Report Blames Mass. Health Website Troubles On Lack Of Skills, Leadership

BOSTON — In the months after President Obama signed the Affordable Care Act (ACA) in 2010, officials in Massachusetts started planning for a new Health Connector website that would be compatible with the new federal regulations. UMass Medical School, the Massachusetts Health Connector and MassHealth came together to work on the project. They hired a Canadian firm, CGI, to build the site which launched in October 2013, but “was not fully operational,” according to a report released Thursday by the technology firm MITRE. Residents who’ve tried to apply for insurance through the site use words like “disaster.”

The MITRE report, which was commissioned by the state, says CGI did not have the expertise to create or maintain the site. Functions were not tested. Data was lost. Tools to fix bugs were not in place. So who from the state should have spotted and corrected these problems? MITRE concludes that it was never clear which of the three state partners was in charge. Gov. Deval Patrick says the shared leadership structure would have been fine if CGI had done its job.

But, Patrick added, “It turns out that this vendor has required and will require a much, much shorter leash. And that’s hard to do by committee.”

The lack of clear authority created other problems, according to the report. The website never had a baseline set of requirements. There was no master schedule. Decisions were not explicit and were not communicated clearly. CGI received conflicting instructions and deadlines from the three parties in charge.

Gov. Patrick is adopting some of the several changes suggested by MITRE. He’s hired a special assistant — Sarah Iselin – who will direct site repairs. Iselin has worked on expanding health insurance for the state, for a nonprofit and most recently at Blue Cross Blue Shield, where she has taken a four month leave. Iselin says there are plenty of places to assign blame for what happened with the Connector website.

“It’s both clear that the vendor wasn’t able to deliver the website they were hired to deliver and it’s also clear that the project management was inadequate for the task,” Iselin said.

Iselin says those problems will be fixed with the help of Optum, a firm that worked with the federal government to fix HealthCare.gov — which was also built by CGI. Funding for Optum’s one month, $9.8 million contract will come out of money budgeted for CGI. The Optum contract includes 300 people who will help residents with paper and online enrollment.

The Obama administration ultimately canceled its contract with CGI. Gov. Patrick is keeping the contractor, at least for the next few months.

“We still need CGI for the time being at least to help us fix a largely fixable system,” Patrick said.

In a statement, CGI says it “looks forward to continuing our work with Optum to accelerate improvement of the Massachusetts Health Connector. We remain determined to help Massachusetts residents get insured by enrolling in health plans via the Connector, and we fully intend to meet our contractual obligations.”

CGI has, it points out, designed successful sites in Colorado, Kentucky and California. Those close to the Connector site says Massachusetts is a more complicated system because the state has many more ways that residents can meet Medicaid eligibility requirements.

Gov. Patrick applauded employees who have come up with ways to work around flaws in the CGI site. He said staff at the Connector and MassHealth have worked tirelessly to make sure that roughly 150,000 Massachusetts residents who were on subsidized insurance, or who are trying to get on for the first time, have some kind of coverage. Patrick apologized Thursday to all those who have been frustrated and worried about not being able to get care. Iselin says she’s confident the state will fix the Connector site and the enrollment process as a whole.

“One way or another,” Iselin said, “we’ll ensure that folks don’t lose coverage and one way or another we get to our goal of having a world class website.”

Iselin plans weekly updates leading up to the next critical federal insurance deadline, March 31. But restoring the public’s confidence may be more difficult than processing the major backlog of insurance applications.

“I’ve put in all this effort and I don’t have insurance and I really don’t know where else to turn” said Dan Ginsburg, who made more than a dozen calls to the Connector in December and January, trying to renew his private health insurance plan.

Ginsburg, who is from Southborough and runs a small software firm, says he bought a family plan on the Connector’s old website last year with no problem. He was finally able to renew last month and sent the Connector a check for more than $1,200. It was cashed, but Ginsburg’s insurer says they did not get the money and cancelled his plan.

Ginsburg says he supports state and federal efforts to expand health coverage.

“I want to see it work, I really do,” Ginsburg said. “But it just seems fundamentally wrong to me that you could be accepting payment for people’s insurance and then not providing insurance. That, to me, borders on fraud.”

