Documents Show Progress, Pitfalls At Vermont Health Connect
Gov. Peter Shumlin says a major software fix at Vermont Health Connect will finally solve shortcomings that have plagued the program since its launch in 2013. But state emails show that the technology is still very much a work in progress. And the documents show taxpayers might end up footing the bill for mistakes related to the transition.
Earlier this week, the governor said he had some good news to share with Vermonters. In a fifth-floor conference room with panoramic views of downtown Montpelier, Shumlin said the customer-service backlog at Vermont Health Connect is down to 4,500 – less than half the number of people that were waiting for changes back in June.
Better yet, according to Shumlin, the software that was supposed to enable automatic updates to customers’ insurance policies was performing as planned. These “change of circumstances” are needed to automatically update changes in a consumer's life circumstances, whether that means a new address, or adding or dropping a spouse or child.
“The good news there is that now the vast majority of those incoming changes are dealt with on the phone within 15 minutes, 20 minutes as the customer waits,” Shumlin said.
That statement isn’t quite accurate: fewer than half of incoming calls are handled in a single phone call. Shumlin’s chief of health care reform, Lawrence Miller, took to the dais to correct his boss shortly after.
But Shumlin’s general premise – that Vermont Health Connect works much better now than it did 10 weeks ago – seems to be about right, according to people who should know.
“There’s still some work to be done with the more complicated transactions, to make the system fully automated, but clear progress has been made,” says Cory Gustafson, director of government and public relations with Blue Cross Blue Shield of Vermont.
The backlog has been more than halved. And the automated change-of-circumstance functionality has begun to replace the laborious, error-prone manual processes that spawned that backlog in the first place.
Emails show concerns
While progress is undeniable, however, significant challenges remain. And internal emails between top officials at Vermont Health Connect and the state’s largest private insurer show that the rollout of the new change-of-circumstance software has hit potholes along the way, and faces more on its path to an Oct. 1 deadline when the technology must be running seamlessly.
Blue Cross officials have on numerous occasions expressed concerns about the testing protocols being used to ensure the new technology will work as well as it needs to. And they’ve sought repeated assurances from Heath Connect officials that financial liability for billing errors resulting from insufficient testing will fall squarely on the state.
“There have been many communications between Blue Cross and Vermont Health Connect representatives that have emphasized how important it is to thoroughly test,” Gustafson says.
Cassandra Gekas, director of operations at Vermont Health Connect, has overseen the change-of-circumstance rollout. Gekas says the emails, obtained by VPR in a public records request, focus mainly on the trouble spots.
“It’s not my job to send emails about things that are working,” Gekas says. “On a day-to-day basis my job is to figure out where the chokepoints are.”
But she says the conflicts illuminated by those correspondences – including concerns about inadequate testing – have largely been resolved.
“Our perspective on the technology is that it’s working incredibly well and I think the numbers speak for themselves on that issue,” Gekas says.
Disagreements between Blue Cross and the state center largely on the adequacy of testing, and the advisability of ramping up automated change-of-circumstance transactions absent more rigorous tests.
A June 30 email chain between Gekas and Blue Cross Director of Audit Dawn Schneiderman centers on a “request to expand CoC in production,” the acronym referring to “change of circumstance.”
Schneiderman says Blue Cross is reluctant “to open the floodgate” for more CoC transactions “until we’re certain” previous transactions are working correctly.
Gekas responds by saying that she’d “wanted us to take the more conservative approach, but at this point I’m concerned that it’s taking too long and we’re not making enough progress.”
In a recent interview, here’s how Gekas characterizes the exchange:
“So I think that conversation is really me saying, ‘Are we ready? Can we expand this a little bit more?’ And Dawn saying, ‘I’m not quite sure why we’re talking about this if we’re still doing testing.’”
Gekas says the exchange resulted in a compromise, and that the transactions pushed through the automated system were largely a success.
“At the end of the day after all these conversations, we did expand it and haven’t found any major defects with this information going across the Blue Cross Blue Shield,” Gekas says.
Gustafson says high error rates for change-of-circumstance transactions earlier in software rollout might have been “resulting from the lack of testing.” But he says things have since improved.
“It’s been dropping from its early levels and getting better through this process,” Gustafson says.
Who pays for errors?
The issue of who gets stuck with the tab for billing errors related to the deployment of the new technology emerges as a pointed theme of the correspondence. And Blue Cross’ anxiousness over the question steps from the fact that, according to Schneiderman, there’s been no “end-to-end testing of the billing process in the new change-of-circumstance environment.”
“I’m asking for confirmation that VHC will be liable for any potential adverse financial impacts to (Blue Cross) if we find, after the fact, that billing/dunning isn’t fully working as expected,” Schneiderman wrote.
In another email, she says it’s Blue Cross’ expectation that quote “we will be made whole.”
Lawrence Miller, chief of health care reform for the Shumlin administration, says Schneiderman never got the confirmation she’d sought. He says no one ever directly addressed Blue Cross’ statements in the emails, and that the question of liability will be left to a reconciliation process next year.
“We’re not going to, we’re not going to take on any responsibility informally outside of a contract,” Miller says. “And we’re not going to do a contract amendment in two hours.”
Gustafson says the state has always said “it would take reasonable responsibility for costs stemming from their system issues.”
The state is expected to unveil this week how much it will pay Blue Cross for Vermont Health Connect-related billing errors from the 2014 policy year.
“So we’ve worked out a rather thorough reconciliation process for 2014, and I don’t expect their positon to change in 2015,” Gustafson says.
Numbers show improvement
Numbers at VHC show the change-of-circumstance technology is trending in the right direction. The proportion of change-of-circumstance service requests being resolved on the same day the customer calls has gone from less than 20 percent at the end of April to about 45 percent as of Aug. 2.
The number of change transactions being sent from Vermont Health Connect to various insurers, meanwhile, has gone from fewer than 300 per week in late June to more than 1,000 per week in August.
The technology still can’t process certain types of changes. Making multiple changes of circumstance in a single policy, for instance, still requires manual workaround. And that’s a feature the state will need to get automated before Oct. 1.
But the universe of changes the system is able to process automatically has expanded dramatically since May 31. Justin Tease, director of implementation at Vermont Health Connect, says it’s all part of a slow “ramp up” that has confirmed the integrity of the new software.
“We haven’t found what I would qualify as a major defect that we have to stop the presses and reassess,” Tease says.
Tease says consumers and the public have been understandably distraught over some of Vermont Health Connect’s high-profile failings. But he says that doesn’t mean the program won’t deliver on its promise.
“Vermont Health Connect is not broken … it just wasn’t finished,” Tease says. “There’s a rich history where it’s really easy to write off the exchange at the headline level, but there’s a lot of nuance under there.”
Tease says the state’s decision to use the $200 million exchange to house its Medicaid population complicated things in the early going. But he says once the technology is in place to support the breadth of services Vermont Health Connect was designed to provide, it will become a major public asset.
“I think it positions us well to make further strategic decisions around health reform within the state, as well as within the agency of Human Services,” Tease says. “It’s because we tied Vermont Health Connect tot some of these larger goals that made it somewhat more challenging. But I think that was just some of the policy and some of the initiative that we didn’t see in some other states.”