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, 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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