IT experts contacted for this story, say that function — sending payment and enrollment information to an insurer — should be an easy step on the Connector website. We’ll track how quickly it gets fixed.

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  • donniethebrasco

    I can’t believe that CGI was let off the hook. They were fired and they walked away. After they cashed their checks.

  • BlueDemocrat

    Give me a break – CGI, through Pete Ihreg, disclosed in July that there was substantial risk to meeting the October date. Requirements by the lofty ex Deloitte consultants was not completed until May 2013. However the Connector leadership – Jean Yang, Roni Mansur, chose to not disclose any risk to the Connector Board. Look at the presentations prior to the October launch. I am sure that CGI has fault but ultimate accountability is with the Connector leadership and its failure to do anything other than to promote “magical thinking”. They need to be removed.

  • Josiah Fisk

    The CGI part of the story is obviously scandalous, but what the Connector has done to deal with these failures — or more to the point, what it has not done — is the even more scandalous part of the story. And it still remains largely untold.

    So far the media has uncovered only a handful of poster-child examples like Dan Ginsburg. Yet I know, having been through something similar to Ginsburg, that the problem is vastly greater than has been reported.

    The Connector has stonewalled every time I have asked how many people were in the same boat as me (that is, people who tried to get insurance through the Connector yet were prevented from doing so because of the gross incompetence of the Connector).

    However, various comments from representatives at other organizations, and from Connector representatives themselves, consistently suggest to me that there are thousands of individuals who, like Dan (and like me), have been exposed to the risk of financial ruin simply because the Connector is not only profoundly inept but has zero sense of responsibility. “Making sure no one goes without coverage?” Game over. It’s already happened, and still is happening.

    The scandal is how unable the Connector has been to do the very simplest thing imaginable: get a list of names to a couple of insurers. In my case, they have had my information since December 6. In spite of constant efforts on my part to get them to honor the promises they themselves made to me, it took TWO MONTHS JUST TO GET THEM TO GIVE MY NAME TO MY PLAN.

    This is not a computer problem! It does not take a computer! A sixth-grade classroom could solve this problem. But not the Connector. In spite of the fact that they were well aware of the problems in their system early on, they somehow failed, continuously, over a period of many weeks, to implement a manual system. What were they doing all that time? Kafka and Orwell would blush to guess.

    Meanwhile, those patient and believing citizens who trusted that the Connector would not betray them have ended up uninsured. Today, I was fortunate enough to learn that I am no longer one of them. But there are many others, I know, who are not so lucky. I urge Martha Bebinger to continue the great work she is doing on this story and find out just how deep the scandal goes.

    • Miles Howard

      Here, here! Martha Bebinger’s coverage of the Connector woes has been a considerable stress reliever. As a self-employed worker, I’ve been waiting for more than two months to receive an eligibility letter since filing my online application in early November. I’m fortunate enough to have my old insurance until March 31, yet there are thousands of people who aren’t so lucky. I’ve supported Deval Patrick over years but he’s woefully out of touch on this. It’s time for him to pony up and offer an immediate fix. Because the idea of Massachusetts allowing citizens to risk medical bankruptcy – through no fault of their own – is not only ironic, it’s plain embarrassing.

      • Josiah Fisk

        Miles — my advice is not to wait. You may never hear from them. I was promised on four separate occasions that someone from the Connector would be in touch with me about my application. I never got those calls. The only thing that seems to work is constant phone calls and visits to their walk-in center. Maybe you’ve been doing this already. In any case, good luck!

        • Miles Howard

          I’ve been calling here and there, but hearing this, I’ll step up my inquiries. Thanks for the advice, Josiah!

    • jefe68

      This problem goes back before the ACA. It took me 6 months to get coverage when after having to find insurance through the Connector.
      They lost faxed tax returns and my application twice. I had to do the entire process 3 times. I had no insurance for 6 months. This was not an isolated event according to the person helping with this at the clinic I’m signed up with.

      With all due respect for Governor Patrick, he’s not being truthful on any of this.

