Health Care

Report: Vermont Health Connect flawed, but state’s best option

From left: Don VanSlochem, John Schaeffer and David Weiher of Strategic Solutions Group. Photo by Elizabeth Hewitt/VTDigger
From left: Don VanSlochem, John Schaeffer and David Weiher of Strategic Solutions Group discuss the report Wednesday at the Statehouse. Photo by Elizabeth Hewitt/VTDigger

An analysis of the state’s health insurance exchange concludes that although the system has “significant deficiencies,” the best course for the state is to stick with it.

The 121-page report by Massachusetts-based Strategic Solutions Group, commissioned by the Legislature in the budget bill, was released Wednesday.

Several issues plague Vermont Health Connect, the analysis found — including incorrect data, problems with data exchanges, lack of automation and poor customer service. The review explored alternatives to the current model, including using the federal exchange, finding a commercial option or looking to technology from another state.

“After reexamining six possible alternative solutions, the most feasible and cost-effective path for long-term sustainability is to continue to enhance the current VHC system,” the report concludes.

The issues with the current system are significant, members of the team that conducted the review said Wednesday at the Statehouse. If the system continues as is, the researchers would not consider it to be “a sustainable platform,” said David Weiher, one of the Strategic Solutions Group analysts. “It needs work.”

To function, the system relies on a number of manual workarounds, he said, which will prove problematic as requirements of the technology shift over time.

The researchers emphasized, however, that they see the technology that provides the foundation for Vermont Health Connect as a “sound investment.”

“We believe you have a roadmap, a very viable roadmap ahead of you to do more work to stabilize and create a platform into the future,” Weiher said.

Peter Shumlin
Gov. Peter Shumlin speaks at a news conference. With him is Green Mountain Care Board Chair Al Gobeille. File photo by Andrew Kutches/VTDigger

Gov.-elect Phil Scott said in a statement that his administration will assess the report’s recommendations and develop a plan to move forward.

“The outcome we all want is an exchange that ensures Vermonters have an easy avenue to affordable health benefits. I will hold my administration accountable to delivering on that goal,” Scott said.

Green Mountain Care Board Chair Al Gobeille, who will serve as secretary of human services in the Scott administration, said the report shows the exchange needs a lot of improvements.

“Basically, it says it’s not sustainable. That’s the bottom line. And a lot of work has to be done to make it sustainable,” Gobeille said.

The review’s recommendation was informed by a $62 million grant from the federal Centers for Medicare and Medicaid Services to fund certain improvements to the existing exchange, Weiher said. The grant pays for the first phase of a planned new technology platform that will be a one-stop shop for determining benefits program eligibility. The grant was approved in September, and the work must be completed by Sept. 30, 2018.

The state will need to budget $6.2 million in matching funds in the next fiscal year to receive the federal money, according to the Joint Fiscal Office.

That federal grant is available only if Vermont sticks with the state-based exchange, the report authors said.

Any other alternative, including switching to the federal exchange or working with another state, would need to be funded entirely from state coffers, according to the report’s authors.

None of the six alternatives the analysts reviewed would allow the state to continue to offer the services it does without interruption to customers, they said.

According to Weiher, one key step for the exchange to get on track will be to remove code built and installed in the program by the now-defunct Exeter Group Inc., a Vermont Health Connect subcontractor that shut down in 2015. That work would be funded by the federal grant, they said.

The report’s conclusions also took into consideration the large portion of the population on the exchange that receives some sort of subsidy related to the Medicaid program — 94 percent.

John Schaeffer, president of Strategic Solutions Group, said it is “hard to speculate” on what changes in federal support could come with the incoming Trump administration.

“The prudent thing to do is to move forward assuming the commitment is strong,” Schaeffer said, saying there is work that needs to be done. “If things change in Washington, you know, that could change everyone’s plans.”

Gov. Peter Shumlin reiterated his support Wednesday for Vermont Health Connect.

“Now that this report is completed, it’s time for everyone to stop posturing and get to work continuing to build upon the system that Vermont has used to achieve the lowest uninsured rates in the nation,” Shumlin said.

Gobeille said the most important area that needs to be fixed is the section that deals with determining eligibility for the Medicaid program.

“That part has to work,” he said. “The platform needs to work, and it needs a lot of work.”

Gobeille said it was clear from the report that moving to the federal exchange or another state exchange was “not viable,” particularly given the unknowns about what will happen with the Affordable Care Act when President-elect Donald Trump takes office.

“It’s certainly not the time to stay with the status quo. We have to make changes. And we have to figure out what we mean by that and when we can get it done.”

