If You’re Seeing This Blog, Change Your Bookmark. Please

New Blog HeaderWe’ve moved a few feet over, and you should follow us there.

We’re no longer at blog.hcfama.org. Our shiny new home is at hcfama.org/blog.

If you’re seeing this post, you need to update your favorites or bookmarks or what you type into the omnibox to get here.

See you at the new place.

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Connector Works On Backlog and Coverage Workarounds. #progress

This morning’s Connector Board meeting served as the second weekly briefing on the Commonwealth’s progress in addressing application backlogs and moving people into coverage, while planning for longer-term website fixes. Materials from the meeting are are on the Connector web site (got to About – Leadership – Board Meetings). The key documents are the powerpoint on open enrollment and the latest “dashboard” summarizing enrollment IT progress.  Yes, there is progress, though much more remains to be done. Our full report is below.

As of February 1st, there are over 11,000 non-group members enrolled in Affordable Care Act (ACA) compliant Qualified Health Plans (QHPs):

  • 3,300 were previous Commonwealth Choice members
  • 8,000 are new to the Connector

Sarah Iselin, the special assistant to the Governor for project delivery, as well Secretary Shor (Administration & Finance), Secretary Polanowicz (EOHHS), Kristin Thorn (Medicaid Director), and Jean Yang, (Executive Director of the Health Connector) form the executive committee that oversees planning and execution of plans to address short-term and long-term issues. With the help of contractor Optum , they are in the process of putting together a strategic roadmap.  The overarching question is: With pending deadlines of March 31st and June 30th, and open enrollment later in 2014, will the HIX (website and underlying IT system) be ready to support full end-to-end enrollment?

Long-term options for the IT system fix include:

  • Stay the course
  • Partial rebuild of components
  • Leverage state or federal exchange functionality
  • Start over

The executive committee mentioned above, with assistance from Optum and advice from the Commonwealth’s CIO Bill Oates, is in the process of assessing these options.

While the team continues to assess their long-term options about IT functionality, the focus of their short term efforts include:

  • Paper application backlog
  • Data entry tool used to enter applications into system
  • Staffing
  • Customer service and escalation processes
  • Website infrastructure
  • Commonwealth Care extension
  • Commonwealth Choice transition


Nine tactical work streams have been created to address these priorities.

Application Backlogs

Progress is being made on the application backlog. In the past two weeks:

  • The backlog was reduced from 72,000 to 54,000. Of those 54,000, 15,000 already have coverage and 39,000 applications are awaiting screening.
  • An additional 15,000 people have been enrolled in transitional coverage through MassHealth, and another 6,000 will be enrolled in transitional coverage the week of March 3rd.
  • A new data entry tool has been implemented which significantly reduces the time it takes to enter paper applications from 2 hours to 39 minutes.
  • As of today, there are more than 230 Optum staff working on data entry.

The second “Massachusetts Health Exchange Dashboard” includes a visual representation of these numbers.

Customer Service

Several MassHealth and Connector customer service issues and themes have been identified, including:

  • Long wait times and resulting abandonment rates
  • Calls answered but no solution was available
  • Without effective resolution from customer service, consumers contact elected officials, government representatives, or Connector leadership
  • Tools, processes and functionality vary across agencies

About 49% of calls to customer service are from residents who want to know whether their application has been received, where the application is in the process and whether they are likely eligible for coverage. The problem is that customer service staff do not have access to the appropriate programs to see this information.

Optum recommended several courses of action to address these issues.

  • Increase number of staff who have access to the application system (MMIS): 20 workers have recently been approved for access and a request is in to get enrollment tool access for Connector staff.
  • Deploy a common tool to track all calls/problems from intake to resolution: meeting scheduled for week of March 3rd to build system.
  • Increase resources and refine processes: 7 Optum staff have been assigned to help with escalation; integrating MassHealth and Connector processes to handle cases consistently; creating feedback loop to notify consumers of result.
  • Improve the consumer experience: Add a new prompt to route calls to new workers to answer “Where is my application?” and related questions; training underway for new MassHealth and Connector customer service  staff.

