State signs $9.5 million contract expanding role of Optum in health care exchange

Vermont signed a revised contract with the tech firm Optum that expands its role in Vermont Health Connect’s operations.

Optum already had a contract worth $5.6 million for consulting work, and the latest deal, signed Aug. 15, is worth an additional $9.5 million for a total of $15.1 million.

Lawrence Miller, chief of health care reform, said Optum’s contract is “open-to-buy” meaning its scope can broaden as needed.

“We’re pleased with the progress that’s been made, so we’re taking additional steps forward,” Miller added.

In the near-term the company will help the state prepare for open enrollment and make the transition away from CGI, but the two parties could eventually arrive at a “fixed cost” contract for Optum to complete the project, he said.

The contract revision includes a Sept. 30 deadline for bringing backlogs to “normal levels” for customers who need to make changes to their coverage or fix errors with billing or personal information.

At latest count, Optum has helped the state halve its backlog of coverage changes and information errors from a high of more than 14,000 to roughly 7,000. Also, close to 4,000 people are having billing issues with Vermont Health Connect. There is some overlap between the two groups, Miller said.

Optum will create a readiness plan to ensure Vermont Health Connect is prepared for the upcoming open enrollment period Nov. 15, when new users will flood the site and old users will need to renew their coverage.

The firm will also continue to manage and improve the escalation process whereby customers having issues that could impact their ability to fill prescriptions or see their doctor can be resolved more quickly.

Optum will continue its role as a consultant for the customer service call centers, and its 125 call center staff will stay on as well, Miller said.

The company will dedicate a project manager and management team to support the development of uncompleted IT work and “participate in the knowledge transfer from CGI.”

CGI is expected to wrap up its work on the exchange Sept. 20, though it will continue to provide web-hosting services for the exchange.

CGI is expected to receive a total of $67 million out of its original $84 million contract for its work building Vermont Health Connect. That sum will be paid despite the fact that Vermont estimated that CGI’s missed deadlines cost the state as much as $25 million in January.

Optum’s new contract includes oversight of CGI’s “contract compliance” and “invoice approval” of payments to CGI in its final days on the job.

Vermont is the latest feather in Optum’s Obamacare cap, as it has already helped remediate the federal healthcare.gov exchange. The firm is also doing remediation work on state-based exchanges in Hawaii, Minnesota, Maryland and Massachusetts. A company official has said they have a presence in virtually every exchange nationwide.

Any Vermont Health Connect contract revisions need to be approved by the Agency of Human Services Central Office, the Department of Information and Innovation and the Agency of Administration.

Revisions that involve additional money being spent must get federal approval, Miller said.

Morgan True

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