Tag Archives: Vermont Health Connect

BCBS Makes Everyone’s Lives Miserable to Save a Little Coin

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This won’t be news to any BlueCross BlueShield health insurance client, but the Blues did something this year that added fresh levels of annoyance to the lives of patients and providers throughout Vermont.

The Blues made a big change in its prescription drug coverage. It hired Optum RX as its pharmacy benefits manager. Which led to new, stricter requirements for a broad array of prescription medications. This will presumably save the Blues some money, but it will do so by offloading a lot of pain and extra work onto patients and prescribers.

(Before I go on, tip of the hat to fellow blogger Matt Sutkoski, who posted his own screed on this topic a few days ago. I’d been thinking about this for quite a while, but his essay crystallized my own thoughts.)

If you heard the ringing of a faint bell at the name “Optum,” that’s because it was a key player in then-governor Peter Shumlin’s Vermont Health Connect fiasco. Step with me into the Wayback Machine, which is set for October 31, 2014 — just a few days before the election Shumlin almost fumbled away to challenger Scott Milne.

On that day, we learned that the cost of VHC would be $20 million higher than expected. And that, my friends, was not the bad news. There were a number of horrible particulars, some of which involved Optum. Its employees were said to be poorly trained and making mistakes. A top VHC official observed that Optum had every motivation to let the work drag on and on, because the longer the project the more money it made.

So yeah, a corporation with some definite baggage in these parts.

What is Optum doing to, ahem, Optum-ize the Blues’ prescription drug coverage?

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Phil Scott said something dumb about technology yesterday

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Check that; to judge by his Twitter feed, he said a whole lot of dumb stuff about technology in Monday’s Innovation Week debate in Burlington. But this time, we’re focusing in on one particularly dumb and potentially dangerous item. This was in response to a question about how the state should select and integrate new software.

Scott said the state should opt for more off-the-shelf technology instead of buying custom-made programs. When his excavation firm needed a new bookkeeping program, he was told it would cost $10,000 to $15,000. Instead, the company chose a $200 QuickBooks program, he said.

Hey, yeah! Maybe we could replace the Tax Department with TurboTax! We could shut down Vermont Health Connect and refer everybody to WebMD! That’s the stuff!

Now, I’m not a technology expert, not by a longshot. But even I can see major flaws in Scott’s simplistic prescription. In no particular order:

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Shoot the Messenger

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As its final months drag onward, the Shumlin administration is remaining true to one of its core principles: Shoot the messenger. We have two prime examples of this time-tested strategery today: a top state official slams a respected media outlet, a move that has backfired big-time in the past; and the administration puts a big fat price tag on transparency.

First, Lawrence Miller, Vermont Health Connect czar, has beef with VTDigger.

[Miller] testified Wednesday in the House and challenged the veracity of a VTDigger story that said the state has been unhappy with its current Vermont Health Connect contractor and is negotiating with another company.

… [Miller said] that any frustration he expressed in emails was a normal part of negotiations.

Digger’s earlier story had quoted emails from a state official expressing dissatisfaction with VHC contractor Optum. Which would be noteworthy, since Optum was supposedly the savior of Vermont Health Connect. Miller pooh-poohed the story’s assertion, saying that a certain amount of “friction” is a normal part of the process.

Maybe that’s true, but here’s the problem. This is the same “Lawrence Miller” who was in charge of the Agency for Commerce and Community Development when it was happily attempting to both promote and regulate the ill-fated EB-5 program. He headed ACCD from 2011 to 2014, when he was tasked with cleaning up the Vermont Health Connect mess.

In other words, Miller has been hip-deep in two of the Shumlin administration’s signature disasters. Is it possible he negotiated Shumlin’s original land deal with jerry Dodge?

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Phil Scott’s Four Corners Campaign

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At this point in the campaign, Lt. Gov. Phil Scott is the presumptive front-runner. He’s got name recognition and personal popularity; he’s got the solid backing of the business/Republican community anxious for a winner.

And he’s campaigning like a front-runner: maximizing appearances before friendly audiences and minimizing exposure to open-ended affairs that might lead to missteps or embarrassment.