Website Infrastructure

In terms of IT capabilities, Optum has helped implement new tools to monitor IT system and website performance and identify issues right away. In addition, Optum added hardware and memory to increase capacity of the system, and implemented IT service management processes to address problems and root causes and keep a record of changes made to the IT system and website.

Commonwealth Care & Transitional Coverage Extension, Commonwealth Choice Transition

As presented at the last Board meeting, CMS authorized Massachusetts to extend coverage for Commonwealth Care and former Medical Security Program members, as well as those in transitional (temporary) coverage through June 30, 2014. MassHealth and the Health Connector have communicated these extensions to various stakeholders and will be sending notices to members soon (mailings for those who got temporary coverage Feb. 1st were already sent out). Information about the coverage extensions can be found on the Connector’s microsite, www.bettermahealthconnector.org and was blasted out via social media.

The Connector is offering a “Fast Path” option for people who need to transition from Commonwealth Choice to a QHP. Fast Path enables members to enroll in a QHP that is most similar to their Commonwealth Choice plan by simply paying their new premium. Commonwealth Choice members also retain the option of shopping for a new plan through the Connector’s website. The Connector mailed packets to 22,096 Commonwealth Choice members with these options. A generic version of the letter is being translated into Spanish and will be posted on the Connector’s website, and a follow-up email will be sent to members on March 3rd, to ensure all Commonwealth Choice members take the necessary steps transition to new coverage by the end of March.

The next Connector Board meeting is scheduled for Thursday, March 13th at 9:00am at 1 Ashburton Place, 21st floor.
– Suzanne Curry

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Health Connector Website/IT Progress Dashboard Released

The State House New Service has already dubbed Sarah Iselin as the “Health Connector web czar.” And her official title is apparently “Special Assistant to the Governor for Project Delivery.” Whatever her title, she’s making big steps forward..

Friday she released the first “Massachusetts Health Exchange Dashboard.” The document includes the following updates of progress made this week:

  • The Health Connector has processed all of the roughly 22,000 applications which had been entered into the system. Of these, nearly 15,000 people have been placed into temporary MassHealth coverage, and around 7,000 were found to be already covered.
  • They made progress on the 50,000 paper application backlog. Of these, 28,000 were screened. Among those screened, 4,000 were discovered to be duplicates, and 15,000 were already covered. This leaves 9000 remaining of the screened applications to be processed, and an additional 22,000 to be screened. Precessing will occurn weekly now, as opposed to the previous monthly schedule.
  • Additional staff have been hired to process applications. By early next week, the Connector expects to have 233 newly trained agents, ramping up to 318 within 2 weeks.

These were encouraging signs of progress. We particularly commend the administration for the transparency around their work. While there is still a long way to go, were are pleased to see substantial advances being reported today.

Posted in MA Health Reform | 1 Comment

When It Comes to Market Share, How Big is too Big?

The Health Policy Commission (HPC) answered this question in its full commission meeting this week on Wednesday, February 19, 2014.  As David Seltz stated in his Executive Director report, the agenda for Wednesday’s meeting was short, but very important.  According to the final report from the HPC regarding Partners Health Care System’s proposed acquisition of South Shore Hospital and Harbor Medical Associates, the answer to this question is written in the data or, more accurately, in the lack of data.  Without abstention, The HPC voted to approve the final report recommending that Partners’ proposed acquisition should not proceed.  Also up for a vote were the final regulations from the Office of Patient Protection (OPP) on health insurance consumer protection. Materials from today’s meeting can be found here, and our full report on details from the meeting is on the backside. Continue reading

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Changes coming to A Healthy Blog and Our Website (hcfama.org)

Friends, changes are coming to this very blog and hcfama.org.

We are completely revamping our website. We’ll have a whole new look and feel and we’ll be making it a lot easier to get involved with our community organizing team, share your personal health care story, and connect with our HelpLine counselors directly. That also means that A Healthy Blog will be undergoing some changes to better integrate A Healthy Blog with the whole site. And that means that there will be some changes for subscribers to our blog as well, and we’ll be posting information about that in due time.

We’re not straying from our mission – to provide the latest updates, information and commentary on health care policy developments in Massachusetts from the Health Care For All vantage point. Please feel free to use the comments to give us your feedback.

Stay tuned for more — much more — very, very soon.

