[T]he two insurance companies that sell products through Vermont Health Connect are warning about the risks associated with fixing the health care insurance website.
Representatives from Blue Cross Blue Shield of Vermont and MVP Health Care told the Senate Health and Welfare Committee on Wednesday the state needs to be prepared to take on substantial risk.
The insurers responded to a report from Strategic Solutions Group that suggests fixing the exchange is the best path forward for the state. A consultant from the group called that fix “a complex bit of surgery.”
The fix involves removing a dysfunctional piece of technology — called OneGate — that is built on top of stable technology—called Oracle. The state could do the work while leveraging a $62 million federal grant, but the effort would last through at least 2018, according to the study.
OneGate is software code provided by a company named Exeter Group that went out of business in late 2015. Vermont, at the time, was the company’s only remaining customer.
“The OneGate product is literally everywhere, so it really is a complex bit of surgery that is required,” David Weiher, from Strategic Solutions Group, told lawmakers in the House at a joint hearing Wednesday.
The report has also recommended encouraging Vermont Health Connect customers who don’t receive help paying for their plans to buy their insurance directly from Blue Cross or MVP and avoid the website altogether. The report says that 4,910 of those customers already enroll directly through the insurers, and another 6,850 could choose that option.
Dawn Schneiderman, the chief administrative officer for Blue Cross Blue Shield of Vermont, said the Legislature should read the full report to understand the risks associated with SSG’s recommendations.
Here are a few of the pitfalls she said lawmakers should pay attention to:
• “The next stage … will be as challenging as the previous work over the last 3 years.”
• “The more extensive scope … and the compressed time frame for completion add new levels of complexity and risk.”
• “The program resources and inadequate governance model that was in place over the last 3 years will need to be addressed to meet the demanding requirements for the work to be performed.”
• “This endeavor has extremely high risk given that Vermont does not currently have all the necessary staff resources or expertise that can immediately be assigned on a full time basis to support a program of this size.”
“We have concerns that the state will be able to overcome the risks associated with the recommended alternative,” Schneiderman said. “It’s easy to spend the money, but what’s most important is that at the end of having spent it that” the problems are fixed.
She said one of the biggest remaining problems is not technology but the quality of the data in the Vermont Health Connect system. “No matter who does the billing, if the data that you have is not clean, you’re really just transferring the problem to another person,” she said.
Susan Gretowski, the lobbyist for MVP, said her company largely agrees with Blue Cross about the risks of fixing the exchange and the data quality issues. She said there are other problems that can be solved by changing policies.
For example, Gretowski said MVP has a policy to accept payments that have a minor error—like if someone owes $89.76 but instead writes a check for $89.67. Vermont Health Connect doesn’t accept payments that are off by a small amount, she said.
Mike Fisher, the chief health care advocate for Vermont Legal Aid, also testified Wednesday. He was chair of the House Health Care Committee three years ago, and said he was dealing with similar problems with Vermont Health Connect back then.
“It feels a little bit like I’ve been here before,” he said.