Tag Archives: Optum

The most important thing that happened this week

… had nothing to do with the Legislature. Well, it had nothing to do with current legislative debates.

And it went uncovered by the media except for Nancy Remsen of Seven Days.

Four representatives of Optum, the contractor working with the state to fix Vermont Health Connect, told legislative leaders Thursday that they expect to deliver an automated change-of-circumstance function as of the May 31 deadline set by the Shumlin administration.

“We are confident we will make the deadline,” Matt Stearns, vice president of external communications, said in an interview after private sessions with legislators.

This is big, assuming Stearns’ confidence is warranted.

I spend a lot of time on the ins and outs of the legislative and political process. It’s fun, it’s dramatic, and it’s a minefield of slapstickery. But I know that most of it washes out in the end. With the probable exception of the Norm McAllister saga, the world will little note nor long remember what was done here. But Optum making the deadline would be truly impactful.

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$20,000,000 is the least of our problems

Big scoop came out Friday. As first reported by VPR’s Peter Hirschfeld, the still-troubled Vermont Health Connect could cost the state as much as $20 million extra this fiscal year — for expenses that the federal government might decide not to cover.

The story got some legs, although it came out in the journalistic dead zone of Friday afternoon. It was picked up by other outlets and became kind of a big deal.

And it was the best possible thing that could have happened to the Shumlin Administration. 

Why do I say that? Because it sucked the oxygen out of that particular room, leaving a much bigger VHC story flailing in its wake. (Mixed metaphor? Sorry.)

The story, by VTDigger’s Morgan True, included the $20 million bit, but also revealed a host of other problems with VHC. The story paints a bleak picture of a system still in disarray, and facing big new challenges in less than two weeks.

The problems, in rough order of appearance in True’s narrative:

— The VHC website will be up and running in time for the new open enrollment period, which starts on Nov. 15. But previously insured customers seeking to renew will be asked to stay away from the website and instead fill out a paper form and submit it by mail. The reason: More of this year’s “customer service frustration” is expected by health care reform chief Lawrence Miller. Great.

— As open enrollment looms, there’s still “a mountain of old problems” that will be impossible to resolve by the 15th. So the masters of health care have come up with a kludge: they’ll keep the old cases active with tricks like fake zip codes, even as they’re working on new cases.

Gee, that sounds like a sure-fire plan. Nothing can go wrong with loading fake zip codes into an already wonky system, can it?

— The state’s contract with its new contractor, Optum, hasn’t been renewed yet. If it’s not by the end of business Monday, the company won’t continue to work and “‘Vermonters will not be renewed and will lose coverage,’ according to a document obtained by VTDigger.”

— The state has failed to keep up with required income verifications for “thousands of Medicaid beneficiaries,” which is “a growing concern of the feds.” If some recipients turn out to be ineligible, the state could be on the hook for their medical bills.

— This is more of a problem than you might think because “during the past year, people were hastily added to the state’s Medicaid rolls in order to close out their cases and get them off the hands of overworked employees,” according to the anonymous VHC worker.

— One anonymous VHC worker reported internal problems with Optum employees making mistakes, being poorly trained, being shuttled in and out of state frequently, and “a lack of ownership on the part of mid- to lower-level state employees,” who believe that if the system fails, Optum will take the heat.

— The motives of Optum and other contractors are being questioned by a top VHC official, who pointed out in an Oct. 15 memo that the contractors “have financial motivation to protract their term of employment… to generate profit.” He says the state needs to find a path forward that gives contractors a reasonable profit but ensures that Vermont doesn’t pay too much.

— “Many of the state employees… are temporary workers.” Some have been working on VHC for over a year, which is far longer than is allowed for temp staff. Unlike regular, unionized state employees, the temps don’t get any benefits, just a straight hourly rate.

— Because some coverage has tax implications and VHC staff are not trained in that area, there’s a fear that thousands of VHC customers could find themselves with an unexpected tax bill come April.

This is all on top of the potential $20,000,000 shortfall. Which is bad enough, but now you know why I say the Shumlin Administration should thank its lucky stars that it was Hirschfeld’s story that got spread around and not Morgan True’s far more detailed, far more damaging one.

Dear Shumlin Administration: Please heed the words of Uncle Barack

President Obama got in a brief tick of turmoil a while back when his approach to foreign policy was summarized as “Don’t do stupid shit.” Which, as the political equivalent of the Hippocratic Oath, makes a world of sense to me.

And I wish our leaders in Montpelier would frame it and hang it over their desks, because it sure would come in handy when dealing with Vermont Health Connect. The latest, ICYMI:

Thousands of Vermont Health Connect customers who signed up to pay health care premiums online recently received email notices directing them to pay through a website that is offline.

