Vermont Health Connect deploys vital 'change of circumstance' system upgrade

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Vermont Health Connect deploys vital 'change of circumstance' system upgrade

Mon, 06/01/2015 - 3:37pm -- tim

by Timothy McQuiston Vermont Business Magazine Vermont Health Connect is still a long way from the seamless, on-line health insurance sign-up product it's supposed to be, but a major system upgrade should go a long way to toward enabling it to get there eventually. Governor Peter Shumlin announced this morning that the VHC system was successfully upgraded this weekend to update the so-called change of circumstance functionality, which will allow customer service staff to process requested changes more quickly.

VHC staff first will start to cleanup the backlog of 10,200 individuals in need of updating (split roughly between Medicaid and Qualified Health Plans through Blue Cross & Blue Shield of Vermont). Staff will now be able to make changes to all systems through one on-line form. The Web site will not be available to individuals to directly upduate their own account until the backlog is cleared up to avoid further errors. That capability is scheduled for October 1. However, they can call VHC to make changes or fill-out an online PDF form. Changes are expected to show up within the next 2-3 billing cycles (months). New filers can also call and get signed up immediately.

The Web site came down Thursday night in preparation for the updates and is back online and available for customers to access their accounts. The system deployment took less than the 36 hours expected. A series of comprehensive, internal verifications then began, and continue, to ensure that newly developed business processes work as expected.

“I appreciate the meticulous preparation that Optum’s team and state staff put into this effort,” the governor said. “They worked around-the-clock to deploy the new system and kept downtime to a minimum. We still have work to do to ensure the Vermont Health Connect system supports the level of customer service that Vermonters deserve, but today’s successful deployment is a major step in the right direction.”

Prior to this upgrade, it was necessary to enter each requested change into as many as six different databases. That process was not only time-consuming but also led to data integrity issues, caused frustration for Vermonters who were unable to see desired changes reflected on their account in a timely manner, and led to a backlog of pending change requests. As of last week, approximately 10,200 customers were waiting for service requests to be completed.

LEFT, Governor Shumlin, Cassandra Gekas (Health Access Planning & Policy Chief) and Lawrence Miller listen to a question at the press conference June 1, 2015, at the VHC offices in Winooski. TOP, Shumlin announces the upgrade along with state, Optum and insurance officials. VBM photos.

Vermont Health Care Director Lawrence Miller said solving the change of circumstance issue is the important first step in resolving all the other issues facing VHC, including a full user Web site interface and the account reconciliation with Blue Cross & Blue Shield of Vermont (neither the state nor BCBS know now exactly how much the state owes the insurer because of the VHC problems).

Miller was careful not to over-sell this new development, as he stood in the same room he stood in when VHC launched -- and immediately failed -- on October 1, 2013.

But, he said, "This is a hugely big deal."

He also said the General Fund budgeted amount is also significantly less than first anticipated. The line-item amounts have gone from $29 million in 2013 to $16.5 for 2017. This is largely due to the federal Medicaid match and the efficiency of having one system for both QHP and Medicaid individuals, or what Governor Shumlin called "biting the bullet" in the initial cost and complexity of setting the system up.

The upgrades successfully deployed this weekend allow customer service staff to enter changes into one database, and then have those changes updated automatically in the others. This will greatly reduce the amount of time it takes to process a customer’s change request and will allow Vermont Health Connect staff to more quickly eliminate the backlog of pending requests.

In order to ensure a smooth roll out of the new functionality some customer service teams will begin processing change requests immediately. At the same time, all staff will be thoroughly trained to make sure they are able to smoothly and accurately process backlogged requests and new requests from customers.

Business customers will continue to go through Blue Cross or MVP as they have been. The federal government has allowed this system with a waiver through 2016.

Blue Cross CEO Don George said the small group program is working well (the governor said he wished they could continue to do it forever). George said he expects that the increase in the small group from 50 employees to 100 employees on January 1, 2016, will pose little hardship from BCBS. He said there currently are just over 3,000 companies representing 35,000 VHC members with BCBS now and the increase at the start of next year will add only 60-100 new companies and 7,000 to 8,000 new members. With all programs, Blue Cross & Blue Shield covers about 250,000 Vermonters.

The deployment of change of circumstance functionality aligns with the milestones for improved customer service outlined by the Governor in March. The next milestone comes on October 1st when two things must happen.

  • First, customers who report a change to Vermont Health Connect by the 15th day of a month will see that change reflected on their next invoice.
  • Second, Optum must deliver the technology needed to enable a smooth 2016 enrollment and renewal process. In practical terms, this means that existing customers will have their 2016 health plan information reflected in all systems by the start of the year as long as they report changes by December 15. The contract for that renewal functionality was approved late last week by the Centers for Medicare and Medicaid Services, the branch of the US Department of Health and Human Services that funds and oversees the development of health insurance marketplaces.

Staff processed more than 21,000 renewal service requests this winter and spring – a crucial pre-requisite to being able to pull off this weekend’s system upgrade. Staff will now be able to make account changes in a fraction of the time.

The following information is intended to help Vermonters understand what to expect in the weeks ahead.

Customers with new changes to report

Vermonters who have seen a change in their status should call the Customer Support Center or fill out a Change Report Form on the website.

The new functionality will decrease the amount of time it takes customer service staff to process changes. By October 1st, Vermont Health Connect will be expected to process changes that customers report by the 15th day of a month in time to be reflected on the next invoice, and changes reported in the second half of the month on one of the next two invoices.

Customers with urgent needs are asked to call the Customer Support Center at 1-855-899-9600 (toll-free).

Customers who have already reported changes

Customers with pending changes do not need to call, as their requested changes have been moved to the new system and will be processed in the coming weeks. Customers can expect to see changes previously requested within two or three bills.