Health Care

Vermont Health Connect is going backward, stakeholders say

Gov. Peter Shumlin and chief of health reform Lawrence Miller attend a news conference at Vermont Health Connect headquarters in Winooski on Monday to announce that a key function of the state's health insurance exchange website is operational. Photo by Morgan True/VTDigger
Gov. Peter Shumlin and his chief of health care reform, Lawrence Miller, right, hold a news conference last year to tout a key function on the Vermont Health Connect website that has now been turned off again. File Photo by Morgan True/VTDigger
People are fed up with Vermont Health Connect.

Lawmakers who play watchdog, insurance companies that rely on the system to sell plans to individuals, and health care advocates who take calls from customers are all concerned about the status of Vermont Health Connect.

Customers continue to flood the health insurance exchange’s Facebook page to say how mad they are, some Vermonters routinely post on Twitter about the issues they’re dealing with, and even officials in the Shumlin administration say the health exchange is a headache.

At a House Health Care Committee meeting Wednesday, all of those issues started to boil over. Blue Cross Blue Shield of Vermont reiterated its request for an independent review of the exchange. The office of the health care advocate at Vermont Legal Aid said calls from frustrated consumers keep increasing.

And Lawrence Miller, the chief of health care reform for the Shumlin administration, said the system has so many errors backlogged right now that Vermont Health Connect had to turn off the change of circumstance function that Gov. Peter Shumlin spent multiple news conferences bragging about.

“We’re going backwards,” said Trinka Kerr, the chief health care advocate for Vermont Legal Aid. “Towards the end of last year, we were making progress. You could get things straightened out relatively quickly, and now things are more complicated than they used to be.”

Trinka Kerr
Trinka Kerr is the chief health care advocate for Vermont Legal Aid. Courtesy photo
Kerr shared data with lawmakers showing that calls regarding change of circumstance issues — from customers trying to make insurance changes because of a life event such as divorce or the birth of a child — hit a one-year low in October and then steadily went up in November and December. She said the situation is “depressing” and, among her staff, there’s “a fair amount of burnout happening.”

“There’s no doubt that sometimes people aren’t getting care as a result of this (health exchange),” Kerr said. “It’s definitely affecting their anxiety level about it.” She has now joined Blue Cross Blue Shield of Vermont in asking for an independent review of Vermont Health Connect.

Don George, the chief executive officer of Blue Cross Blue Shield of Vermont, called Vermont Health Connect a technical problem that should be viewed as a human issue because sick people “should not have to be worried about the status of their health care coverage.”

“Medical science tells us that the support system around people during those times in which they are receiving treatment can have an impact on the outcome of their treatment,” he said. “We view ourselves as an extension of that support system.”

Administration under fire, again

Miller, the chief of health care reform, said Wednesday that Vermont Health Connect has disabled the automated change of circumstance feature on the website because of technical issues. As a result, the backlog of patients who need to change their insurance because of a life event has mushroomed to about 4,000.

Miller immediately drew fire from lawmakers who complained they learned about the backlog Tuesday from a story on Vermont Public Radio.

The news comes near the end of Vermont Health Connect open enrollment — the once-a-year period from Nov. 1 to Jan. 31 when people without insurance can buy it through the exchange, and people with insurance can renew or change their plans for any reason.

And the revelation undermines assertions Gov. Peter Shumlin made less than four months ago when he declared Vermont Health Connect was mostly functional. On Oct. 1, he said a backlog of more than 10,000 change of circumstance requests had been cleared, with the exception of 100 to 200 complicated cases.

A few weeks later, on Oct. 29, Shumlin held a news conference to say he expected open enrollment to go well. In November, he held another news conference to say the system was able to automatically renew about 18,000 health plans for people who did not request changes to their insurance.

At the Oct. 29 news conference, Miller repeated what he told the Legislature just days before: that when open enrollment began, there would generally be “smooth sailing” and the worst the state should expect was a “light chop.”

But neither mentioned in the news conference that a company in Boston called Exeter Group was about to tell the state of Vermont it would stop building Vermont Health Connect’s front-end portal, deliver imperfect code it had been working on to the state, and go out of business.

