Impatience mounts for immediate exchange fixes

By Katie Kerwin McCrimmon

Colorados health exchange needs to be fixed now, not next month or next year, say increasingly frustrated board members for Connect for Health Colorado.

It really had to be fixed yesterday, said Nathan Wilkes, an IT expert and chair of the exchange boards Operations Committee, who earlier this week called the mandatory Medicaid application that customers must fill out before they can move forward onerous, odious and embarrassing.

He and other board members believe that the complex Medicaid application and other problems could be driving away customers. Only 3,408 people bought insurance through the exchange in October.

Steve ErkenBrack, president of Rocky Mountain Health Plans and the only insurance industry executive now on Colorados exchange board, said Colorados system is not working as he had hoped.

The question is when can we get it fixed? ErkenBrack said.

The board for Connect for Health Colorado is scheduled to meet Monday and board members want to see solid plans for both short- and long-term fixes that they can implement immediately.

A spokeswoman for Colorados Medicaid programs said in a written statement that managers are working to fix Colorados problems.

We are continually reevaluating our paper and online applications to improve the customer experience, Rachel Reiter, a spokeswoman for Colorados Department of Health Care Policy and Financing, said in a written statement. We are working on upgrading our application to be more user friendly.

Earlier this week, Medicaid managers met with exchange managers and some board members and decided Colorado should pursue a much simpler streamlined application like the one Kentucky is now using.

But the soonest they say they can accomplish that is next October in time for customers to enroll in plans for 2015. They also did not give estimates on how much building an entirely new system would cost.

In the meantime, Medicaid and exchange managers have been meeting with one another, but have not offered specific plans for how to fix problems now.

And thats not flying with board members.

Taking a bye on this year is not an acceptable solution. This is something that needs to be fixed and it needs to be fixed as quickly as we can get it fixed, ErkenBrack said.

He said he does not have data yet for Rocky Mountain on how many customers have bought plans through the exchange. And hes not surprised that overall sales on the exchange for October are low.

This is a very long-term effort that Colorado started many years ago. How the results play out in the first month is not nearly as important as fixing the structure, said ErkenBrack.

Deciding to buy health insurance is a big decision. He and others expect people to mull their options or procrastinate until deadlines get closer. But as the cutoff date of Dec. 15 approaches for customers to buy insurance so it will start on Jan 1, ErkenBrack said purchases will have to increase dramatically. To accomplish that, Colorado needs to make it much easier for customers to navigate Colorados system, he and others have said.

ErkenBrack also worries that if Colorado doesnt attract enough of the healthier, younger customers that it needs to balance the risk pools for carriers like his own, the current problems could make it impossible to know what went wrong.

To the extent that you have had these technological can obscure some flaws, ErkenBrack said. At the end of the day, if we didnt attract the young invincibles, we need to know, Why is that? Did they give up because of the technological flaws? Some of these challenges create longer-term policy issues. How do we improve this effort?

Colorado is unusual among the 14 states running their own exchanges in that lawmakers set up Connect for Health outside of state government. That has led to months of sparring between Medicaid and exchange managers. They have separate computer systems built by separate outside consultants. Friction became so heated between the two entities in the spring that yet another outside consultant evaluating the exchanges technology portals warned that Colorado needed a third party to triage and manage the project. (Click here to read the report from the outside consultant, First Data.)

By the numbers
  • 3408 number of plans sold in Colorado in October
  • 34,168 number of new Colorado Medicaid clients enrolled in October
  • 48,995 number of enrollments in Washington (6,390 private, 42,605 Medicaid)
  • 37,003 number of enrollments in New York (13,313 private, 23,717 Medicaid)
  • 31,545 number of enrollments in Kentucky (5891 private, 25,656 Medicaid)
  • 90 minutes to 2 hours or more: time its taking experienced people to fill out Colorados mandatory Medicaid form
  • 30-to-50% how often exchange managers contend people are getting a real-time acceptance or denial for their Medicaid application
  • 50-to-60% how often state officials contend people get real-time Medicaid acceptance or denial
  • 95% ideal percentage of people who should be getting real time Medicaid acceptance or denial
  • $200 million approximate cost to build Colorados health exchange
  • Cost for new Colorado streamlined application no estimate yet
  • Dec. 15: deadline to buy insurance plan in order for coverage to start on Jan. 1
  • 138,000: mid-level goal for number of people Colorado pledged to sign up for health insurance in 2014

Back in February, Medicaid and exchange managers decided they couldnt build a single system like the one they want now so customers can apply in one place for coverage.

The derailment of that earlier plan has left Colorado exchange customers frustrated for a variety of reasons. In order to qualify for any financial assistance, customers must complete an extremely long and cumbersome Medicaid application. Some find out right away that they qualify for Medicaid or get a denial and can move forward. But others have gotten stuck without any answers. Some may have to wait as long as 45 days, which could push people past the Dec. 15 cutoff . (Click here to read Stuck in Colorados black hole.) Customers can continue purchasing insurance through March 31 during an extended open enrollment period in 2014, but if they wait to buy, their insurance wont go into effect right away.