(VTDigger’s Mark Johnson contributed to this report.)

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  • stephen whitaker

    Its good to have some expert recommendations, FINALLY.

    What should be now explored now is whether we can modify the system in a manner which makes it useful for neighboring states, such that we can share the costs going forward.

    The same analysis is necessary with the HIE or Health Information Exchange which we provided nearly $50Million for VITL to build for us. Unfortunately, VITL seems to have assigned all of that intellectual property to the vendor Medicity, as subsidiary of Aetna Insurance. This was in direct violation of the agreement with the Vermont Department of Health Access.

    If we have to start over, lets get started. The new Attorney General should pursue Vermont’s intellectual property, in court if necessary, and we should build a system that is open source, shareable and in cooperation with neighboring states.

    We need to break this pattern of multi-million dollar boondoggles.

  • Dan McCauliffe

    How about letting individuals and small businesses buy health insurance somewhere else outside the exchange, as allowed in all the other 49 states? Those that wish to avoid further torture would at least have an alternative and less painful way of obtaining their health insurance.

    • Walter Carpenter

      “Those that wish to avoid further torture would at least have an alternative and less painful way of obtaining their health insurance.”

      Having experienced this before, I know how it is just another way for insurers to sell junk policies that do no good and avoid accountability for them because it is much harder to sue an insurer that is out of state and they know it.

  • Dave Bellini

    I don’t understand the last paragraph. Also, I don’t see why Vermonters are forced to buy insurance only through a mechanism that everyone agrees doesn’t work.

  • edward letourneau

    This would become a better system if we just made state workers and school employees buy their insurance through the exchange. If its good enough for people paying taxes, its good enough for all.

    • Patricia Goodrich

      Are you implying that state workers and school employees (also known as “teachers”) don’t pay taxes? They will be very surprised.

      • Edward letourneau

        They need to be using the heath insurance site — and the health insurance programs — that everyone else is required to use. Its time to end the special treatment for some.

      • Kathy Callaghan

        I certainly would be. I’d like all my taxes back that I paid while a state employee for 19 years! Just in time for Christmas, too!

      • Tom Grout

        So, if I have an inherited home valued at $350,000 I am supposed to pay $3500 in taxes when I make $32,000/yr as compared to a teacher making $45,000 with a $200,000 home?

    • Kathy Callaghan

      “People paying taxes…”. Several comments: State employees and teachers are significant taxpayers. Also there was a 2016 report that showed that if large groups (state employees and teachers) were added to the exchange the exchange would essentially “blow up”. It can’t handle what it has now, let alone large groups. The opposite is what needs to happen. The legislature needs to repeal the law that forces small groups and individuals to buy only through the exchange. Lessening the burden on the exchange not increasing it is the way to do. If you have a car with an overworked engine climbing a hill, adding five more people to the car doesn’t solve the problem.

      • Tom Grout

        Nor does adding more education staff with declining enrollment solve the education mess.

      • Frank Beardsley

        Let’s stress the system and see if it indeed ‘blows up’. If it does, it would prove $250 million helped line a lot of pockets for an inferior product and it should be abandoned. If this 2016 report really exists, and we’ve kept digging at a furious pace, I would consider that fraud, waste and abuse.

      • Walter Carpenter

        Also there was a 2016 report that showed that if large groups (state employees and teachers) were added to the exchange the exchange would essentially “blow up”.

        Why not do the easiest thing and simply expand Medicaid (or Medicare-for-all) to cover all Vermonters? I know that we would have to work with the reimbursement rates along with a great many other details about with the program and that this would take time. It would at least be easier and more helpful in the long run than trying to figure out whether or not the exchanges have too many, whether to buy insurance in or out of the exchanges, dealing with deductibles, whether someone is eligible or ineligible for this or that program, and whether teachers and state workers should have a different health program than the rest of us.

  • Jim Cristiansen

    So, I wanted to check out what our legislature paid for and whom they paid. A quick trip to Strategic Solutions Group website made the value of this report crystal clear.

    From their mission statement, …”All of our Team Members understand our customers’ focus and we dedicate ourselves to ensuring all business and IT requirements are met, while staying true to our mission of streamlining public sector processes. At SSG, we will not rest until our dreams become a reality. ”

    As of 7:50 this morning…

    The “learn more link” that follows the SSG mission statement is broken.

    The “Learn more” link on the SSG home page under the “IT Solutions that Work” banner is broken.

    Confidence is not real high on this one.

