MONTPELIER — The contractor working on Vermont’s health insurance exchange has issued a report that is highly critical of the Vermont Health Connect management structure established by state officials and the original vendor, CGI.
Optum, which was brought on board this month after Gov. Peter Shumlin fired CGI, wrote that the management structure and process “contributed to (the state’s) lack of project ownership and CGI’s lack of accountability.” Optum also found that management processes “do not align with industry best practices and are insufficient or ineffective.”
“As a result CGI has not met its commitments in the contract and the project has not met the expectations of (the state). The project team’s ability to deliver the remaining contractual requirements is a ‘High’ risk, and as such, immediate corrective action is required,” the report states.
Optum found that accountability for program management is unclear. “Neither (the state) nor CGI believe they are accountable for project outcomes,” the report says.
Lawrence Miller, whom Shumlin tapped in January to serve as chief of health care reform, said the findings by Optum represent “something of a snapshot.” The report stems from an assessment period in June, Miller told reporters Friday.
The findings released Friday are similar to previous assessments by independent parties.
“We’re using this information … to make decisions about the best way forward with the project,” Miller said.
Department of Vermont Health Access Commissioner Mark Larson, who has faced heavy criticism from Republicans and opponents of the exchange, defended the state’s work despite ongoing shortcomings in the technology.
“On a broad level what we have taken, generally, from this report is that we have worked hard with our vendor partners to create a foundation for Vermont Health Connect,” he said. “It is a foundation that we can build on moving forward.”
The insurance exchange, mandated under the federal Affordable Care Act, has been troubled since its October launch. Thousands of users who need to change information, such as their address or marital status, must undergo a cumbersome manual process rather than the faster, automated system the website was expected to offer.
Additionally, small business employees still are not allowed to enroll through the website and must obtain insurance directly from carriers. That function is expected to be available next year at the earliest.
State officials said Friday that Optum, which was originally brought on to help the state address a backlog of “change of circumstance” requests, has been succeeding. About 10,000 of the 13,000 backlogged requests have been addressed, they said. Officials expect to address a total of 19,000 by mid-October.
“The goal is to not have a backlog generated in any meaningful way again,” Miller said. “You should be able to report a change and have it be effected in the next billing cycle.”
Miller also said, however, that manual processes will continue to be used into next year. Development work on the unfinished website functions will take a back seat to ensuring current customers can renew coverage later this year.
“There’s a meaningful amount of work to be done,” he said. “We’re going to follow good practice going into something like an open enrollment period and freeze code (development) where we are.”
Miller said he does not anticipate any major developments with the site until after the next open enrollment period, which will run through mid-February.
“That’s just sort of the unpleasant realities of running the business,” he said.
Optum recommended the state hire an information technology director to take charge of the development side of the exchange. Miller said the state is already in talks with someone to take that job, but he declined to elaborate because an agreement has not been reached.
“We do expect to have somebody engaged in that role, actually, next week,” he said. “We’ve been looking very specifically with experience not with just these types of projects, but as close to in this space as possible.”
Additionally, the state has transferred David Martini, who was with the Department of Financial Regulation, to the health access department to oversee operations. Lindsay Tucker, who had been deputy commissioner under Larson, is being transferred to a different role.
Asked if the state should have discarded CGI sooner, Miller said doing so would not have been feasible because the state was in the process of open enrollment with tens of thousands of Vermonters seeking coverage.
“I don’t see practically, given enrollment and other issues, that an earlier transition would have been successful,” he said.
Bob Daub, Optum’s program manager, said the report shows opportunities for improvement. He said improved communication and collaboration between the state and its vendors will help.
“That’s a starting point for moving the ball forward,” Daub said.
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