When HealthCare.gov got off to an embarrassingly poor start, plenty of people took blame but no one took the fall—at least not until the Obama administration decided a couple of weeks ago to replace the lead contractor, CGI Federal, with Accenture. At several state-run exchanges, though, it’s been a different story. Four of the 17 states running their own insurance marketplaces saw their health exchange directors resign in the last couple of months.
The executive director of the Hawaii Health Connector, Coral Andrews, left Dec. 6, after the website launched two weeks late, drew complaints for being too slow and difficult to navigate, and had reportedly enrolled fewer than 500 of the 170,000 people eligible for coverage. "The Hawaii Health Connector has been my baby," she told Hawaii News Now. "I now need to let go and let someone else take charge.”
Maryland’s Health Exchange Director Rebecca Pearce also resigned Dec. 6, after technical issues with the website were coupled with a controversy that erupted over her Thanksgiving vacation to the Cayman Islands where she was reportedly unreachable.
Taking time off also contributed to the departure of Minnesota’s Health Exchange Director April Todd-Malmlov who resigned in mid-December after the public learned of her nearly two-week vacation with the state’s Medicaid director in November.
And in Oregon, where the online marketplace still has yet to fully launch, Executive Director Rocky King resigned his leadership of Cover Oregon earlier this month, citing personal health reasons.
We asked all four states to fill us in on how these abrupt changes have affected their organizations. Hawaii and Maryland failed to respond, but Minnesota and Oregon’s new directors took some time to share how they’re cleaning up their respective messes. Their separate, condensed interviews follow.
In Minnesota, Scott Leitz took a leave from his job as assistant commissioner of health care to become interim CEO of MNsure, while it searches for a permanent chief executive.
Has the change and uncertainty in leadership impacted morale or workflow in any way?
Scott Leitz (SL): Change in leadership is always disorienting for employees, but the staff has been enormously patient, committed and welcoming. We've worked hard to maintain morale and workflow during the change.
Have all of the employees been willing to work with you or is there some resistance?
What has been your biggest issue?
SL: Our website works reasonably well for most people, but not well for too many people. The biggest challenge is getting the technology working the way people expect from website functionality. As a result of these malfunctions, we have had quite extensive wait times at call centers, sometimes over 90 minutes.
What went wrong with the technology?
SL: The site we built is modular, and we had four different vendors working on the front end. They were all off-the-shelf systems that had to be modified, and there were problems with the connections between modules as they passed applicants from one area to another. About 30 percent of people coming in were not cleanly passing through eligibility determination. That’s significant.
What are you doing to fix the problems?
SL: IBM has been on the ground with 12 to 15 folks to get the pieces to work together. We also brought Optum in to do a holistic end-to-end review. We needed an overall view of where the system is working well and where the challenges are. Their recommendations will come to us later this week. I also spend a lot of time communicating with stakeholders, which hasn’t been as solid as needed, to develop trust and transparency. And we are trying to be fairly open in the media in acknowledging that a lot of folks have had challenges.
Have you seen any improvements yet?
SL: We’ve gotten [eligibility determination problems] down to about 2 percent. Call center wait times are down but still high—about an hour wait. We are putting in place some contingency plans, depending on the functionality of the site, to process people by paper to meet the March 31 open enrollment deadline.
Cover Oregon’s interim Executive Director Bruce Goldberg, M.D., took a leave from his job as director of the Oregon Health Authority, while they also look for a permanent replacement.
What has been your biggest challenge?
Bruce Goldberg (BG): Today, we don’t have a fully functioning website that can enroll people end to end. We have put in place a hybrid process where people can apply, but they have a number of manual steps. It’s running reasonably well now—at this point about 65,000 have enrolled; 23,000 in commercial insurance and 42,000 in Medicaid—but it’s not were we want it to be.
What are you doing to fix the problems?
BG: I’ve only been here six weeks, just a short period, but my focus is threefold: getting the website up and operational, getting people enrolled and improving customer service. We have hired about 400 additional people to process the apps through manual steps. We brought in some outside expertise to look at code and functionality. We are testing it now and we’ll know in the next few weeks whether it works. We are also developing contingency plans and looking at what pieces of the technology we can leverage and use perhaps with other existing technology, such as the enrollment infrastructure from another state or with the federal marketplace.
What might other states learn from your experience?
BG: This is a really busy time for all the states. The Affordable Care Act is one of the biggest changes in health care our nation has seen in 50 years. My advice for people is perspective; we are really in the beginnings of big change. This is not just about health insurance coverage, it’s also how people get the care they need and how the system focuses on improving people’s health.