After the news came out in November, Miller said he was optimistic because the state’s other contractors hired the former Exeter employees to keep working on the code. By Dec. 31, the exchange was scheduled to start using that software to help bring the state through its open enrollment period.

But Miller said Thursday the code was not ready, so the state didn’t accept the software, and it turned off the change of circumstance function to keep the system from sending the state hundreds of error messages.

“Exeter going out of business was a rogue wave,” Miller said in an interview, invoking another sailing metaphor. “We had the requisite knowledge but not in the structure that’s been there before.”

Rep. Chris Pearson, P-Burlington, told Miller on Wednesday that he did not learn about the change of circumstance issue until Tuesday, when he read a story on VPR’s website. Pearson told Miller that lawmakers should hear about a problem before reporters do.

“I have real frustration because we’re promised everything — we’re promised the world time and time again,” Rep. Doug Gage, R-Rutland City, said at the Wednesday hearing. “We have more problems with this than we can shake a stick at.”

“We put more money into it, more time into it, more promises, and we’re still at the same place,” Gage said. “The thing doesn’t work.”

Miller said in an interview he had intended to describe the change of circumstance problem Tuesday. He also said he mentioned back in October that Vermont Health Connect may need to turn off the change of circumstance function in the future.

“It was public information, and I totally intended to say it, and I definitely apologize to the committee for not making that understood,” Miller said. “I didn’t effectively (communicate it), I mean clearly, because they feel surprised.”

Blue Cross will need more settlements

George, the Blue Cross CEO, estimated Friday that 4,000 change of circumstance requests are backlogged in Vermont Health Connect.

Blue Cross Blue Shield of Vermont CEO Don George speaks at the unveiling of a mental health services collaboration, called Vermont Collaborative Care, between Blue Cross and the Brattleboro Retreat on Tuesday, May 28, 2013. At right are Brattleboro Retreat President Rob Simpson, Brattleboro Retreat Vice President Peter Albert and BCBS Chief Medical Officer Robert Wheeler. Photo by Andrew Stein/VTDigger
Blue Cross Blue Shield of Vermont CEO Don George speaks at the unveiling of a mental health services collaboration in 2013. File Photo by Andrew Stein/VTDigger
Additionally, he estimated 1,400 households on any type of insurance were not able to renew their plans under Vermont Health Connect. The insurer tried to contact as many customers as possible and asked them to reapply for renewal. It tracked about 700 of its own customers and helped them get health care.

The insurer is still unable to automatically reconcile customer accounts, which is part of what causes billing issues for customers. In October, George had said the company was “anxiously awaiting” the ability to do monthly automatic reconciliations in 2016.

George said Friday that Blue Cross would not be able to do automatic reconciliations for any of 2016. He said the insurer will continue to pay providers for care that patients signed up for, and the state of Vermont would likely need to pay Blue Cross another settlement in 2016.

“There will be both a premium reconciliation and a claims reconciliation (settlement) that will be required for 2015 and 2016,” George said. “Our hope was that the 2015 one would be a smaller dollar and scale than 2014. I don’t think we can hope that 2016 will be a materially smaller reconciliation.”

He is also reiterating his request from October to have the administration commission an independent technical review of Vermont Health Connect. He said the state auditor did a performance audit, and an external consultant did a compliance audit, but he wants to understand the technical foundation and history of the exchange.

George said the exchange should have been set up in three steps: Business people would write a business plan; technical people would write a technical plan based on the business plan; and software engineers would write code based on the technical plan.

He said there is a lot of space in between those three steps for someone to mess up the system, and nobody has looked at it independently. He called it irresponsible to attempt to move to the federal exchange — as some have called for — without knowing what foundational issues are in the exchange.

Miller doesn’t want to move to the federal exchange, but also doesn’t want to commission an independent review. He said the Legislature’s budget analysis office has hired a consultant, Dan Smith, to help lawmakers navigate information technology projects. He said Smith would help them “think through the appropriate questions and review technical documents.”

He said several people have been working at Vermont Health Connect six days a week, and on holidays for two years. “The best way to get a stable level of customer service is to get (workers) a stable system that they can do their jobs with,” he said.