Vermont took down its health exchange Web portal Sept. 14…  But the state and its contractors apparently forgot during the intervening three weeks to cancel an automated email blast that directed roughly 6,500 people who signed up to make payments online. Those people, about 20 percent of the website’s commercial customers, were directed to visit vermonthealthconnect.gov to view their premium invoice.

(ahem.)

NNNNNOOOOOOOOOOOOO!!!! 

Stop it! Just stop it!

Stop doing stupid shit!

“Apparently forgot,” eh? Maybe some of you should come to work tomorrow and find that your keys no longer work because your bosses “apparently forgot” to let you know about your change in employment status.

This bout of apparent forgetfulness happened under the new contractor, Optum, and under the revamped administrative team of Harry Chen and Lawrence Miller, so we can’t blame this on the dearly departed (CGI, Doug Racine) and the recently rendered invisible (Mark Larson).

I’m a strong supporter of the current iteration of health care reform, and I have high hopes for single-payer. As a result, I’ve too readily accepted Administration assurances that they’ve learned their lessons, they’re working hard, they’ve got a handle on it, and they’ll fix it.

This time, as Bullwinkle T. Moose used to say, for sure.

But I am getting tired of defending the Governor and getting the ground cut out from under me. Maybe that’s why a new poll shows him with a 45% favorable rating against 41% unfavorable. In spite of the fact that he’s running for re-election against the legendary comedy team of Mr. Blandy and Mr. Fringey.

So, Shumlin team, please tell me there won’t be any more screwups, revelations of past blunders, delays, or embarrassing emails to the very constituents who (a) were in line to benefit from Vermont Health Connect and would love to see it work, and (b) now have every reason to be royally pissed off at the authors of this reform.

A protest vote for Doug Racine is startin’ to look awfully tempting.

The Friday Afternoon Newsdump of the Year

Gee, what a co-inky-dink. A new report on the rumblin’, stumblin’, fumblin’ rollout of Vermont Health Connect was released on Friday afternoon. 

Before Labor Day weekend. 

When Governor Shumlin was hundreds of miles away, at his vacation home in Nova Scotia. 

Ah, leadership. 

The report is pretty damning, and should have been tackled head-on by the Governor instead of being shuffled quietly out the door on a holiday weekend. It’s not too late; he could come back to work, express dismay at the report’s conclusions, take repsonsibility for administrative failures, promise to learn lessons and do better in the future, and maybe even fire a few people. 

Now, that would be leadership. And it would allow the Governor to launch his re-election campaign next Monday in a strong, purposeful, and accountable manner. Do I think that will happen? Eh, probably not. But it’d be nice. 

The report was written by Optum, the consulting firm that’s trying to fix the mess left behind by former contractor CGI. Topline, per VTDigger: 

A lack of leadership at Vermont Health Connect left the tech firm CGI unaccountable for work it was supposed to complete on the state’s health care exchange, according to a consultant’s report released Friday.

 

The state “ceded” responsibility for the project’s success to CGI, …and as a result, “CGI has not met its commitments.”

This is bad. This is not a technology issue in a super-complicated new system, as the Administration has insisted; it’s a failure of management on the part of Administration officials who should have been riding herd on CGI. Instead, the Vermont Press Bureau’s Neal Goswami says, 

Optum found that accountability for program management is unclear. “Neither (the state) nor CGI believe they are accountable for project outcomes,” the report says.

Am I the only one who’s appalled by that? CGI was fired for poor performance; but state officials failed to make CGI “accountable for project outcomes.” As any business-school professor could tell you, that’s fucked up. And if CGI deserved to be fired, so do the government officials who played a big part in its failure.

And none of those officials are named “Doug Racine.” 

Optum recommended that the state hire a project manager with experience in handling large-scale IT projects. State health care reform chief Lawrence Miller says the state is about to hire such a person. 

Well, huzzah. That’s a little bit late, isn’t it? 

In March, TIME Magazine published a cover story about how the federal health care exchange was on the brink of complete failure last fall. The Obama Administration realized, belatedly, that while they had a lot of policy expertise, they were woefully short in IT. So they basically called the Geek Squad: a team of IT experts from Silicon Valley “dropped what they were doing… and came together in mid-October to save the website. … Washington contractors had spent over $300 million building a site that didn’t work, this ad hoc team rescued it and, arguably, Obama’s chance at a health-reform legacy.”

You’d think, after all of that, the Shumlin Administration would have known it had a huge challenge on its hands, and that it required both IT expertise and intensive management oversight to fix the health care exchange. 

Instead, only now are we hiring an IT expert. 

On Friday, in the Governor’s absence, Lawrence Miller and Health Access Commissioner Mark Larson released the Optum report. And their statements were not at all encouraging; they downplayed the significance of the report and the need for further action. Miller called the report “something of a snapshot,” although as Goswami says, “the findings… are similar to previous assessments by independent parties.” In other words, this report may have been a snapshot, but the picture has stayed pretty much the same over time. 

