[S]tate officials announced this week that Vermont will change course on two major components of a health care information technology suite that were originally planned to interact with technology that backs up Vermont Health Connect.
Human Services Secretary Hal Cohen sent an email to his staff Wednesday announcing that the agency would restart the bidding process on two major IT projects: an integrated eligibility system and core management of the Medicaid Management Information System.
The integrated eligibility system was meant to help Vermonters find out instantly whether they are eligible for one of 42 state benefit programs, such as food stamps or Medicaid.
“The procurements for MMIS Core and for integrated eligibility have been canceled,” said Richard Boes, the state’s chief information officer, in an interview Thursday. He is commissioner of the Department of Information and Innovation.
“However, work will continue on both MMIS and IE to figure out how we can move forward with smaller projects that are more focused on the needs of Vermonters and how we can accomplish things in smaller pieces more successfully,” he said.
“There are some very successful parts of (these projects) that we would like to make sure that we can leverage moving forward, and that’s the strategy that our federal partners are encouraging that we pursue,” he added.
Federal regulators at the U.S. Centers for Medicare and Medicaid Services did not immediately respond to an inquiry for comment. Cohen wrote in his Wednesday email that they supported his decision.
Both projects are part of a multifaceted IT system, called the Health Services Enterprise Platform, which was scheduled to cost Vermont at least $771 million over five years, according to information released in August by the Department of Information and Innovation.
The Shumlin administration sent out a request for proposals for an integrated eligibility system in March 2014. The administration then spent months in negotiations with a contractor called Wipro. The five-year estimated cost for the eligibility system was $174.3 million.
The Medicaid Management Information System has several parts, including a pharmacy program and a care management program. The project, known among state officials as “MMIS core operations,” had a five-year cost estimate of $195.8 million.
All parts of the platform were scheduled to use the same back-end databases as Vermont Health Connect, and the state was planning to get up to 90 percent federal funding. The Legislature is now reconsidering whether it should stick with Vermont Health Connect or move to a federal exchange.
The Agency of Human Services had been planning to begin building all the Health Services Enterprise Platform projects by the end of 2018 to meet federal funding guidelines. However, those timelines put the projects in a “yellow” category at the Department for Information and Innovation, meaning they had substantial problems.
Officials were able to secure that level of federal funding — nearly double what the state usually gets for health care IT projects — in part because the Health Services Enterprise Platform projects would help Vermont manage Medicaid enrollment. It is unclear whether Vermont can leverage a similar proportion of federal money in the future.
Boes said the Centers for Medicare and Medicaid Services has common platforms for Medicaid management that use products by the company Oracle. “We want to leverage those best practices that have been developed but do so in small increments,” he said.
“I think this is the right way to go,” Boes added. “I’m 100 percent on board with Hal’s decision, and I’m very supportive of the strategy moving forward.”
Support for integrated eligibility was fading
The Department of Information and Innovation wrote updates of the two health IT projects in a Jan. 19 report to the Legislature’s Joint Fiscal Office. Neither project was scheduled to receive additional funding for fiscal year 2017, according to the report.
The Jan. 19 report said the Shumlin administration had spent $39.2 million in federal money and $3.9 million in state money on the integrated eligibility project so far. The report said an independent review on integrated eligibility started Oct. 27 and was on schedule to be completed by Jan. 28.
The report also identified “project risks” for integrated eligibility. The report said the Agency of Human Services and Department of Information and Innovation needed to “clearly allocate and determine accountability for tasks between business analysts, technical leads, project management, enterprise architecture, network engineering, desktop support, developers” and several other stakeholders.
The report also said Vermont would “assume a huge financial risk if it enters into a contract without the multi-vendor sharing platform and the multiple applications in place. There are assumed and unclear assumptions around reusability by vendors and unclear responsibility for shared services within the project.”
Dan Smith, the IT consultant working for the Joint Fiscal Office, told the Senate Committee on Institutions on Jan. 26 that most of the money for an integrated eligibility system had been spent on personnel and contracts, not actual hardware.
“Vermont, like every other state, is trying to find our path,” Smith said, “but it’s very difficult, and there’s a real price to be paid if you’re going to be the first kid on the block, if you’re going to be the first to do it your way.”
“Complexity kills,” he said. “The more complicated you make the project, the more trouble you’re going to have down the road. Don’t be first. Let another state be first and piggyback on what they did.”
The same day, Smith told the House Committee on Corrections and Institutions, that “based on what I’ve seen in that independent review, I would not sign that contract” for integrated eligibility. He added that if the state reached a contract for the project, “it would be months down the road.”
Status of MMIS was less clear
The Jan. 19 report on Vermont’s IT projects said MMIS core operations was in the vendor selection procurement phase and the state had not started implementing the technology.
“Priority status has been issued to other (Health Services Enterprise Platform) projects already underway,” the report said. “With limited state staffing resources available, there is a potential risk that adequate staffing may not be readily available when required.”
According to a blog that posts updates from the Agency of Human Services and Department of Vermont Health Access, the MMIS core management project had two main bidders in 2014: a Maryland-based company called CNSI and Hewlett-Packard.
Two other companies — Contact Center, owned by Optum, the main contractor on Vermont Health Connect; and Maximus, the main call center operator for Vermont Health Connect — were bidding on running a call center for MMIS in 2014.
The state never implemented a new MMIS system in response to that bidding process.
On Dec. 31 the state solicited comments from vendors on a draft request for proposals for the Health Services Enterprise Platform — a signal that it was seeking to write a new RFP.
“The intent of the Solicitation, if or when published, is to attain competitive sealed, fixed price proposals for Information Technology Maintenance and Operation (M&O) of the State of Vermont’s Health and Human Services Enterprise Platform,” the document said.
“The scope of the draft Solicitation could expand based on comments received,” it said. “The intent is any future RFP would result in a multi-year fixed-price, deliverable-based contract with the option to renew for additional terms.”
