February 2014

Connector slide shows progress in processing application backlog
February 27, 2014

This morning’s Connector Board meeting served as the second weekly briefing on the Commonwealth’s progress in addressing application backlogs and moving people into coverage, while planning for longer-term website fixes. Materials from the meeting are are on the Connector web site (got to About - Leadership - Board Meetings). The key documents are the powerpoint on open enrollment and the latest "dashboard" summarizing enrollment IT progress.  Yes, there is progress, though much more remains to be done. Our full report is below.

As of February 1st, there are over 11,000 non-group members enrolled in Affordable Care Act (ACA) compliant Qualified Health Plans (QHPs):

  • 3,300 were previous Commonwealth Choice members
  • 8,000 are new to the Connector

Sarah Iselin, the special assistant to the Governor for project delivery, as well Secretary Shor (Administration & Finance), Secretary Polanowicz (EOHHS), Kristin Thorn (Medicaid Director), and Jean Yang, (Executive Director of the Health Connector) form the executive committee that oversees planning and execution of plans to address short-term and long-term issues. With the help of contractor Optum , they are in the process of putting together a strategic roadmap.  The overarching question is: With pending deadlines of March 31st and June 30th, and open enrollment later in 2014, will the HIX (website and underlying IT system) be ready to support full end-to-end enrollment?

Long-term options for the IT system fix include:

  • Stay the course
  • Partial rebuild of components
  • Leverage state or federal exchange functionality
  • Start over

The executive committee mentioned above, with assistance from Optum and advice from the Commonwealth’s CIO Bill Oates, is in the process of assessing these options.

While the team continues to assess their long-term options about IT functionality, the focus of their short term efforts include:

  • Paper application backlog
  • Data entry tool used to enter applications into system
  • Staffing
  • Customer service and escalation processes
  • Website infrastructure
  • Commonwealth Care extension
  • Commonwealth Choice transition


Nine tactical work streams have been created to address these priorities.

Application Backlogs

Progress is being made on the application backlog. In the past two weeks:

  • The backlog was reduced from 72,000 to 54,000. Of those 54,000, 15,000 already have coverage and 39,000 applications are awaiting screening.
  • An additional 15,000 people have been enrolled in transitional coverage through MassHealth, and another 6,000 will be enrolled in transitional coverage the week of March 3rd.
  • A new data entry tool has been implemented which significantly reduces the time it takes to enter paper applications from 2 hours to 39 minutes.
  • As of today, there are more than 230 Optum staff working on data entry.

The second "Massachusetts Health Exchange Dashboard" includes a visual representation of these numbers.

Customer Service

Several MassHealth and Connector customer service issues and themes have been identified, including:

  • Long wait times and resulting abandonment rates
  • Calls answered but no solution was available
  • Without effective resolution from customer service, consumers contact elected officials, government representatives, or Connector leadership
  • Tools, processes and functionality vary across agencies

About 49% of calls to customer service are from residents who want to know whether their application has been received, where the application is in the process and whether they are likely eligible for coverage. The problem is that customer service staff do not have access to the appropriate programs to see this information.

Optum recommended several courses of action to address these issues.

  • Increase number of staff who have access to the application system (MMIS): 20 workers have recently been approved for access and a request is in to get enrollment tool access for Connector staff.
  • Deploy a common tool to track all calls/problems from intake to resolution: meeting scheduled for week of March 3rd to build system.
  • Increase resources and refine processes: 7 Optum staff have been assigned to help with escalation; integrating MassHealth and Connector processes to handle cases consistently; creating feedback loop to notify consumers of result.
  • Improve the consumer experience: Add a new prompt to route calls to new workers to answer “Where is my application?” and related questions; training underway for new MassHealth and Connector customer service  staff.

Website Infrastructure

In terms of IT capabilities, Optum has helped implement new tools to monitor IT system and website performance and identify issues right away. In addition, Optum added hardware and memory to increase capacity of the system, and implemented IT service management processes to address problems and root causes and keep a record of changes made to the IT system and website.

Commonwealth Care & Transitional Coverage Extension, Commonwealth Choice Transition

February 24, 2014

It isn’t often that an organization as busy as Health Care For All has the opportunity to take a deep breath, look at the challenges ahead, appreciate our staff and volunteers and strategize about the most effective way to interact, invite, engage and move toward our mission in cyberspace.  Fortunately, we have carved out the time and today you are invited to see the results. hcfama.org has been redesigned to be a more inviting and accessible tool for all.  It isn’t perfect yet, but our expectations are high that this update of our website will allow us to accelerate our successes.

