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The home for VPR's coverage of health and health industry issues affecting the state of Vermont.

Shumlin Administration Had 'Red Flag' Warnings About Health Exchange Early And Often

The Shumlin administration was warned repeatedly over the past year that staffing shortages, technical problems and other issues with its main contractor threatened the launch of the state’s health exchange, documents show.

A series of reports prepared for the Department of Vermont Health Access highlight continuous and growing concerns about the state’s ability to launch Vermont Health Connect on time, dating back to early this summer.

Gov. Peter Shumlin said on Vermont Edition Nov. 1 that he was unaware of problems with the exchange until after Labor Day. But a May 22 report advised top officials in the Department of Vermont Health Access to “elevate missed deliverable dates or milestones to highest levels within the State and CGI.”

April 24, 2013: "Thus, a go forward decision for the Medicaid capabilities being requested and the [redacted] required are being made without really knowing all the risks - which is a real red flag to meeting the October date."

CGI Technologies and Solutions, the contractor the state hired to build the exchange, repeatedly missed deadlines, shifted due dates and failed to effectively communicate, the reports show.

State Auditor Doug Hoffer said the reports raised “a number of interesting questions” and confirmed Tuesday that he plans to conduct a performance audit of “DVHA and/or CGI contracts.”

The reports were issued by Gartner Consulting, a Stamford, Conn. firm hired to assist the state in quality assurance and contractor oversight for the build-out of the state’s health care exchange. The bi-weekly quality assurance reports use a color-coded system to define the risk presented by a given issue, such as a missed deadline or staffing shortages.

Credit Department of Vermont of Health Access

Starting on April 24, and continuing through Sept. 29, every report contained a page asserting that the entire health care exchange project should be considered “HIGH RISK” or “RED status due to unresolved risks to meeting the October 1 deadline for Go-Live.”

Robin Lunge, director of Health Care Reform for the Shumlin administration, said the project was rated as red from the beginning due to the ambitious deadline mandated by the Affordable Care Act.

“All states knew that Oct. 1 was an aggressive deadline, and the project was considered challenging because of that deadline. The various risk areas that Gartner would identify would be discussed and handled by the project team working on that project, and they would work with Gartner to understand what the concern was, make sure we fully understood it,” then go to work fixing it, Lunge said.

Vermont has received $172 million from the federal government to design, build and implement the exchange. The state has an $84 million, three-year contract with CGI to do the bulk of the work.

May 22, 2013 (Recommended Action): "Escalate missed deliverable dates or milestones to highest levels within the state and CGI."

The website for Vermont Health Connect launched on schedule Oct. 1. But it failed repeatedly in the beginning, and experienced other technical glitches in the following weeks. Some of those problems have been fixed, but the electronic payment system is still not working.

State officials recently told CGI that Vermont is preparing to withhold $5 million under the contract because of problems with the exchange. (Officials say the state actually incurred $26 million in damages, but the contract limits the amount the state can hold back to $5 million.)

A spokesperson for CGI was not available for comment Tuesday due to an ice storm in the Washington, D.C. area.

Lunge said the Gartner reports that gave early warnings were only one side of the story. CGI also produced weekly reports, which she said responded to issues Gartner raised. VPR requested all 2013 reports related to rollout of the exchange, including the CGI documents. Despite statutory time limits set out in the state’s access to public records law, the Department of Vermont Health Access has not yet released the CGI reports, Lunge said, because CGI is in the process of redacting them.

Crashing deadlines

The Oct. 1 deadline for the launch of the exchange came up early and often in the reports. The April 24 report mentioned “a real red flag to meeting the October date.”

The same report told state officials to tamp down their expectations for the exchange’s user experience.

“Gartner understand (sic) it would be nice to have more functionality in October and that it would make the user interface for both HBE [Health Benefits Exchange] and Medicaid much better,” the report said. “But it would seem this is a time to think of ‘must haves’ and not ‘nice to have.’”

June 19, 2013: "No comprehensive test approach or plan [has] been published or approved, and the full extent of required testing is unknown."

Soon after that, problems with internal deadlines and quality control began to dominate Gartner’s reports. A May 14 report warned that there “appear[ed] to be very little control over changes in the project schedule, deliverables, or scope. Potential impact to other project areas – both internal and external – are not analyzed or alternatives presented.”

That concern was realized in the next report, which said that in “recent project schedule updates from CGI, a number of project deliverables have been shifted out to the future without having gone through a Change Management process.” Such a process would ensure that changed deadlines were “institutionalized,” Lunge said, and that any necessary changes were made to the contract.

The May 14 report also said the “development environment” for the exchange – akin to a virtual tool shop that developers use to build the final project – was overdue.

“A delay in any environment being made available presents a risk to the project timeline, which has very little or no slack available,” the report said.

Over the following two weeks, that concern became an issue, and the May 22 report said the environment “is not yet fully configured or available.”

Gartner’s May 22 report also said the CGI weekly updates – the documents Lunge said will tell CGI’s side of the story – lacked detail on quality assurance issues.

“A large-scale, highly-integrated and complex project such as the HBE [Health Benefits Exchange] demands constant coordination and communication between stakeholders,” the Gartner document says. But that goal was “not accomplished with the current CGI status report.”

July 17, 2013: "While this approach allows for the maximum user testing time there is a risk that incomplete or non-functional system elements will be presented to users."

By July, Gartner’s concerns had turned to testing protocols for the new information technology system with the consultants issuing reports that flagged testing as a serious issue. By Sept. 28, it was clear the exchange launch wasn’t likely to go smoothly.

“Missed delivery dates and milestones, especially delays in environment availability, delayed testing to the point that functionality may be deployed with minimal testing,” said the last report before the exchange launched Oct. 1.

Who got the warnings?

According to Lunge, the Gartner reports were sent to four state officials by email: DVHA Deputy Commissioner Lindsey Tucker, DVHA Director of Change Management Justin Tease, Department of Information and Innovation Enterprise Project Management Director Tom Jenny and Beth Rowley, a manager in the state’s Agency of Human Services.

The May 22 report advising these officials to send an issue to the “highest levels” probably never reached Shumlin, Lunge said.

September 28, 2013: "Missed delivery dates and milestones, especially delays in environment availability, delayed testing to the point that functionality may be deployed with minimal testing."

Lunge said this problem likely stayed within the Department of Vermont Health Access and was handled by Commissioner Mark Larson along with Tucker.

Frequent reports of missed deadlines by contractors, Lunge said, ultimately made the project work better.

“I think the appropriate comparison point would’ve been ‘What happened in other states where they didn’t identify these risks?’” Lunge said. “Did they do better than us, did they do worse than us? I think what you would see if you did that comparison is that other states who weren’t aggressively managing their vendor would have ended up with even more serious problems than Vermont did.”

Gov. Shumlin was asked directly what he knew, and when, about problems with Vermont Health Connect. A caller to VPR’s Vermont Edition on Nov. 1 said he heard from people working on the project in July that the health care exchange was way behind schedule. Shumlin said he had not received the same information.

“I don’t know who your sources are,” Shumlin said, “but I didn’t have the same information that you had, let’s just put it that way.”

Update 12/19/2013: In response to requests for comment on this story, CGI Vice President of Global Communications Linda Odorisio issued the following statement by email:

"Despite the many challenges of this complex program, Vermont Health Connect is enrolling consumers thanks to an enormous team effort. CGI fully intends to honor the terms of its contract while at the same time dedicating its resources to continually improve Vermont Health Connect."

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