Miller also said the Administration would use the report “to make decisions about the best way forward with the project.” Well, that’s half right. But you should also use the report to assess the failings of the past — so that you stop repeating them. 

For his part, Larson was even more determinedly lipsticking the Optum pig: 

“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.” 

I’m sure they’ve all worked hard. But I’m not convinced that they have worked well or effectively. In fact, if the Optun report is accurate, a lot of the hard work has been wasted or misdirected thanks to a lack of accountability and oversight. Working hard is not an excuse for failing to deliver the goods. 

Oh, and the other news from the ultimate Friday afternoon newsdump: on Optum’s advice, Vermont Health Connect has stopped working on fixing the system. Instead, it will try to make the incomplete system more customer-friendly in advance of the November-February open enrollment period. Further work on fixing the system won’t resume until after open enrollment. 

Great. Even as Governor Shumlin is unveiling his single-payer health care system and asking the Legislature to approve it, Vermont Health Connect will still be an unproven work in progress. 

You know, if I were a lawmaker, I’d refuse to take any action on single-payer until Vermont Health Connect is fully functional. The Governor can’t, in fairness, ask lawmakers to vote for a huge new system as long as the health care exchange isn’t working. 

I’m fully aware that single-payer will actually be simpler than Vermont Health Connect. On a policy level it makes perfect sense. But on a political level, you can’t take the next step in the process until you’ve successfully finished the previous one. 

Beyond the immediate situation, bad as it is, I have a more existential concern. Governor Shumlin earned a reputation as a capable manager in his first term, thanks largely to his response to Tropical Storm Irene. The endlessly-troubled health care rollout threatens his reputation for good management. And that’s why I’d advise him to step up strongly and take his medicine. And, yes, fire  the people who failed to hold CGI accountable. 

If he doesn’t, I fear the best days of the Shumlin Administration may be over. When you’ve been in office for a while, and the opposing party is in disarray, there’s a natural tendency to relax a bit, start seeing yourself as invulnerable, and pay more attention to your image than to the quality of your work. That is the beginning of the end for great leaders everywhere throughout history. Is it the beginning of the end for Peter Shumlin? 

And for single-payer health care?

This time they’d better get it right

The latest turn in the saga of Vermont Health Connect came today, with the cancellation of CGI’s contract to develop VHC’s endlessly troublesome website. The move comes seven months after the Obama Administration fired CGI as contractor on the federal website, and four months after Massachusetts did the same.

You can say the Shumlin Administration waited too long; or you can say they tried to stick with CGI as long as they could because the company knew more about the system than a new contractor possibly could. And, as the Freeploid’s Nancy Remsen reports, this disaster had many fathers:

The marketplace… has struggled since its launch Oct. 1. CGI missed many deadlines to complete processes and make fixes, although state officials and independent analysts have noted the unreasonableness of the compressed federal timeline that all states had to meet.

That “compressed federal timeline” was the result of numerous conservative lawsuits against the Affordable Care Act. No serious progress could be made until the Supreme Court had its say, which basically cut half of the preparation time for Obamacare’s launch.

But either way you slice it, the time had come for “a fresh perspective,” as health care reform czar Lawrence Miller put it. Whether CGI was truly at fault or not, a ritual sacrifice was called for. Its replacement, Optum, had already been hired to address a backlog of stalled “change of circumstance” requests.

It must also be noted, disapprovingly, that Miller and Mark Larson of the Department of Health Care Access were left to announce CGI’s departure in what looks, in media photos, to be a dreary and hastily-arranged encounter with the media. No sign of Governor Shumlin who, according to his official schedule, is in Montpelier today but couldn’t manage to join his long-suffering functionaries. He’ll be in public all over the place the rest of this week, wherever there’s good news to be announced; but not today. Sorry.

Those of us who support health care reform with single-payer as the ultimate goal have been frustrated by the continued delays and setbacks at VHC. And by the repeated (and routinely unfulfilled) assurances from the Shumlin team.

Well, now is the time to get it right. Good thing the Governor doesn’t face a signficant electoral challenge this year — although the longer this goes on, the more likely the Democrats are to lose seats in the Legislature. And with moderate Dems already doubtful about single-payer, Shumlin really can’t afford to lose any votes.

But beyond that, if VHC’s troubles continue into next winter, it’s hard to see the Legislature seriously considering a single-payer plan. Miller has accurately noted that single-payer will actually be a lot less complicated than the health care exchange — a bigger machine, but with far fewer moving parts. Still, why should the legislature go ahead with single-payer while VHC is still unproven?

This is a critical time for health care reform. There’s better damn well be measurable, actual progress before Election Day.