Scott Administration: Outside Audit Of Vermont Health Connect Tells 'Story of Improvement'

Jun 13, 2017

A recently released external audit of Vermont Health Connect says the state-run insurance exchange has met all requirements set forth by the federal government.

Consumers of Vermont Health Connect have endured a host of troubles since the program launched three and a half years ago. Public perception had run so sour that Republican Gov. Phil Scott ran on a promise of doing away with a state-run exchange altogether.

But a new audit, which examined exchange operations during the last fiscal year, yielded an “unqualified opinion” from the independent firm that conducted the analysis. Cory Gustafson, commissioner of the Department of Vermont Health Access, says that’s “as good as it gets when it comes to audits.”

“The report to me really speaks to a story of continuous improvement at Vermont Health Connect,” Gustafson says.

Two years ago, results of a similar audit were far worse.

Due to a laundry list of operational shortcomings, auditors at the time deemed Vermont Health Connect to be out of compliance with federal regulations.

“The big problems that were seen in 2014 and early 2015 are less and less and less and the service levels are higher and higher and higher,” Gustafson says.

That’s a noteworthy assessment from an appointee of Scott, given that the first-term Republican governor spent much of last year’s campaign calling for a wholesale overhaul of the embattled health insurance exchange.

"I both want to congratulate the exchange team for doing some good work and also continue to communicate to Vermonters that more work needs to be done." — Chief Health Care Advocate Mike Fisher

Changes to Vermont Health Connect are still in the works, to be sure. Scott says he’ll have a plan in place by the end of this year for proposed operational reforms.

But Gustafson says the system’s foundation is sound, and that the program is showing “continuous improvement.”

Mike Fisher is the chief of the Office of the Health Care Advocate, a consumer advocacy organization run by Vermont Legal Aid. Fisher says measures of consumer satisfaction continue to rise.

“The numbers continue to get better,” Fisher says. “The number of Vermonters who are caught up in real challenges are smaller and smaller.”

Fisher, however, says those improvements mean little to the Vermonters who still struggle with billing errors, lapses in coverage, or extended delays making changes to their policies.

“For those Vermonters who have a real challenge, that story that the numbers are getting smaller doesn’t matter. They’re still frustrated as can be,” Fisher says. “I both want to congratulate the exchange team for doing some good work and also continue to communicate to Vermonters that more work needs to be done.”

"Data integrity is a piece that we want to see improvement in." — Commissioner of Vermont Health Access Cory Gustafson

Gustafson says the bulk of those challenges can be traced back to the same issue.

“Data integrity is a piece that we want to see improvement in,” Gustafson says.

The audit, performed by a firm called Berry Dunn, assessed Vermont Health Connect operations between July 1, 2015 and June 30, 2016, and it notes problems with data verification.

Gustafson says the long-term solution to those data integrity issues is finding a more reliable way to automate the transfer of the data. Gustafson says it’s unclear at this point what options his department has for rectifying the issue. But he says the state has begun to search for solutions.

“[We’re] asking the industry and the vendors that are out there, how could we potentially look at this differently, talking to other states about what they’re doing,” Gustafson says. “Those are the paths we’re going down right now.”

For people who buy federally subsidized insurance plans on Vermont Health Connect, or for those on Medicaid, operational issues with the exchange might not be the biggest concern on the horizon.

Health care legislation recently passed by the U.S. House of Representatives would roll back billions of dollars in federal health insurance subsidies for many people who receive coverage through the exchange.