      • deeeeeeeeeeeeznutz

        I’m not sure if he deserves due respect anymore. It’s nice that he apologized but it’s obvious he doesn’t think this will be fixed by April 1. How long are people going to have to wait? Why would you hire new management and not fire the old management that let things get this bad in the first place?

        • jefe68

          Being nasty to the Governor might feel good, but in the big picture of this it’s prudent to be diplomatic.
          That said, this is on the state, and in my opinion it’s Connector executive director Jean Yang who should be fired ASAP. CGI is at fault, that’s for sure, but the mismanagement of the project is alos on the state and the lame idea of putting UMass Medical School, the Massachusetts Health Connector and MassHealth in charge.

          • deeeeeeeeeeeeznutz

            Of course she should be fired. And guess who should fire her!

          • jefe68

            The other question, where are the legislators?

          • BlueDemocrat

            I don’t fault the legislators. Every report on the progress from the Connector was glowing – no hint of the issues, concerns of CGI in July. Not sure the Board, legislators, etc would have been able to probe, etc with blatantly misleading information provided to them by Connector leadership. Of most concern is that there continues to be rosy pictures of the “progress” made when in fact it is false and wrong. No acknowledgement of issues other than the evil delivered at the hands of CGI on the poor Connector leadership – they are so over their heads to effectively manage this self inflected crisis.

            Secondly, having another policy wonk and competitor (health plans), Sarah Iselin, oversee the turnaround seems ill-advised and less than comforting. Qualified in so many areas – just not an operations and IT capacity.This crisis needs someone skilled at fixing messed up projects – not strategy, policy direction. I wonder why the health plans are not screaming about this – what a mess.

            Third – what is the track record of Optum, a division of United Healthcare. They were as complicit in the US federal hub mess – no evidence that they are the “turnaround” agents.

            Is it too much to ask for skilled leadership – what about the individuals that executed the launch of the Health Connector?

          • jefe68

            In the early days of this, yes I agree, the legislators and the governor were mislead. Now that it’s clear that there has been serious problems with the entire Mass Health Connector organization, I would have thought that the legislators would be all over this. Especially since it’s costing the state a lot of money that they have earmarked for this project.

          • BlueDemocrat

            I understand and agree with you

          • BlueDemocrat

            Optum – true, they fared better than CGI in the healthcare.gov mess. However, they are now the white knights coming to the rescue of the federal site, Massachusetts, Maryland and Minnesota. I hope for great success – I am just unclear what their delivery track record is to warrant the white knight status

    • Cynth

      Yes, this isn’t simply a technical problem. Computers don’t misinform people seeking guidance and assistance, lose checks and documents, become confused or conflicted about internal procedures, and fail to report issues to supervisors and oversight committees.

      I support universal health coverage, I liked the old Connector system, and I participated in it from the beginning as a show of support. After waiting weeks for my issue to be resolved under this new system, having paid over $1000 in premiums, and still having to pay out of pocket in full for all my medical care despite my “coverage,” I have decided to purchase my plan directly from my provider and bypassing the Connector altogether. I am among the fortunate who have this choice; and I feel frustration and outrage for those who don’t.

      That no one has yet resigned or have been relieved of their posts over this demonstrates a continued lack of accountability, and it doesn’t make me hopeful that this will be resolved soon. I hope the press dig deeper into this issue.

      • BlueDemocrat

        I agree – I thought the old Connector served a public good. I think the most cost effective, easiest out now would be to allow individuals to directly enroll through chosen plans. By pass the Connector – it serves no purpose other than a distraction. The health plans all know what they are doing and will fix this on their own. It should call into question what the role of the Connector is and is it worth the surcharge cost. I don’t think so and suspect the health plans would agree.

      • Josiah Fisk

        Cynth — beautifully said. I agree with every point you make. As to your experience with the Connector (I keep wanting to call it the Disconnector), it’s even worse than mine. By the way, I, too, approached my plan provider directly but they only offer the type of plan I wanted through the Connector. I hope you at least get your money back.

