Many exchange navigators are frustrated with tech problems

Navigators with the Vermont Chamber of Commerce (from left) Julie McDonough, Laura Doe, Kathy Megrath,  Karen Winchester and Shannon Wilson. Photo by Andrew Stein/VTDigger

Navigators with the Vermont Chamber of Commerce (from left) Julie McDonough, Laura Doe, Kathy Megrath, Karen Winchester and Shannon Wilson. Photo by Andrew Stein/VTDigger

Organizations charged with helping Vermonters navigate the state’s new health insurance market say its information technology (IT) systems are improving. But they are concerned about how ongoing IT hiccups and delays could affect Vermonters’ ability to enroll in new plans before their current ones expire.

This summer, the Shumlin administration doled out $2 million in federal funds to 18 organizations. These so-called navigator groups and their 200-plus navigators are responsible for raising awareness and providing in-person help to Vermonters enrolling in the new health insurance market, called Vermont Health Connect. Navigator groups target different populations, from the uninsured to women to business owners and their employees.

While many of these organizations note success on the outreach and education fronts, their effort to enroll Vermonters on new insurance plans has been far less fruitful.

Lynn Raymond-Empey runs the Vermont Coalition of Clinics for the Uninsured. The organization supports 10 free clinics across the state and received about $205,000 in navigator funds to target uninsured and underinsured populations.

The organization has helped more than 8,000 Vermonters understand the new market and subsidies. The market got off to a rocky start on Oct. 1, and in 2014 the state is requiring all Vermonters buying insurance independently or via businesses with 50 or fewer employees to buy plans on Vermont Health Connect.

Part of the coalition’s education campaign includes sitting down individually with the roughly 1,500 Vermonters who seek treatment at its clinics every month.

Raymond-Empey said that although the organization surpassed its projections for outreach, its enrollment numbers are far behind schedule due to IT issues.

“In the last week, we began seeing enrollments going through all the way to plan selection,” she said. “The problem is: We’re still having people where we go through the process with them and something happens with the IT in the middle of the application. We lose all of the data and information and end up having to reschedule with that person again.”

The payment mechanism that would allow Vermonters to buy plans on the market is not yet functioning, and the state system is not fully connected to the two health insurers that are selling a total of 18 plans on the market — Blue Cross Blue Shield of Vermont and MVP Health Care.

“Everybody had been so focused on this being an online application system and this is the way to go that they hadn’t really put in place a good system for going back to paper applications,” she said. “There wasn’t a good plan B in place. I think they expected to have some issues, but I don’t think they expected the size and the amount of the difficulties just with logging in.”

Raymond-Empey’s chief concern is that thousands of lower income, working Vermonters will lose their current plans at the end of the year because the subsidized Catamount and VHAP programs are set to expire on the new year.

“We want this to work,” she said. “We want to have more people insured. We’re doing everything we can to work with the state to problem solve because VHAP and Catamount go away on Jan. 1, and each week or day that goes by that we can’t successfully enroll people, it backs up and makes the demand for our work that much greater.”

Raymond-Empey is not alone in her concerns.

The Vermont Chamber of Commerce

The Vermont Chamber of Commerce received the largest navigator grant in the state, worth $260,000. It is teaming up with some of the other 34 chambers across the state to target employers and employees who are required to buy health insurance on Vermont Health Connect.

The chamber has an experienced team of health insurance experts that is very familiar with the enrollment and billing systems.

For decades, the Vermont chamber has administered a health insurance program for the members of all chambers in the state. The program, VACE Insurance, currently covers about 4,000 small businesses and 18,000 lives. At the end of 2013, it will no longer exist, and those businesses and their employees must buy coverage on Vermont Health Connect.

Shannon Wilson, director of finance and insurance for the chamber, said that navigators “all along were being told that on Oct. 1, we’d be able to enroll people. There’s only so much time, and the demand has been huge from the business community.”

Wilson and the four navigators that work with her are booked solid through the end of November, and they had expected to enroll employers and employees during this time. But the market hasn’t launched as planned.

The chamber struggled to even get its navigators logged in to Vermont Health Connect for the first two weeks, let alone enroll businesses. Wilson said the system has improved, but it is still ridden with errors, and one error can cause a business to restart a tedious process from the beginning.

Jan. 1 is when the plans of roughly 75,000 Vermonters are set to expire. Wilson and Vermont Chamber President Betsy Bishop say they were already concerned about the short time frame to enroll Vermonters in a completely new market. Add a constant stream of IT blips to the radar, and they say they doubt it is feasible to enroll all of the Vermonters who need insurance by that date.

“The math doesn’t work,” Bishop said, looking at her navigators’ schedules. The navigators generally meet with employers for four to six hours, and many parts of the enrollment process that were supposed to be automatic are being done manually, she said.

“The math of the days and hours is what’s of concern to us,” Bishop continued. “The initial thought was that many of these folks would be able to go into the system on their own without a navigator. Since the website is not working, we’re getting an increasing workload to help them, but there’s not enough people to do that.”

Bishop has consistently advocated in recent years to make enrollment in the market voluntary and provide plans outside of the market. She has thus far been unsuccessful in that push.

“The reason we thought it was really important to be voluntary is because anytime you move a big database, it’s prudent to continue the existing database in the event things don’t go as smoothly as you think,” she said.

She also notes that the Legislature voted for and the governor signed off on a recent bill that included contingency language, which would allow Vermonters to keep their current plans in the event that the market is not functional. She said that language was included for an extraordinary circumstance like the one the state is now experiencing.

Republican legislative leaders called on the Shumlin administration to use this measure if the site was not fully functional by Dec. 1, but Gov. Peter Shumlin kept mum on any and all contingency plans at a Thursday press conference.

