With the continuing issues with the Health Connector/MassHealth enrollment website, we get asked the following questions constantly:
The old web site worked just fine. Why did they need to build a new one? Why can’t they just go back to the old one?
It’s a fair question. It’s also being asked in a more accusatory manner by some political candidates, who are claiming that we should have asked for a “waiver” from the whole ACA and just kept our old system.
What most people who ask this question don’t realize is that the Connector and MassHealth are trying to build more than just a website. The web interface is just the visible tip. Underneath is a whole new processing system for health program applications, eligibility and enrollment.
So, here’s part of the answer, based on what we know:
1. Until now, there was no enrollment website for most people. The Connector’s web site only allowed people seeking unsubsidized coverage to fill out an online form to enroll and select a health plan. That was for just around 40,000 people out of the over 250,000 people covered by the Connector. For everyone else, there was no public enrollment website.
To enroll in subsidized coverage, one had to go to a community health center, hospital, or a few community groups that were authorized to use the state’s “Virtual Gateway.” It was not open to the general public. We’ve been told that once, by accident, it was open for the general public for a few hours on a weekend. A number of people filled out applications while they could, and all of the applications were filled out incorrectly and had to be redone. That’s why the state only allowed trained people to fill out the form.
The new system will allow the general public to set up an account, fill out their own forms, and submit it themselves.
2. The old “Virtual Gateway” form did not process verifications. If you had a hospital worker fill out the form for you, you still had to fax in separately the income, residency and other verifications required for state programs. Then state workers had to manually associate the faxed-in documents with the form transmitted by the Gateway.
The new system will perform these functions automatically, in the background and in real time, by checking information already known to the state or federal government. For example, the system will check your wages with the Department of Revenue to see what your income is. Only if there’s a substantial discrepancy will the enrollee have to submit verifications.
3. The old system that determined eligibility was antiquated and difficult to update and maintain. Decisions took a long time to process. Under the old system used to process Connector and MassHealth applications, the determination of which program an applicant was eligible for was made by a system called “MA-21.” This 1980s era mainframe-style system was slow and very difficult to update. Changes in eligibility rules required lengthy, complex programming changes. The system produced awful form letter notices that were locked into a format that made it hard for people to understand. Decisions often took weeks.
The new system is designed to make instant real-time eligibility decisions. It will be easier to upgrade as program needs change. It also will be a platform for applications for other programs beyond health care.
Our HelpLine staff’s full-time job is enrolling people into coverage, so the current dysfunctional system makes us frustrated and furious at time (but note: the past few days we have had reports of substantial improvements in the system, with some people successfully applying, being determined eligible, and enrolling at one sitting). But the old system wasn’t so wonderful either.
We have two goals. First, everyone eligible for insurance must have a temporary solution, even if it means creatively working around some rules while the systems work is in progress. Then second, if we can get to a system that meets the goals outlined by the state, we will have made enormous strides to building a responsive, modern eligibility system that should last for a long time.
We’re looking forward to Thursday’s Connector Board meeting, just announced today, where we hope more progress can be made on system improvements.
-Brian Rosman, Health Care For All
(cross-posted on the HCFA A Healthy Blog)
I would love to see these as universal goals for most government social/health services programs.
However, we had no trouble with Connector prior to the October mess and as far as I know – hopefully, but truly don’t want to explore after spending countless hours and days trying to re-apply through the new portal – we have the same coverage at the same rates.
There has been no acknowledgement that our re-application has been submitted, reviewed, approved……..acted upon……..or in the queue to be acted upon. And, we had to go to a community health center to re-apply since the website was impossibly dysfunctional.
MassHealth has systemic problems that do not allow for the flexibility needed.
I believe both Romney and Patrick tried to get more funds for various system upgrades through the legislature but were unsuccessful. That was probably why there was such a push to obtain as much federal funding for the health exchange as possible. There has been a lot of turnover among state CIOs and some major restructuring (I assume that means layoffs) under Patrick.
I am not sure what’s the best way to manage government IT. It must be hard to strike a balance between keeping and paying the right people, getting rid of the wrong people, and relying on outside expertise.
In my opinion, these are problems that are solvable, given the wealth of managerial and technical talent in Massachusetts.
After reading of the problems with the Commonwealth Connector, I tried to call Mass. Blue Cross directly to get insurance. What a mistake! First, it took me five minutes just to get to speak to somebody. That person, then told me that she had to transfer me to a different person on the sales team. Then I was put on hold for another seven minutes. When my call was finally answered, they said that I had been connected to the wrong sales department. So, I was put on hold again. I got frustrated and hung up.
So, I don’t know how bad the Connector is, but it seems like Mass Blue Cross doesn’t really care about helping people sign up for insurance.
The people who actively seek to sign up are likely to be people who need insurance – in other words, people that BCBS would have to pay claims for, at a much higher rate than employer-supplied groups. I’m sure their actuaries have determined that the set of people who enroll through their employers is more profitable than the set that buys the insurance independently.
I did backend software development for insurance companies for a time.
The reason why insurance companies build software is to deny more claims. Software is literally measured by its successful (on appeal) claims denial rate, as percentage of total claims processed. The reason why they hire medically-trained agents is to deny more claims. The reason why call centers hire agents — and build information systems to support them — is to deny claims.
Welcome to the reality of US health care.