The latest example: the left-wing group Rights & Democracy organized a pair of events for gubernatorial candidates on April 9. Accepting the invitation: all three Democratic candidates, plus Republican Bruce Lisman.

Mr. Front-Runner (not exactly as illustrated)

Mr. Front-Runner (not exactly as illustrated)

Rejecting: Phil Scott.

What’s the matter, Phil? Can’t take the heat, so you’re staying clear of the kitchen? I guess not. Scott’s formal response to R&D:

“I’m not convinced my candidate would get fair and equal treatment at a forum hosted by a very liberal organization. Therefore, we would like to respectfully decline participation in your organization’s forums,” wrote Scott Campaign Manager Brittney Wilson.

She has a point. But heck, Bruce Lisman’s gonna show up.

Besides, if Phil Scott claims to have the necessary cojone quotient for being governor, shouldn’t he be able to handle an unfriendly crowd?

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The Property Tax Rebellion Has Been Postponed Indefinitely

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It’s common knowledge that the people of Vermont are mad as hell over the high cost of public schools. And even angrier over the Legislature’s attempt to fix the problem. The situation was so dire that Governor Shumlin and Democratic leaders rushed through a fix to Act 46’s perceived unpopularities at the start of this year’s session.

Then came The VPR Poll, which showed an astounding lack of engagement with the issue. Here’s how I wrote it up:

As for Act 46, the school governance bill seemingly reviled by all — from conservatives who want tougher spending controls, to liberals who want no restrictions — most people are, well, ehh. Only 13 percent are “very familiar” with Act 46; 44 percent are “somewhat familiar”; and a whopping 42 percent are “not at all familiar.”

… Also, despite the Act 46 uproar, a solid 51 percent support Vermont’s efforts to encourage school consolidation. An underwhelming 29 percent oppose. 20 percent say “it depends” or “no opinion.”

One week later came Town Meeting Day, and the results add more credence to the poll. Josh O’Gorman of the Vermont Press Bureau totted up the numbers, and the conclusion may surprise you.

Around the state, voters approved 95 percent of school spending plans, and approved five merger plans by wide margins, according to unofficial data from the Vermont Superintendents Association.

All told, voters approved 231 of the 242 budgets offered Tuesday, creating a three-year trend that has seen fewer budgets defeated each year.

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The VPR Poll: Everything You Know Is Wrong

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Previously in this space, I looked at The VPR Poll’s reading of the race for governor. To encapsulate: Phil Scott has a huge early lead, Bruce Lisman’s in the crapper, and the two Democratic candidates are still trying to build identities with a largely uninvolved electorate.

The poll is an important snapshot of the race — really, our first since last fall, when the field was still a work in progress. But even more interesting are the issues results, which campaign builders ought to be examining closely. Because the message, as Firesign Theater once put it, is

Everything You Know Is Wrong

Well, maybe not everything, but a whole lot of things.

Issues that are supposed to be driving forces in 2016? Eh, the voters don’t much care.

Positions that could make or break a campaign? Over and over again, The People fail to conform to conventional wisdom.

Darn people!

Generally, the poll depicts a populace that’s more or less okay with how things are going and not especially engaged in politics. This, despite an ongoing barrage of doom-and-glooming by Republicans and certain interest groups.

Examples: A broad desire to stay the course or go even further on health care reform; widespread acceptance of large-scale renewables; strong endorsement of Vermont’s efforts on climate change; healthy support for the state’s school consolidation efforts; and huge majorities in favor of modest gun-control measures.

After the jump: the details.

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Another nail in Vermont Health Connect’s coffin

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The vultures are circling. The wolves are howling. The diminished corpus of Vermont Health Connect is crawling across a pitiless landscape; every time an oasis appears, it turns out to be a mirage.

Things aren’t lookin’ good.

I’ve been a strong supporter of Governor Shumlin’s health care reform plan — hopefully as a first step toward single payer, or at least universal coverage of some kind. I have bought and consumed every confident reassurance ever issued by the Governor and his minions. I have, unfairly in retrospect, mocked his critics as mindless partisans. I have allowed my hope to be renewed by fresh reassurances, most recently last fall, when the administration announced that VHC had met its performance benchmarks.