Miller blamed CGI Technology Systems, the exchange’s original contractor, for not providing technical specifications to the state. That makes correcting fundamental problems with the website even more difficult, he said.

George agreed that Vermont Health Connect staff should continue moving forward on their work. An external reviewer, he said, could answer foundational questions about the technology without adding to the Vermont Health Connect workload.

“Given that it’s been two years, that’s our best recommendation,” George said. “If you keep doing what you’re doing, you’re going to keep getting what you’re getting.”

What they’re getting

Vermont Health Connect has about 33,000 customers who buy individual insurance through the website. The state has been in the process of moving about 143,000 Medicaid patients over to the exchange.

Blue Cross insures about 90 percent of those 33,000 individuals. In 2015, Blue Cross reported receiving 795 calls for every 1,000 customers who are on the individual exchange, compared with 736 per 1,000 in 2014.

“(Vermont Health Connect) customers call much more frequently, with more urgent concerns, than customers in any of our other lines of business … despite the fact that the (VHC) call center is the customer’s primary point of contact for many issues,” Blue Cross wrote in a presentation.

Alex Kaufman, who buys a plan through Vermont Health Connect, called VTDigger in December while he was also on the phone with the Internal Revenue Service. He said he was trying to explain to the IRS that he was not insured in 2014, even though Vermont Health Connect reported to the federal government that he was.

Kaufman said he spends up to four hours a week on the phone with Vermont Health Connect. “Every piece of mail I get from (Vermont Health Connect), I have to call, because they’re just these computer-generated (bills),” he said.

“You kind of get used to it,” he said. “And you just feel so terrible for the people you’re talking on the phone. I get on the phone and I apologize to them. The humans are trapped in the machine.”

Some other comments on Facebook and Twitter from Vermont Health Connect customers are here:

WHY am I still getting Billed !! my Insurance been cancelled for almost 2 Months .

Posted by Debbie Murphy on Jan. 15, 2016

I haven't heard anything about my insurance Coverage for 2016 and I need a prescription filled. I called to check. …

Posted by Kayne Strippe on Jan. 15, 2016

I've been trying since NOVEMBER 2, 2015 to change my plan for 2016.I thought it was finally fixed on Dec 23rd but I just…

Posted by Nancy Rampala-Cahlin on Jan. 14, 2016

Your system is a joke. 8 calls and over 9 hours of hold time, and 2 reps that have promised to call me back that never…

Posted by Jessica Judd on Jan. 13, 2016

Please get it together. I have been trying to sign up for a month and have met with an assister, called on three…

Posted by Laura Kyle on Jan. 11, 2016

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Erin Mansfield

Recent Stories

  • Since its inception, I have spent dozens and dozens of wasted hours on the phone, and numerous exchanges of email all the way up to the governor and Lawrence Miller, trying to sort out my wife’s coverage through Vermont Health Connect. We finally ditched her so-called subsidy this year and signed up directly with Blue Cross / Blue Shield. Although it costs us $600+ more a year, my lowered blood pressure will add years to my life and my increased productivity will more that make up the difference. Now I welcome seeing my wife’s monthly health insurance bill, knowing that we can actually figure out what is owed and what has been paid, and knowing she’s still got health insurance. Someone needs to drive a stake through the heart of Vermont Health Connect.

  • Jim Christiansen

    At what point does this ongoing administrative incompetence become criminal?

  • Stan Hopson

    If Shumlin and Co. were flying airplanes we’d all be dead.

  • Kim Fried

    Any apologies here? Any accountability here? Just look at the expressions on the faces in the picture and you have the whole story.

  • H. Brooke Paige

    Larry (Miller) your VHC racehorse is on its last leg, PLEASE shoot the poor thing and put it out of its misery ! The heck with what the FEDs say turn the web site over to someone, anyone, who knows what they are doing – like BCBS, who have been carrying your “water” as best they could all along,

    Patient/Clients need to have healthcare they can rely on, admit defeat and turn it over to the professionals.

  • Dave Bellini

    They have lied about “savings”, they have lied about cost and they have lied about function.

    • Peter Everett

      They’re called Politicians. Nothing g out of their mouths resembles truth!!!