I find myself wanting to shout “The new phonebook is HERE! The new Phone Book is HERE!!” but the 1979 Steve Martin reference is not quite universal in the halls of 30 Winter Street, to say nothing of the antiquated notion of an alphabetical list of phone numbers in hard copy.  What is unanimous however is Health Care For All’s need for and creative use of technology to do the work we were founded nearly 30 years ago to do – to create a more consumer centered health care system that is accessible, affordable, and delivers patient centered and culturally competent comprehensive care for everyone. 

The tools at our disposal to do our jobs may have changed, but the basic value placed on each person’s story and experience has not changed at all.  Welcome to the new hcfama.org.  Please come and explore and let us know what you think.  Our expectation is that conveying updates and information will be much easier, and engaging constituents and educating consumers will have fewer barriers as we work hard to improve our health care delivery system!

-Amy Whitcomb Slemmer

February 21, 2014

Health Connector Dashboard report showing progress on screening backlog of applications

The State House New Service has already dubbed Sarah Iselin as the "Health Connector web czar." And her official title is apparently "Special Assistant to the Governor for Project Delivery." Whatever her title, she's making big steps forward..

Today she released the first "Massachusetts Health Exchange Dashboard." The document includes the following updates of progress made this week: 

  • The Health Connector has processed all of the roughly 22,000 applications which had been entered into the system. Of these, nearly 15,000 people have been placed into temporary MassHealth coverage, and around 7,000 were found to be already covered.
  • They made progress on the 50,000 paper application backlog. Of these, 28,000 were screened. Among those screened, 4,000 were discovered to be duplicates, and 15,000 were already covered. This leaves 9000 remaining of the screened applications to be processed, and an additional 22,000 to be screened. Precessing will occurn weekly now, as opposed to the previous monthly schedule.
  • Additional staff have been hired to process applications. By early next week, the Connector expects to have 233 newly trained agents, ramping up to 318 within 2 weeks.

These were encouraging signs of progress. We particularly commend the administration for the transparency around their work. While there is still a long way to go, were are pleased to see substantial advances being reported today.

February 20, 2014

The Health Policy Commission (HPC) answered this question in its full commission meeting this week on Wednesday, February 19, 2014.  As David Seltz stated in his Executive Director report, the agenda for Wednesday’s meeting was short, but very important.  According to the final report from the HPC regarding Partners Health Care System’s proposed acquisition of South Shore Hospital and Harbor Medical Associates, the answer to this question is written in the data or, more accurately, in the lack of data.  Without abstention, The HPC voted to approve the final report recommending that Partners’ proposed acquisition should not proceed.  Also up for a vote were the final regulations from the Office of Patient Protection (OPP) on health insurance consumer protection. Materials from today’s meeting can be found here, and our full report on details from the meeting is on the backside.

February 19, 2014

Friends, changes are coming to this very blog and hcfama.org.

We are completely revamping our website. We’ll have a whole new look and feel and we’ll be making it a lot easier to get involved with our community organizing team, share your personal health care story, and connect with our HelpLine counselors directly. That also means that A Healthy Blog will be undergoing some changes to better integrate A Healthy Blog with the whole site. And that means that there will be some changes for subscribers to our blog as well, and we’ll be posting information about that in due time.

We’re not straying from our mission – to provide the latest updates, information and commentary on health care policy developments in Massachusetts from the Health Care For All vantage point. Please feel free to use the comments to give us your feedback.

Stay tuned for more — much more — very, very soon.

February 13, 2014

MOCC slide

MOCC stands for the “Massachusetts Operational Command Center.” It’s the structure set up by Sarah Iselin, the Governor’s special assistant tasked last week with managing the repair of the states health insurance enrollment website and underlying IT. Monitoring operations around the clock, and holding a accountability “Quarterback Call” meetings twice a day – 9:00 am and 5 pm, the center is modeled after the federal Exchange Operations Center in Columbia, MD that fixed the healthcare.gov website.  It’s up to the MOCC to get things working for Massachusetts health care. Do not mock the MOCC.

Jean Yang, the Connector’s Executive Director began today’s Connector Board meeting with a forceful and heartfelt statement about the challenges the Connector team and the residents at large are facing.  She thanked the Connector Board for their support and for “keeping their eye on the end game” and pledged to effectively engage the Board during this challenging time.

