Site glitches and failures have turned Vermont Health Connect, the state’s healthcare exchange, into a political football. Republican leaders are calling on the Shumlin Administration to invoke an emergency provision of state law that allows Vermonters to keep their current health care coverage if the exchange isn’t working as planned.
As state teams scramble alongside contractors to get the exchange website fully functional, it remains the largest information technology project the state has ever undertaken, according to the official overseeing the build out.
Mark Larson is the commissioner of the Department of Vermont Health Access (DVHA). He sat down with VPR to explain how the exchange works and what user data is doing behind the scenes as people attempt to get insured through VermontHealthConnect.gov.
The goal of the exchange is to create a new, centralized platform for Vermonters to get insurance coverage. The project is among the largest information technology systems ever undertaken by the state. It needs to communicate with myriad federal and state systems to calculate available coverage options and subsidies and also connect with private insurers when users ultimately buy coverage.
Problems with the system so far have largely been a result of the complexity and the tight security required when handling so much sensitive data. Early on, the site was not properly optimized, causing failures when users tried to connect. Once that was solved, a compatibility issue in communicating with federal computers caused that connection to fail about 30 percent of the time, Larson said. The heavy security also gave many users difficulty when trying to log into their accounts. Larson said these problems have largely been solved, but the state and lead contractor CGI are now working on getting the CGI-created system communicating with a third-party payment processor that allows users to pay for insurance coverage.
Here’s how the system works, and where it doesn’t:
To use VPR's interactive guide to Vermont Health Connect's systems and process, click here.
User data zips through Internet connections at the speed of light, and it can often be difficult to conceptually grasp things like “cloud computing” and “data hubs.” But procedurally, Vermont Health Connect is doing online what could be done (with less speed and more difficulty) with pen and paper.
When a user first points his or her browser to VermontHealthConenct.gov, it’s much like walking into a building such as the Department of Motor Vehicles and taking a seat in the waiting room: The site doesn’t know who the user is or what their insurance status is, just that they’re there.
The first step that identifies users to Vermont Health Connect is account creation. This is a similar process users go through for an account on a site like Twitter or Facebook. When this is done, users essentially just have the digital equivalent an empty manila folder with their name written on it.
To give users’ accounts official significance – in other words, making that account more important in the government’s eyes than the user’s Twitter profile – they must link their identity to it. This is the analog of adding the first items to the users’ folders. Identity verification calls for more information than account creation. Here, Vermonters must enter more sensitive personal data like their Social Security number and address.
Once users submit that data, it’s sent to the Vermont Medicaid database and a federal data hub, where it’s sorted and passed on to a number of federal agencies including the Internal Revenue Service (IRS), the Social Security Administration, the Department of Homeland Security and the Centers for Medicare and Medicaid Services. These databases send back their own information about the user, including citizenship status, veterans’ benefits, annual income and tax data, and subsidy eligibility.
Critics say this verification step, which requires large amounts of personal and private data, comes too soon in the process. NPR’s Steve Henn spoke with e-commerce expert Sina Djafari, who said “you want to actually encourage people to move as far along in the process as possible without requiring any information from them.” His criticism is aimed at the federal Healthcare.gov, but that site’s procedures are similar to Vermont’s state exchange.
When Vermont Health Connect is working properly, Larson said, the identity verification step happens “in real time” as the users work. On paper, this now-instant step would take much longer. Users would have to fill out a form with their personal information and mail it to both state and federal agencies, which would in turn fill out and return their own forms specific to the individual. Those would go back into the users’ manila folders at Vermont Health Connect, now tied directly to their social security number and other government records of their identity.
With their online profile (or manila folder) properly labeled and full of personal identity information, subsidy qualifications, current government benefits and income data, users are now ready to shop for insurance. Their personal data is required beforehand because the information in the users’ folders dictates the options the health care exchange presents them with.
Vermont Health Connect uses the users’ profiles to generate a list of coverage options, considering both public and private options. Users can choose any of these options, adding another sheet to their digital folder. The process isn’t done here.
Up to this point, the user experience has been completely limited to Vermont Health Connect’s redundant servers, maintained by CGI in Pennsylvania and Arizona, and state and federal databases. While users may have chosen a private plan from MVP, Blue Cross Blue Shield or Delta Dental, the private company still hasn’t been informed of that choice, and users haven’t paid their first premium.
The system that is supposed to accept payments from users still isn’t working, and that problem has caused some Vermont Republicans to call for a delay in some key deadlines for the state exchange. When it is working, Larson says, payments will be the responsibility of a third-party vendor called Benaissance. After users select a plan, Vermont Health Connect will send the plan’s information and some basic user data (like name and billing address) to Benaissance, which will bill the user for their premium. Once users have paid up, Bennaissance sends payment confirmation back to Vermont Health Connect. That will end up in users “folders” as well.
Next, with no additional action from users, Vermont Health Connect will send notification to the coverage provider they’ve chosen along with confirmation that they’ve paid. This is analog to Vermont Health Connect using information they already have on file to fill out an enrollment form and then mail it to the insurance provider. Any subsidies users qualified for are sent directly from the IRS to the coverage provider. Once the provider’s computers have processed the incoming information, they will send Vermont Health Connect confirmation that users are enrolled and they send an insurance card and information packet to the users, just as they did before the exchange launched.
Now in users digital “folders,” Vermont Health Connect has confirmation of their identity, income and government assistance data, and information about their health coverage plan. All of this is covered under the Health Insurance Portability and Accountability Act, which means it has the same privacy protections that health insurance information has had since the mid 1990s.