    • Tom burke

      Put Larry Miller, Peter shumlin and and all the programmers onto the exchange- only option-must buy their insurance on the exchange. Once they experience the nightmare, problems would be fixed in 30 days. Since this will never happen, find a state where a health exchange is working and buy a copy of the software.

  • Katherine Silta

    Once again, as they say”you cannot make this stuff up.” Debacle after debacle. And these are the same people who have the audacity to think they can effectively manage every health care dollar in the state INCLUDING Medicare via a waiver from the Feds. Just this past Friday the governor was on VPR bragging, and I said at the time it sounded too good to be true.. Lets’ fast forward the election and put ourselves out of this misery.

  • David Usher

    More than $200 million to build and $45 million annual operating costs with

    “about 33,000 customers who buy individual insurance through the website. The state has been in the process of moving about 143,000 Medicaid patients over to the exchange.

    Blue Cross insures about 90 percent of those 33,000 individuals. In 2015, Blue Cross reported receiving 795 calls for every 1,000 customers who are on the individual exchange, compared with 736 per 1,000 in 2014.”

    is a travesty.

    This VHC fiasco makes my blood boil. Where is the accountability for the incompetence for this egregious waste of taxpayer dollars? Governor Shumlin is wise to leave office. He would never be reelected under this dark cloud of incompetence and lies.

    And now this administration wants an all-payer waiver from the feds to administer Medicare $. Legislators beware!

  • Patricia Crocker

    Governor Shumlin, it’s time for you to pick up the phone and call Dan Feliciano to fix this mess.

  • Randy Jorgensen

    My mother and father in law have been trying to sign up for two months with no avail after my father in law lost his coverage, and his Job.

  • Bill Kinzie

    Shumlin and Miller should resign or be remove from office.
    The incompetence and arrogance is criminal.

  • Bill Dunnington

    Someday, somebody will do a post mortem on this whole effort – and it will become a classic business school case for how not to …… in the meantime, why not ditch this and go Federal?

    • Walter Carpenter

      “why not ditch this and go Federal?”

      The Federal one is worse and the subsidies on it are something to laugh at. The entire ACA needs to be put into the graveyard and left there and Medicare-for-all be put into its place. The exchanges cannot be made to work for anyone else other than the medical-industrial complex no matter how hard you try to do them.

  • Duncan Kilmartin

    Vermont government, with few exceptions (e.g. Motor Vehicles, Vtrans, occasionally the Tax Department), is going backwards, especially in the essentials:

    The Education Agency now reflects Shumlin’s multifaceted dysfunctions, and cannot count the beans accurately, much less understand what constitutes effective education;

    Health Care, which proves beyond doubt that Shumlin, his handpicked bureaucratic leaders, the Speaker, and other legislative leaders, think that life/death and health care decisions can be made on a smart phone in order to satisfy their unrequited ambitions to be viewed as important in the daily lives of Vermonters and their families.

    Economic vitality: loss of middle class families and a generation of their children who could make “Vermont great again”. Government is not doing anything to get them back.

    I am not shocked that Chris Pearson and Vermont Legal Aid have become critics of Vermont Health Care. I just hope they can accept the evidence in its entirety, i.e. trying to have government make essential private personal decisions for the citizenry doesn’t work.

    My hat’s off to Vermont BC/BS for their long suffering effectiveness in the face of incompetent and counter-productive governmental fiat. I can personally attest to their effectiveness and member orientation. About two years ago, when my spouse was being treated at Dana Farber, she was denied coverage on a medication she needed and which had been filled on multiple occasions before.

    It was a Friday evening, and I left a message on the home phone of two BC/BS officials. Guess what: I got a call from Don George, BC/BS CEO at 10:00 p.m. that evening when he returned home from dinner, and he personally took charge and got the problem solved.

    No press conference surrounded by aides for “moral support”; so self-congratulation for failure. Just stepping up to the plate and effectively working “long after hours” to solve a member’s problems.

    Do you think Shumlin thinks or acts the same way? Guess again.

  • Krista Conley

    What a lost opportunity. It took me two months and only the support of amazing BCBS team running interference for me night and day, to get my coverage. I got the bill faster than I got the plan information. That stung.