Yang admitted that the current workarounds to get people coverage are not working well enough, despite extremely hard work by staff.   To Yang, the two most urgent issues raised at yesterday’s legislative hearing about the IT issues include:

  • What the Commonwealth can do to get out of this situation ASAP; and
  • People need help, and the current workarounds are not yet sufficient.

Meeting materials are posted on the Connector’s website (go to About, Leadership, Board Meetings and scroll to Feb. 13). Our report takes just one click.

February 7, 2014

Between Governor Patrick’s press conference this morning (press release; and in-depth report from the Springfield Republican) and the Health Connector Board meeting this afternoon (Connector meeting presentation (pdf)) , today has been a busy day for discussing the key challenge of Affordable Care Act (ACA) implementation in Massachusetts – namely, how to fix the MassHealth & Health Connector’s flawed website and underlying IT system. Our full report is below:

Governor Patrick was emphatic about the goal of keeping everyone in coverage: “Those who have coverage will not lose it,” he said, “and those who are seeking coverage will get it…. We’re not going to let anyone go without insurance. It’s not going to happen. We have an obligation that is an obligation in law, and we have a moral obligation and a commitment to doing so.”

In late January, the Health Connector – in consultation with federal officials at the Centers for Medicare and Medicaid Services (CMS) – hired the non-profit technology firm MITRE to complete an assessment of the existing IT system.  The MITRE report (pdf), submitted on Tuesday, cites the IT vendor’s (CGI) lack of sufficient resources and poor project management and communications structures as major drivers of the deficient IT system.  The report also brings to light the lack of unified vision among the Commonwealth’s HIX (Health Insurance Exchange) project team, including EOHHS/MassHealth, the Health Connector and UMass Medical School, resulting in project oversight challenges.

MITRE suggests three main options to move the HIX system forward:

  • Sever the contract with CGI and work with a new vendor to start over building a new system
  • Work with a new vendor to continue incrementally improving the current system
  • Break the current system down into distinct technical segments and re-engineer each segment as to complete the system with a combination of CGI and new vendors

In response to these recommendations, Governor Patrick appointed Sarah Iselin to oversee efforts to repair the website and IT system.  Iselin, who is taking a four-month leave of absence from her role as chief strategy officer at Blue Cross Blue Shield of Massachusetts, will report directly to the Governor and act at the point person for the project. She committed to holding weekly briefings on the project’s progress.

Connector Board 2-6-14 Next Steps

NECN has a good summary of today’s news, including comments by Health Care For All Executive Director Amy Whitcomb Slemmer. Iselin was a guest today on WBUR’s “Radio Boston” program, and we think this 10-minute interview is the best summary of where we are and where we are going. Click below to listen:

February 6, 2014

With the continuing issues with the Health Connector/MassHealth enrollment website, we get asked the following questions constantly:

The old web site worked just fine. Why did they need to build a new one? Why can’t they just go back to the old one?

It’s a fair question. It’s also being asked in a more accusatory manner by some political candidates, who are claiming that we should have asked for a “waiver” from the whole ACA and just kept our old system.

What most people who ask this question don’t realize is that the Connctor and MassHealth are trying to build more than just a website. The web interface is just the visible tip. Underneath is a whole new processing system for health program applications, eligibility and enrollment.

So, here’s part of the answer, based on what we know:

1. Until now, there was no enrollment website for most people. The Connector’s web site only allowed people seeking unsubsidized coverage to fill out an online form to enroll and select a health plan. That was for just around 40,000 people out of the over 250,000 people covered by the Connector. For everyone else, there was no public enrollment website.

To enroll in subsidized coverage, one had to go to a community health center, hospital, or a few community groups that were authorized to use the state’s “Virtual Gateway.” It was not open to the general public. We’ve been told that once, by accident, it was open for the general public for a few hours on a weekend. A number of people filled out applications while they could, and all of the applications were filled out incorrectly and had to be redone. That’s why the state only allowed trained people to fill out the form.

The new system will allow the general public to set up an account, fill out their own forms, and submit it themselves.

2. The old “Virtual Gateway” form did not process verifications. If you had a hospital worker fill out the form for you, you still had to fax in separately the income,  residency and other verifications required for state programs. Then state workers had to manually associate the faxed-in documents with the form transmitted by the Gateway.

The new system will perform these functions automatically, in the background and in real time, by checking information already known to the state or federal government. For example, the system will check your wages with the Department of Revenue to see what your income is. Only if there’s a substantial discrepancy will the enrollee have to submit verifications.