Today, not so much. Today I’ve turned a corner. I remain hopeful, but the confidence is gone.

The last straw was yesterday’s article by VTDigger’s Erin Mansfield, which began like this:

An independent expert on health care strategy advised the state to spend as little money as possible on Vermont Health Connect technology in the immediate future and instead use resources to evaluate alternatives to the exchange.

Frank Petrus, a senior managing partner at Connecticut-based Gartner Inc., told lawmakers the state should stop spending money to build new Vermont Health Connect technology, try to leverage investments it has already made, and commission a study that would take three to four months.

Basically, he wants to put VHC into hospice care. Stop trying to fix it, just help it “limp along a little while longer.”

Ugh. Yeesh. Aaaaaarrrrrgh.

This isn’t coming from a free-market ideologue, but a guy with unimpeachable bona fides:

Gartner has consulted for several state health exchanges, including Vermont Health Connect, and has a great deal of experience in public sector human services.

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Mr. Miller has a hissy fit

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Here’s a new one in Vermont governance: a top state official refusing to “work with” a reporter who covers his beat. Strange but true. And he put it in writing!

Dramatis personae: Lawrence Miller, chief of health care reform; and Erin Mansfield, health care reporter for VTDigger. Miller wrote a hot blast of an opinion piece in response to Mansfield’s recent article about the latest wave of problems with Vermont Health Connect, and here’s the opening paragraph:

The most recent exchange story is an extremely slanted piece of journalism. It does not tell the whole story of Vermont Health Connect, accuses me of lying, and creates an inaccurate perception. This particular column follows repeated factual inaccuracies by VTDigger’s health reporter, adding the new feature of character assassination. I give up. I will not work with her anymore.

Digger, for its part, “stands behind the accuracy” of Mansfield’s story.

I don’t know who’s right and wrong here. Maybe she overemphasized the negative, which is often the case in journalism. Non-news is, by its nature, not news. When something works, we don’t write a screaming headline about it.

But Miller’s version doesn’t pass the smell test.

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Just what we needed: More bad news on Vermont Health Connect

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The headline says it all, thanks to Erin Mansfield of VTDigger:

VERMONT HEALTH CONNECT IS GOING BACKWARD, STAKEHOLDERS SAY

The “stakeholders” are Blue Cross Blue Shield of Vermont and Vermont Legal Aid, an unlikely pairing to be sure. BCBS is calling for an independent review of the troubled health care exchange, and Legal Aid is fielding scores of complaints from “frustrated consumers.”

“We’re going backwards,” said Trinka Kerr, the chief health care advocate for Vermont Legal Aid. “Towards the end of last year, we were making progress. You could get things straightened out relatively quickly, and now things are more complicated than they used to be.”

Some of Governor Shumlin’s high-profile declarations of victory are now looking inoperative. The “change of circumstance” function, which was supposed to be a benchmark for VHC, had to be taken off line because it simply wasn’t ready to handle the workload. And as a result, the backlog is back!

Yes, VHC has a backlog of change orders numbering about 4,000. To put that number in perspective, VHC has a total of 33,000 customers who buy individual policies through the website.

Now, I stopped being good at math in about the seventh grade, but to me that looks like the backlog amounts to 12 percent of all customers served. Which is, in a word, dreadful.

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Some good news arrives by a very circuitous route

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Here’s something you wouldn’t expect, based on all the continued carping about Vermont Health Connect. The Times Argus, Saturday edition:

Vt. Health Exchange Called the Best

And Seven Days:

GAO: Vermont’s Health Exchange More ‘Operational’ Than Others

The news comes from an audit of state health exchange IT systems conducted by the Government Accountability Office, and released on Wednesday. The Vermont rating was not highlighted by the GAO, but it was definitely there. A chart on page 38 of the 109-page report shows that Vermont had the best operational status of any state-run health exchange. In a measure of four categories, Vermont was judged “fully operational” in three, and “partially operational” in the other one.

The chart was first reported in the Connecticut Mirror, which highlighted Connecticut’s rating of “partially operational” in all four.

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