  • Ralph Colin

    And these are the same people who are requesting a waiver from the Federal Government so that Vermont may take over the administration of Medicare for Vermont residents! God help us all.

    OK, Shumlin and Miller. You’ve proved your point. We accept it. You have no competition. You ARE the most incompetent administrative government executives in the U.S. today. You get your medal. Now RESIGN and give us a break.

  • Lisa Ravalese

    If Vermont Health Connect were a private company it would have folded long ago. I hope the next governor is willing and able to clean up this mess.

  • And Shumlin wants us to believe that his “group” can handle all-payer? The level of arrogance and incompetence is staggering. VHC has never and will never function to an acceptable level. To allow the state to have this all-payer system, including Medi-Care is insanity. To those of you on Medi-Care, time is running out. Your health care costs and services will change dramatically- and not for the better.
    It is well past time for the legislature to repeal Act 48.
    Seniors, take note and hold onto your wallets. It’s going to get ugly if this is allowed to continue.

  • Nancy Rampala

    VT Health Connect is a severely flawed and broken organization. I have been trying since NOVEMBER to get them to change my coverage for 2016 and get me the correct cards from Blue Cross so I can access health care. They tell me it’s a “billing issue” and the correct cards denoting the correct plan for 2016 will be sent to me. It is now almost FEBRUARY and I have yet to receive the correct cards. I cannot access health care and am in need of medication for Pulmonary Embolisms and COPD. I have written to the Governor (twice!) and now the Burlington Free Press to see if they can do an expose on this failed system. Someone needs to FIX this NOW!

  • Bill Olenick

    The whole kit and caboodle is bass ackwards.

    Communities over a certain population should set up their own local health center, and hire salaried doctors and nurses, to treat most aliments such as colds,flu,broken bones,cuts,burns and to monitor medications of long term chronic patients, as this will lift a huge administrative burden off the system.

    In a two tier approach, at the local level you set up a system for minor treatments, with local resources, and for major illness set up a local level but statewide coop to administrate coverage, and do not let a politician within a mile of the set up, nor one of those self righteous, do gooders, who are well meaning, but wouldn’t know common sense if it knocked them up the side the head…

    Combine that with the new local run health care centers, providing instruction and classes on prevention of illness by teaching how to grow/buy good,healthy food ,and how to prepare healthy meals, as pure food, grown local where possible, is the best medicine money can buy ,with this approach being far less costly than continuing eating mass produced food, grow in a manner that ensures, illness and disease, taking hold in the population.

    Use the government to negotiate caps on drug pricing,such as the Swiss approach, along with medical equipment and supplies to the local health centers, combined with nationwide tort reform, that would result in great liability cost reductions, for the medical providers, and then the nations health care would be on the right, common sense, track.

    The whole kit and caboodle should be dismantled and rebuilt from scratch and the rebuilding done from the local level up and not from a centralized, failed model, downwards…

  • John Poratti

    Our governor is totally responsible for getting us this far. He continues to spend money like a drunken sailor with no regard for tax payers. The man has no integrity and thinks all he has to do is make promises and everything will be fine. And now the state wants the Feds to turn over our Medicaid money. A total joke….

  • Carol Frenier

    Bruce Lisman is right. The VT state government has no business “experimenting” further with our health care. Remember this when decisions get made about and “all-payer-waiver.” What makes us think the VT government can come up with a system to make these payments to providers without endless delays and errors? How many physicians will be left in the state after that?

  • Deborah Billado

    At what point do we make those in Montpelier accountable for such a hugh waste
    of our resources (money and time). How can anyone feel good about this and the
    school funding horror show. Can you hear the suitcases being packed by those
    who are leaving this nightmare of a mess made by those in Montpelier. I am sure
    there are many good intentions. But the fact of the matter is all they have done is
    created an environment that is unaffordable to many people. We not only
    need balance in the house and senate we also need people who have experience in
    balancing a checkbook. Not sure that exists today. Lets end this fiasco and elect
    some new people and restore some balance in November.

  • RJ Potter

    Countdown: (2-8-16) There are 333 days until Governor Peter Shumlin leaves office.

  • Denise Cutler

    Why aren’t the rest of the Vt Democrats speaking out about this? What more has to happen before they admit that it is time to try something else?