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Do Not Mock the MOCC

MOCC slide

MOCC stands for the “Massachusetts Operational Command Center.” It’s the structure set up by Sarah Iselin, the Governor’s special assistant tasked last week with managing the repair of the states health insurance enrollment website and underlying IT. Monitoring operations around the clock, and holding a accountability “Quarterback Call” meetings twice a day – 9:00 am and 5 pm, the center is modeled after the federal Exchange Operations Center in Columbia, MD that fixed the healthcare.gov website.  It’s up to the MOCC to get things working for Massachusetts health care. Do not mock the MOCC.

Jean Yang, the Connector’s Executive Director began today’s Connector Board meeting with a forceful and heartfelt statement about the challenges the Connector team and the residents at large are facing.  She thanked the Connector Board for their support and for “keeping their eye on the end game” and pledged to effectively engage the Board during this challenging time.

Yang admitted that the current workarounds to get people coverage are not working well enough, despite extremely hard work by staff.   To Yang, the two most urgent issues raised at yesterday’s legislative hearing about the IT issues include:

  • What the Commonwealth can do to get out of this situation ASAP; and
  • People need help, and the current workarounds are not yet sufficient.

Meeting materials are posted on the Connector’s website (go to About, Leadership, Board Meetings and scroll to Feb. 13), except the open enrollment presentation, which is here. Our report takes just one click. Continue reading

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Meet the New Boss. (NOT the same as the old boss)

Between Governor Patrick’s press conference this morning (press release; and in-depth report from the Springfield Republican) and the Health Connector Board meeting this afternoon (Connector meeting presentation (pdf)) , today has been a busy day for discussing the key challenge of Affordable Care Act (ACA) implementation in Massachusetts – namely, how to fix the MassHealth & Health Connector’s flawed website and underlying IT system. Our full report is below: Continue reading

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FAQ: Why did the Connector need a new website? Why can’t they just use the old one?

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 Connctor 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

Posted in MA Health Reform | 3 Comments

BREAKING: Health Connector Board Meeting Scheduled For Noon Tomorrow (UPDATED)

The Health Connector has scheduled a board meeting for Thursday, Feb. 6, from 9:00 am to noon. (UPDATED UPDATE: The meeting will start at noon, and is scheduled to go to 3 pm.)

According to the agenda (pdf), the only topic is the current open enrollment period. The agenda indicates that a vote is scheduled.

Because the meeting was not on the previously established schedule, it will be at Gardner Auditorium, in the State House.

Posted in MA Health Reform | 1 Comment

When Things Go Wrong in the Ambulatory Setting

HCFA is one of a number of organizations involved in the PROMISES (Proactive Reduction of Outpatient Malpractice: Improving Safety, Efficiency, and Satisfaction) Project in Massachusetts. This project, which was funded through the federal Agency for Healthcare Research and Quality (AHRQ) Medical Liability Reform and Patient Safety Demonstration Grants, has been working to test interventions to improve safety in 16 ambulatory primary care practices.

The focus is on improving safety through improvement in test results management, referral management and medication management, with an overarching goal of improving communication (among staff, between providers and practices, and between staff and patients).

One of the areas that the PROMISES group, including HCFA, worked on was developing guidelines for primary care practices to follow when there has been harm caused to a patient. In 2006, Harvard hospitals came together to develop a document called When Things go Wrong which focused on the inpatient setting and the importance of disclosing errors to patients and families. The PROMISES group discussed the need for similar guidelines for the outpatient setting and together developed When Things Go Wrong in the Ambulatory Setting. HCFA is a co-author for an article about this document which was recently published in The Joint Commission Journal on Quality and Patient Safety.

This article will give national attention to these carefully considered guidelines, hopefully spreading their use not just in Massachusetts but across the country. These guidelines will be extremely useful as health care providers strive to carry out the apology and disclosure sections of the Massachusetts 2012 payment and delivery system reform law (Chapter 224).

You can see the guidelines on the PROMISES Project website, which includes the video above, featuring Dr. Lucian Leape, lead author of the original When Things Go Wrong document, and Dr. Gordon Schiff, lead primary care physician for the PROMISES Project, and case study videos.
Deb Wachenheim

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