A different take on being a navigator

Peter Sterling, director of the Vermont Campaign for Health Care Security, says he and his group’s two other navigators aren’t as concerned about enrolling Vermonters on Vermont Health Connect.

Peter Sterling

Peter Sterling, executive director of Vermont Campaign for Health Care Security, which has three navigators. Photo by Alan Panebaker/VTDigger

At the present, they are more focused on raising awareness about the new market and its products than they are about trying to help people actually buy the plans.

“In this first month, 99 percent of the people I’ve talked to are really more interested in information gathering than they are enrolling,” Sterling said. “This is a lot for people to process. Nobody has called me up saying, ‘I need to be enrolled today, why isn’t this happening?’”

Sterling said that he tells those who want to enroll to wait a few weeks for the state to iron out the kinks.

“I want consumers to have a good experience enrolling,” he said. “I don’t want to take the chance of the site crashing.”

Sterling and his team are focusing on lower and middle income Vermonters earning up to 300 percent of the federal poverty line. Many of the Vermonters in that group are 18 to 30 years of age.

“The main challenge I encounter is that young people under 30 do not seem interested in receiving information about the exchange,” he said. “Basically, they walk past me. Older people are much more interested.”

Sterling says that most people have a low “health insurance literacy,” and he finds that groups of fewer than 10 people are easiest to educate. He spends many days sitting by the Montpelier Department of Motor Vehicles and outside of public libraries.

He regularly zigzags the state to meet with Vermonters one-on-one, and he regularly follows up with these residents.

“I would never view it as a waste of time to drive an hour to talk to four or five people,” he said.

Andrew Stein

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  • These horrible complicated health websites beg the question of why we don’t have free universal healthcare.

    If healthcare was simply paid for out of taxes that were levied – say for the F-35 project. There would be no need to involve insurance companies or complex IT systems that by their nature compromise our privacy.

  • rosemarie jackowski

    A question for Peter Sterling and all of the other Navigators: What should a person who needs dental care do? Please, don’t tell me that they should go to Costa Rica. That is the solution that some have used. Dental Tourism is gaining in popularity – but that is not an option for most of us.

  • Walter Carpenter

    “These horrible complicated health websites beg the question of why we don’t have free universal healthcare.”

    Ask your federal congress this question. They are the ones who came up with this law.

  • Kathy Callaghan

    There would still be a need for enrollment under a universal health care system in Vermont. That’s because there sill still be multiple payers, as has now been admitted by some of the architects of “single payer” (although it was known all along)..

    Unfortunately “single payer” is a misnomer that denotes an image that is not accurate. Federal Medicare, veterans health coverage, out of state employers (i.e., Verizon) and others will still be separate payers. And, if Vermont chose not to cover illegal aliens, those folks would be excluded as well. Hence, the need for enrollment.

    The Exchange enrollment problems to date do not bode well for the proposed 2017 Green Mountain Care health care system. Vermont has a terrible track record of trying to implement new computer systems, even when they are unique to Vermont (e.g., do not need to interface with outside systems).

  • Walter Carpenter

    “The Exchange enrollment problems to date do not bode well for the proposed 2017 Green Mountain Care health care system.”

    I disagree:) It should be much easier because when everyone is eligible and enrolled there will not be any need for this vast complexity. And I also disagree about the need for enrollment under single-payer. Now, it is true that there will be multi-payers — the fed programs and all — but there will be no need to enroll and such, or to be income eligible, because Vermonters already will be enrolled.

    Anything else of mine come your way?:)

  • Craig Powers

    Verbatim quote from Obama:

    “If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”

    Except in Vermont.

  • Hilary Cooke

    Three Navigator groups articulating three different missions which can only mean three different measurements of success…and I am sure of no failures. It really speaks to ideology trumping managerial governance.
    Politics aside, one of things that concerns me is 90,000 Vermonters not having health insurance on January 1st. Nothing is more disruptive to a health care provider (ie. hospital or physician) than having a patient show up without evidence for reimbursement. Billing to a payer is done at least twice, bills to patients and cash flow is significantly impaired.
    Now multiply that to an entire health care system. The idea of an open enrollment period extending months into 2014 only exacerbates this problem. It won’t be pretty.
    This is so not ready to roll out on many levels. In Vermont, rarely do we hear the perspective of an essential stakeholder, the health care provider. I hope they can survive this rollout.
    I think we all want universal access to healthcare to be successful so it is an absolute shame that it has been botched so badly. The Navigator program is just one case in point….remember, we get what we measure.

  • Dan Carver


    A clarifying question for you:
    Are you saying there should be no need to enrollment, when Vermont’s single-payer system comes to existence in 2017?

    When I read your comment, all I think of within that context, is any person in the world can come to VT and have medical treatment performed in VT at the VT tax payer’s expense.

    What system do you propose, instead of enrollment, for VT providers to know how to spend our funds on eligible people?
    Help me understand.
    Thank you.

  • Annette Smith

    The part about the system that I was not aware of was the income sensitivity giving some people subsidies and requiring an interface with the IRS to verify income.

    These websites have been set up to require logging in first, and then you can get the specific information about your subsidy. As Peter points out, most people want information first. There was an interview on NPR Saturday afternoon with a software developer who said that the log-in requirement is unnecessarily overcomplicating things. If you want to buy a house you can use a mortgage calculator to get a basic idea of what your payments would be. This could easily have been done with the healthcare website, so all of us who need first to look at all of those plans and determine specifically what will work for us could be spending our time getting that information rather than reading news stories about how hard it is to log in.

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