Vermont Health Connect is going backward, stakeholders say

[P]eople 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.”

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.

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:

1:19:12 on hold with Vermont Health Connect! That’s how I spend my time off these days.

— Alexander Lee (@alexanderplee) December 30, 2015

OK, I was on the phone yesterday afternoon for an hour trying to talk to someone at Vermont Health Connect. I… https://t.co/eZGMlTRDiZ

— Dennis Tatro (@Denlore) December 15, 2015

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