        While it’s true that many of the stories that have come out are from those of us who are able to survive situations like yours or mine without serious financial hardship, it defies all logic to assume that this is true of most individuals caught up in the same failures of the system. At the same time, it’s also true that you or I would have had a lot more to lose should we have been unlucky enough to experience a health catastrophe during a time when we weren’t insured. In that sense, the Connector has been playing Russian roulette with our life savings.

        BlueDemocrat — excellent point. There seems no practical reason why the Connector couldn’t simply have functioned as a source of information to help people compare plans, and perhaps as the branch of state government that determines which plans meet ACA standards. I believe the reason they got into the transactional part is that the ACA was written that way. In hindsight, not a great idea, though I don’t see how anyone was supposed to expect that it would be such a disaster.

      • jefe68

        It’s because we live in the era of passing the buck and blaming the other guy. It’s pretty outrageous that Jean Yang and Roni Mansur have not been held accountable. And now it seems the Patrick administration kept information about this mess from the legislators.

  • Jennifer

    When I actually get subsidized health care, I will be very grateful. It has just been a real tough journey getting there. I have literally been trying to get enrolled since mid October, taking all instructed steps, following up with multi-hour phone calls (most of this time on hold) and I STILL haven’t succeeded. I had to complete forms twice (the second time on paper since the computer “lost” the online ones). It looks like I will finally be enrolled by 1 March.

    (jefe68: I WAS given temporary coverage but a health care provider I see weekly does not accept it, so it has been of limited help; I may be skipping important appointments until I get can signed on.).

    All of this said, when I actually get someone on the phone, I have had the best service that could possibly be offered with such limited resources — kudos to the folks that fulfill this thankless job — helping frustrated, angry people navigate this impossible system.

    Looking forward to fruition!

    • jefe68

      I was given an extension for the coverage I already had through Commonwealth Care. Which apparently is not the same as what you have.
      I assume my doctor will take it as he did before this mess.

    • http://byrondennis.typepad.com/theabcsofmedicare/ Dennis Byron

      Jennifer

      Please make sure the healthcare provider you see weekly does accept the subsidized “insurance” you think you will be getting! Many providers did not accept Commonwealth Care and Commonwealth Choice so many may not accept these new replacement policies (ConnectorCare for most of Commonwealth Care’s former subscribers and HPQs for the rest)

  • Lisa

    Considering the state did very well with commonwealth
    connector, which I used for my small business, I cannot believe the ineptitude
    of the current system. I started to work with the Health Connector back in October.
    They led me to believe I was registered as a business because I had
    filled out items online. Then after many phone calls I come to find out I needed to fax in paperwork. Then after faxing in the paperwork they sent me and contacting them again to find out where I was in the process, I was informed I filled out the wrong paperwork for the insurance I was purchasing. After a mad scramble I then
    faxed in the correct paperwork and after contacting them again was informed
    that they *LOST* it. I was then requested to send the paperwork again with a letter and the fax transmittal that it was received to only be told that the insurance that I requested was not available for me the next month because I missed the cut off date. And that I had to resubmit everything again – oh and they found additional paperwork that I needed to fill out – and no they did not know what to tell me on how I could go about getting insurance as a stopgap for the month of January. In fact I have spent hours between them and buying private insurance online for January just so we can be insured – whereas at that point I was “insured” privately but still not in the insurers system and need to continue to call each day to try
    and get a number so that my husband could get the medication that he needs. Ironically I deal with insurance companies everyday due to my business. I cannot
    imagine if I had no understanding of the insurance community. Furthermore, if I ran my business the way health connector is being run I would have lost all my customers by now. Lastly, I’d love to complain and file something as a customer but I do not even have that option.

  • jefe68

    MassHealth have worked tirelessly to make sure that roughly 150,000 Massachusetts residents who were on subsidized insurance, or who are trying to get on for the first time, have some kind of coverage.

    I would really like some proof to back up this statement. I know a lot of Commonwealth Care users have been given an extension of their coverage until March 31st, but what happens after that? The site is still a disaster. Everyday there are more people commenting on the Connector FB page who are telling stories that are the exact opposite of what Governor Patrick is spinning here.

    • BlueDemocrat

      I agree – just abysmal management and complete miss by Gov. Patrick