frustration is ongoing, but they say progress is being made.

In order for Vermont Health Connect to function smoothly, the change of circumstance backlog must be wiped out, the 834 errors eliminated and processes for users to renew coverage must be in place before the open enrollment period begins in November.

“Worst-case scenario is the VHC IT system will not be able to support renewals,” the Optum report said. It suggests a manual process if the technology isn’t ready.

If that sounds familiar, it’s because Optum’s recommendations have informed the talking points of state officials – primarily Lawrence Miller, chief of Health Care Reform – since the company was hired in June.

Optum has fresh perspective on problems state workers and contractors have identified but were unable to resolve, said Mark Larson, commissioner of the Department of Vermont Health Access.

Optum has also brought in 125 call center workers to help with the change of circumstance backlog.

Morgan True

Comments

  1. Jim Barrett :

    In a matter of days progress is made?????? What baloney.

  2. Walter Carpenter :

    “In a matter of days progress is made?”

    How do you know?

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