UPDATE: Massachusetts – Time for Brutal Choices

For Massachusetts Health Connector’s Board of Directors, which is meeting today, the key question is: How bad do things have to be – and for how long – before the consequence is a brutal decision?

We know that MITRE, a private contractor, was hired to do a technical review of the flawed website of the Massachusetts state insurance exchange. MITRE is the same company that pointed out certain vulnerabilities in HealthCare.gov that have later been fixed.

CGI, which has been responsible for development, failed to deliver a working website. Worse than that: after three months, there is still no indication that CGI has the competency required to fix the website.

A key problem is said to be the payment module; it has never worked properly. In retrospect, Massachusetts would have been far better off had they decided to simply pass enrollment data to the insurance companies and leave payment collection to them.

Governor Deval Patrick has signaled that CGI will be held “accountable” – legalese for a possible lawsuit.

“It's something I've asked the team to look at. I'm very concerned about the performance of CGI and whether we got what we paid for, and I think most of us feel we have not.”

The automated determination process, through which the connector determines what subsidy someone is eligible for and what insurance program they should be in, has not worked, forcing the connector to process applications by mail. There have been problems in account creation, log-in, slow performance, time-outs, and random and sporadic error messages.

According to the Health Connector, only 500 people were able to enroll online during October, November and December. An additional 4,200 people have been enrolled manually and by email. That is hardly what was envisaged. So how does CGI respond? According to the same article by Shira Schoenberg:

Linda Odorisio, a spokeswoman for CGI, said in an email that CGI is continuing to work with Massachusetts officials to deliver improvements and expand the functionality of the Massachusetts Health Connector.

“Accountability” is perhaps the least relevant question right now; lawyers can fight over broken contracts and compensation later.  The important issue is what strategy to pursue going forward. The Massachusetts Health Connector has basically three options:

• Hope that CGI is able to fix their state insurance exchange
• Leave the fix to another vendor
• Have Massachusetts residents enroll through HealthCare.gov, either as a temporary or permanent workaround

While Massachusetts’ website has worked at least partly, Oregon has a website delivered by Oracle that has yet do enroll a single person online. Despite having to rely on paper applications, Oregon managed to enroll 20,000 people. By contrast Massachusetts has managed to enroll only 4,676 people in private insurance plans. The state has been compelled to provide temporary insurance for an additional 22,000 people who enrolled for insurance.

Whatever the scope of the problems caused by CGI, it does not appear that Massachusetts invested sufficient resources early enough to manually process the tens of thousands of applications received. (Oregon had as many as 500 case workers working 12-hour shifts.)

The comparison between Massachusetts and Oregon is apt for another reason; both states have roughly the same enrollment targets for the 31st of March: 250,000 and 237,000 people, respectively.

Will Massachusetts continue to hope that CGI will fix their insurance exchange – despite all indications that CGI is unable to do so? Would HealthCare.gov have been repaired in November and ended up enrolling 1.1 million people in private insurance plans if the job had been left to CGI? Forgive me, but I am highly doubtful.

The clock is ticking. How quickly can MITRE deliver its technical review and recommend a viable path forward? Is it too little, too late? How long can the Board of Directors live with thousands of Massachusetts residents being stuck in limbo with regards to their health insurance? Hopefully not much longer.

We should not be surprised if the Massachusetts Health Connector announces a far-reaching decision later today or tomorrow, or very soon indeed.

Update (01/10): The consulting company MITRE is working on a fast track; they will present their recommendations to the Massachusetts Health Connector by January 17th. You can read more about the discussions at yesterday’s board meeting here.

Meanwhile, the Obama Administration has decided to terminate its agreement with CGI, due to the company’s unimpressive initial delivery of HealthCare.gov, as well as its decidedly lacklustre performance during the last few months’ intense efforts to improve the federal website. According to the Washington Post report, CGI will be replaced by Accenture.