Other customers are reporting problems with Connect for Healths website and have had to deal with long wait times. Still others in resort areas are walking away because they have found the prices too high.

Board member Ellen Daehnick, who runs a small manufacturing business called Helliemaes Handcrafted Caramels, wants fixes now and worries that if purchases continue to lag, Colorados exchange may not be financially viable in the long run.

She said just getting the Connect for Health website launched was a huge undertaking. Its clear that buying insurance is far more complex and a lot less fun than buying a pair of shoes. Some customers will clearly wait to spend their money until they must. Nonetheless she feels that the launch has been a disappointing start.

With only 3,408 people signing up in October, pressure mounts for ever-more monthly sign-ups in the coming months, which makes it all the more urgent to fix any problems quickly. In order to keep pace with a mid-level goal to sign up about 135,000 people by the end of March in 2014, Daehnick said Connect for Health now has to sign up about 25,000 people a month in each of the next five months.

If we dont meet those numbers, Im genuinely concerned about whether we can meet this promise thats been made to the people of Colorado. Were spending a lot of public money. Transparency is not just an option. Its the only option.

She said shes not certain that board members are getting all the data they need to figure out exactly whats going wrong. Certainly the Medicaid application is cumbersome. But there may be other problems.

When I look at the number of contacts (through the call center and chats) compared to enrollment numbers and when I look at experiences that individuals have had, this all makes me wonder if there are potential technical difficulties with the (Connect for Health) website, Daehnick said.

Shes also concerned about the number of people who have been turned down for Medicaid and should be prime customers for the exchange. Medicaid officials say they have given health exchange officials data on 27,000 people who have received denials. During Mondays meeting, health exchange officials could not confirm that they have that many. In fact, denial numbers have been all over the map with Connect for Health officials saying that they may have had as few as 4,000 and Medicaid officials mentioning numbers as high as 90,000.

The financial picture is also complicated. So far, building Colorados health exchange has cost about $200 million with three federal grants and state funds left over from the now defunct high-risk pool called Cover Colorado.

Users will also pay fees and starting in 2016, Colorados exchange is supposed to support itself through sales.

Where to get help:
  • Connect for Health on the phone: 1-855-PLANS-4-YOU (1-855-752-6749)
  • Questions about Medicaid applications: 1-800-221-3943
  • Online: Connect for Health Colorado (mobile app will be available initially for Droid smart phones)
  • Questions about Medicaid:

If we want this endeavor to succeed, weve got to get out in front of emerging issues. We cannot wait for bad news to surprise us, Daehnick said. Thats why members of the board are being so insistent on getting good, complete data.

Daehnick is one of two board members whose terms started this summer, so she was not a part of earlier decisions. Nonetheless, she wishes that apparent problems between the two agencies had been ironed out previously.

Im surprised that now, a month in, were saying that we have to fix this interface (between Medicaid and Connect for Health). Why didnt we address that when we were building this big technology project?

We need an immediate short-term solution, she said. Our primary duty is to make this as easy and fast for people immediately.

Board member Nathan Wilkes runs a computer networking business called Headstorms, Inc. He also has a son who suffers from hemophilia and needs extensive health coverage. (Click here to learn more about Wilkes son.) Wilkes filled out an entire Medicaid application two years ago and found it far too detailed back then. He expected the exchange version to be much simpler. But he said exchange board members were blindsided by the form in October because Medicaid managers unveiled it just as the exchange launched.

I had expected that the questionnaire that would be co-branded with (Connect for Health) wouldnt have all those extraneous questions in there, he said.

Wilkes said there are two problems. First, some people will refuse to fill out the form because they find it too invasive, long or complex. Second, hes troubled that many people are not getting real-time results when they finish applying for Medicaid.

Its unclear exactly how often people get results right away. Exchange managers say its as low as 30 percent. Medicaid mangers say its as good as 60 percent. Regardless, its not good enough, Wilkes said.

Its a far cry from what we want. I dont think its unrealistic to get to 95 percent, Wilkes said. We didnt expect the numbers would be as low (as they are) because we were being told wed get in the 90s I think if we had a shared eligibility system liked wed planned, it would be easier to get the higher numbers.

For now, Wilkes said the time for solutions is long overdue.

Its an urgent issue, he said. Its possible that a considerable number of people are going to fall through the cracks whether they stop (applying) because theyre not going to answer the questions or they are past the window to get eligibility determinations (and buy insurance).

For board member Richard Betts, owner of ASAP Accounting and Payroll in Telluride, unveiling Connect for Health has been a learning experience.

When you start interjecting the public at large, you find out a lot of things. The public will surprise you every time, he said.

Betts wants a short-term fix and is inclined to make the Medicaid questionnaire much simpler.

It seems excessive. By the same token, there are a lot of people who want us to make sure we have safeguards in place so the system is not abused, Betts said.

Were like everybody else. Were frustrated. Wed like for it to be fixed faster. We need to respond to the buying public now.