Health connector got it done, but barely; $20m in fixes needed
The Massachusetts Health Connector’s newly rebuilt website needs an additional $20 million in renovations this year and will require even more fixes next year to become fully functional, according to the agency’s new executive director.
In an interview four weeks after taking the helm, Louis Gutierrez estimated that thousands of consumers hit roadblocks because of software flaws and inadequate customer support during the open enrollment for health insurance that ended Monday.
“There’s a really long road ahead,” said Gutierrez, who brings deep experience in information technology to the Connector post. “There’s a substantial amount of missing functionality and a substantial range of defects that we’re going to need to remediate.”
Although the Connector has issued daily activity reports, Gutierrez’s comments Friday provide the first overview of the challenges and costs that remain — despite the website’s success in enrolling large numbers of people and weathering high user activity.
The $20 million expenditure would be on top of the $254 million already spent on building and rebuilding the website — most of it covered by federal grants — after an epic software failure in 2013. But Gutierrez said he does not expect to need a new appropriation; the additional money has been cobbled together from unspent federal funds and other money already set aside for the Connector and MassHealth, the state’s Medicaid program.
Gutierrez, who was formerly a principal in the Massachusetts IT consulting firm Exeter Group and years ago served as the state’s chief information officer, said he was “deeply impressed with the energy and commitment” of the team that replaced a hobbled website with software constructed in just a few months. But he said a project of such magnitude probably requires three years of work.
Gutierrez’s priorities include refashioning the awkward payment system, fixing software kinks that caused some customers to get stuck, and asking Dell Inc., the company that ran the overwhelmed call center, to assess its performance and recommend improvements.
“A lot of people were served,” Gutierrez said of open-enrollment period, “but it could certainly be an arduous experience at times.”
Consumers told the Globe of confusing instructions online, hours spent on hold, weeks waiting for insurance cards, misplaced checks, and misinformed consumer service agents.
Attorney General Maura Healey’s consumer protection division received a little over 100 complaints from Connector users, mostly people who paid for insurance but were not enrolled, Healey spokeswoman Cyndi Roy Gonzalez said.
But thousands of other consumers successfully enrolled, Gutierrez said, noting that he was pleased with updated enrollment numbers released Friday: Between Nov. 15 and Monday, 125,402 people paid for health plans through the Connector, and 286,255 enrolled in MassHealth, the state’s Medicaid program.
Additionally, more than half a million people used the website to instantly ascertain whether they were eligible for assistance, a function the previous website never once accomplished. The system withstood high volumes: On the peak day, Dec. 23, with 138,081 unique visitors, the website did not crash or slow, even at the moment when 2,273 clicked at the same time.
“We did something that the Commonwealth and its residents I hope will be really proud of,” said Maydad Cohen, the top official who oversaw the website reconstruction and who leaves his post next week. “This next group is going to take it and make it even better.”
Created by a landmark state law in 2006, the Connector has long served residents who do not obtain health insurance through an employer. But then in 2013, the federal Affordable Care Act required the Connector to upgrade its website with new functions, and that new website failed spectacularly.
Unable to determine what coverage people qualified for, the state ended up enrolling more than 300,000 in a temporary Medicaid program, with all expenses paid by taxpayers — at a cost still not tabulated.
Since last spring, the Connector has been working with the Virginia technology company hCentive to rebuild the website. Pressed for time, the new website’s architects focused on the essentials and postponed many functions, such as enabling consumers to readily find out if their doctors were in a health plan’s network.
That caused problems for Catherine Sullivan, 38, of Roslindale, who discovered in early January that her obstetrician was not in the plan she had purchased. Now eight months pregnant, she has been trying for weeks to switch to a plan her doctor accepts. Despite paying two months’ premiums and spending what she estimates was “15 or 20 hours on hold” with customer service, Sullivan said the insurer still has no record of her.
John E. McDonough, a professor at the Harvard School of Public Health and an architect of the law that created the Connector, has been watching the Connector’s progress from afar.
“It’s a spectacular and positive reversal of year one,” he said of the recent enrollment period.
The enrollment numbers, however, reveal some unexplained gaps.
Of the half-million people who had their eligibility determined, a quarter did not go on to enroll. Despite a $16 million outreach effort, fewer than half of the people who had been put on temporary MassHealth signed up for a new program.
And 80,000 people signed up for subsidized health insurance when 92,000 had previously been enrolled in a similar program.
“They need to ask hard questions about where these people are,” said Joshua Archambault, director of health care policy at the Pioneer Institute, a conservative-leaning think tank.
“Either they failed miserably in the outreach, or all the people have gone somewhere else.”
Cohen, the outgoing Connector official, said some people may have obtained insurance through another source, and predicts that more will sign up throughout the year. The Connector plans to conduct surveys to find out more about those who did not enroll.
Amy Whitcomb Slemmer, executive director of Health Care for All, an advocacy group that has a contract with the state to do outreach and to handle consumer complaints, said her agency canvassed 400,000 homes, double the number planned, to let people know about the need to sign up. “It went more smoothly than we could have hoped,” she said. “We knew there was going to be unprecedented volume, uncharted territory.”
While Lora Pellegrini, president of the Massachusetts Association of Health Plans, said the Connector is “light-years” ahead of where it was last year, she noted some snags. In January, for example, the health plans did not receive the files of about 200 people who had paid for coverage.
Joanne LeBlanc, 51, of Easton, may have been one of them. She paid the Connector on Dec. 8 for coverage for herself and her two daughters, but despite many phone calls, she said she was not enrolled in her chosen plan until Friday morning. She has been paying for medical care out of pocket for two months, but expects to be reimbursed.
Don Mauch, 62, a semiretired financial consultant who lives in Norwell, said his premium check went missing for weeks. When he called for help, he spent more than an hour on the phone with a customer service representative who was unable to do anything.
“The young man was reduced to tears, literally, trying to find a supervisor. My heart went out to him. He was trying so hard,” Mauch said. “It was obvious that the customer service people were not prepared and were not trained properly.”
Connector officials say that customer service representatives received weeks of training and regular refresher courses. But they acknowledged the call center was overwhelmed, on some days failing to answer more than half the calls. Wait times on Feb. 23 averaged 41 minutes during the day, but many waited longer. The fact that so many people — many more than expected — sought help on the phone suggests the online process needs to be easier to follow.
Gutierrez is working on prioritizing system improvements for next fall’s open enrollment, but foresees a multiyear effort.
“I do not expect a fully functional website with all bells and whistles for this fall,” he said.
Felice J. Freyer can be reached at firstname.lastname@example.org.