3. The old system that determined eligibility was antiquated and difficult to update and maintain. Decisions took a long time to process. Under the old system used to process Connector and MassHealth applications, the determination of which program an applicant was eligible for was made by a system called “MA-21.” This 1980s era mainframe-style system was slow and very difficult to update. Changes in eligibility rules required lengthy, complex programming changes. The system produced awful form letter notices that were locked into a format that made it hard for people to understand. Decisions often took weeks.

The new system is designed to make instant real-time eligibility decisions. It will be easier to upgrade as program needs change. It also will be a platform for applications for other programs beyond health care.

Our HelpLine staff’s full-time job is enrolling people into coverage, so the current dysfunctional system makes us frustrated and furious at time (but note: the past few days we have had reports of substantial improvements in the system, with some people successfully applying, being determined eligible, and enrolling at one sitting). But the old system wasn’t so wonderful either.

We have two goals. First, everyone eligible for insurance must have a temporary solution, even if it means creatively working around some rules while the systems work is in progress. Then second, if we can get to a system that meets the goals outlined by the state, we will have made enormous strides to building a responsive, modern eligibility system that should last for a long time.

We’re looking forward to Thursday’s Connector Board meeting, just announced today, where we hope more progress can be made on system improvements.

-Brian Rosman

February 6, 2014

The Health Connector has scheduled a board meeting for Thursday, Feb. 6, from 9:00 am to noon. (UPDATED UPDATE: The meeting will start at noon, and is scheduled to go to 3 pm.)

According to the agenda (pdf), the only topic is the current open enrollment period. The agenda indicates that a vote is scheduled.

Because the meeting was not on the previously established schedule, it will be at Gardner Auditorium, in the State House.

When Things Go Wrong in the Ambulatory Setting

February 3, 2014

HCFA is one of a number of organizations involved in the PROMISES (Proactive Reduction of Outpatient Malpractice: Improving Safety, Efficiency, and Satisfaction) Project in Massachusetts. This project, which was funded through the federal Agency for Healthcare Research and Quality (AHRQ) Medical Liability Reform and Patient Safety Demonstration Grants, has been working to test interventions to improve safety in 16 ambulatory primary care practices.

The focus is on improving safety through improvement in test results management, referral management and medication management, with an overarching goal of improving communication (among staff, between providers and practices, and between staff and patients).

One of the areas that the PROMISES group, including HCFA, worked on was developing guidelines for primary care practices to follow when there has been harm caused to a patient. In 2006, Harvard hospitals came together to develop a document called When Things go Wrong which focused on the inpatient setting and the importance of disclosing errors to patients and families. The PROMISES group discussed the need for similar guidelines for the outpatient setting and together developed When Things Go Wrong in the Ambulatory Setting. HCFA is a co-author for an article about this document which was recently published in The Joint Commission Journal on Quality and Patient Safety.

This article will give national attention to these carefully considered guidelines, hopefully spreading their use not just in Massachusetts but across the country. These guidelines will be extremely useful as health care providers strive to carry out the apology and disclosure sections of the Massachusetts 2012 payment and delivery system reform law (Chapter 224).

You can see the guidelines on the PROMISES Project website, which includes the video above, featuring Dr. Lucian Leape, lead author of the original When Things Go Wrong document, and Dr. Gordon Schiff, lead primary care physician for the PROMISES Project, and case study videos.

-Deb Wachenheim

disparities bill cover
February 3, 2014


The State House News Service reported on Friday that the House Ways and Means Committee is voting on legislation to create a permanent Office of Health Equity within the Executive Office of Health and Human Services.

Health Care For All has long supported this legislation, working with a broad coalition of disparities advocates in the Disparities Action Network to draft the bill back in 2009. This session's bill, H. 2071, was introduced by Representatives Jeffrey Sánchez and Byron Rushing, along with 30 co-sponsors. It was already approved by the Public Health and Health Care Financing Committees (which offered a minor amendment).

In addition to creating an address in state government focused on health disparities, the bill would create a framework for a comprehensive approach to health disparities. The approach encompasses all the activities of state government, such as housing, transportation, education and economic development. It requires that each state budget submission identify major state initiatives that affect health and health care, and their impact on health disparities. It also calls for an annual report card on progress in reducing disparities.

HCFA urges the House and Senate to approve the legislation. The state has made important strides, creating a Health Disparities Council and an Office of Health Equity within DPH. Passage of this legislation would make health disparities an institutional concern at the highest levels of state government.

- Brian Rosman