    • Jim Cristiansen

      Update. SSG fixed their site. Hopefully they can offer solutions to repair VT Heath Connect in such a timely manner.

  • As the State nears a major transition of power, this report represents a perfect metaphor of “how not to pass the torch”.

    As we all expected, Mr. Shumlin will dump the VHC and huge mess on to Governor Elect Phil Scott. The people will be left to pay for the continuing and seemingly unending costs of patching up perhaps the worse boondoggle in Vermont history.

    When “passing the torch”, it is customary to do so in such a manner that the recipient can grab the torch’s handle. In this case Mr. Shumlin has pushed a burning end of the torch toward Phil Scott and he has no alternative but to accept the responsibility and accompanying pain.

    All of this happens only days after a very defensive Shumlin told us that the Vermont Health Care Exchange is the best in the country.

    Good luck to soon to be Governor Scott.

  • John McClaughry

    The report evaluates the use of a commercial system, like h-centive, that runs the exchange in Massachusetts. Here’s the most telling line in the report: “For a state like Vermont, having a proud history of being an independent and progressive leader in health care services, a commercially packaged solution may not be immediately embraced.”
    Translation: “we have to do things our way, with local staff, never mind if there’s a better, sustainable, and less expensive way available, the taxpayers can always cover our failures.”

  • Joyce Travers

    To call this system “flawed” is a gross understatement. A system that takes a year to make a simple change to a subscriber’s coverage and then penalizes them to the point where they cannot afford coverage is WAY more than just “flawed”. A system that holds people hostage by only offering two carriers and not allowing any competition (in or out of state) forcing subscribers to pay higher than necessary rates isn’t just “flawed”. A system that allows a medical conglomerate to create a monopoly that makes obscene profits by billing carriers inflated amounts – paid for by subscribers through premium increases – is more than “flawed”. I cannot afford health insurance under the present system. I have a full time job and have not had coverage for six months. Oh, and I will have to pay a “penalty” at tax time for not being able to afford coverage. Somehow the word “flawed” just doesn’t seem strong enough to describe the anger, fear and hopelessness I have experienced. And I doubt I’m alone

  • I think back to a story on Channel 3 a few months ago about a woman who gave birth to twins prematurely last July. After 16 days, one of the boys died. Since then, she has received at least 4 notices from VHC telling her that they would cancel her insurance if she didn’t provide the name of the pediatrician who would take care of, get this, her dead son. In response, Lawrence Miller said he was appropriately said he was “deeply sorry. This never should have happened.” To highlight Mr. Millers ineptitude, he went on to say he “can’t guarantee this mom (that)it won’t happen again.” How hard is it to make sure that another request isn’t sent out. Apparently it is too hard for the VHC software and this inept management to figure out. And this report recommends we spend another 60 or 70 million to get it straightened out. Good luck with that.

  • We spent 200 million dollars to sign up and serve 47000 uninsured Vermonters health their health insurance. Not FOR their health insurance, just to sign them up.

    After four years, the designers still cant quite accomplish this task. Nobody wants to tell Dad the car rolled into the lake, but lets face it– this isnt government anymore, its chaos. The size of the disaster does not justify allowing it to continue.

  • Ignoring for the moment the “unmitigated disaster” (my Democratic House Rep’s words, not mine) that Vermont Health Connect has been to date, It sounds like this report’s recommendation is based on a rather illogical construct.
    John Schaeffer, president of Strategic Solutions Group, said it is “hard to speculate” on what changes in federal support could come with the incoming Trump administration. “The prudent thing to do is to move forward assuming the commitment is strong,”

    How is it “prudent” to assume that Trump’s commitment is strong when all he’s said is he’s going to replace it?

  • Howard Dindo

    The state’s best option has been, “follow the money”. Now that the Federal Gravy Train will be drying up in 23 days, VT will have to fend for itself. No more of having a Federal Administration willing to put us in debt by another 20,000,000,000, print worthless currency and bleeding businesses into bankruptcy. Trump will use Capitalism to distribute goods and services and not Socialism having a national government deciding on what is “Fair and Reasonable” in the distribution of goods and services. The new Trump motto for “Fair and Reasonable” is, “You don’t work, you don’t eat”. VT’ers are about to get “Berned”, again! How can this happen! As our politicians say, “If you can’t make socialism work in the Bronx, bring it on in VT”. As far as the present VHC program, don’t be fooled. It’s performance is worse than ever. There are individuals having net worth in multi-millions getting a subsidy. Why, because subsidies are not based on net worth but income. “Let the facts get into the way”!