When Minnesota launched its new health insurance exchange Oct. 1, the problems came quickly.
By late October, the error rate at the MNsure website peaked at 22 percent.
In November, state officials started rerunning 30,000 applications because of a variety of problems, including inaccurate rulings about whether people qualified for financial assistance.
In December, the call center was overwhelmed, and people endured waits of more than two hours while trying to finalize coverage before a New Year's Eve deadline.
The next big deadline for MNsure comes March 31, the date by which consumers must obtain health insurance or possibly face penalties under the federal Affordable Care Act. There are still problems with the health exchange website, but MNsure officials say they've taken steps that should prevent a December flashback.
"The site is functioning better," said Scott Leitz, the interim chief executive of MNsure. "I'm not going to say that everything has been solved, but it's a much more functional system than it was.
"We're better prepared to answer people's questions when they do have problems," Leitz added, "and prepared if all else fails to get them into coverage using more manual means."
Health insurers that sell policies through MNsure agree that improvements have been made. Even so, the health exchange is falling far short of its original goals, said Marcus Merz, chief executive of PreferredOne, a Golden Valley-based insurance company that's been the most popular choice of people buying commercial policies through MNsure.
"It's working better only because MNsure has thrown bodies at it, and we're throwing bodies at it," Merz said. The process for individuals to sign up for coverage and for insurance companies to get information about enrollees is "still very manual, and it's still very labor-intensive," he said.
Of the overall experience thus far, Merz added: "It's been a nightmare."
Minnesota launched MNsure last year to implement the federal health law, which requires almost all Americans to obtain health insurance by month's end.
Those who don't could face a tax penalty of either $95 or 1 percent of income, whichever amount is greater.
The deadline is important for another reason. Once it passes, most consumers in the market for individual health insurance policies won't have another chance to buy coverage until an open enrollment period that starts Nov. 15. At that point, policies would take effect Jan. 1.
The restriction doesn't apply to everyone, since people can still enroll in the state's Medicaid and MinnesotaCare health insurance programs after March 31. There's also a chance to buy individual health insurance policies after March 31 in the case of "life events," such as the loss of job-based coverage or the birth of a child.
State officials, health insurance companies and the federal government have been pumping up messages about the March 31 deadline in recent weeks, with hundreds of outreach events scheduled across Minnesota. The goals are to boost lagging enrollment in commercial health plans through MNsure while also attracting younger and healthier consumers.
The launch of MNsure was chaotic and confusing, said Dannette Coleman, a senior vice president at Medica, a health insurance company based in Minnetonka.
Many consumers struggled with the website. Then they turned to the call center for help but found operators who weren't trained to address information technology problems, said Coleman, a member of a state task force that offered advice on creating MNsure.
Compared with that earlier experience, she said, consumers now using the MNsure website are likely having less trouble.
The improvement shows in the consumer calls being fielded this month at HealthPartners, said Donna Zimmerman, a senior vice president with the Bloomington-based insurer.
"They are not calling us to intervene with MNsure to help get enrolled," Zimmerman said. "We believe that the MNsure website is working better."
Officials have tackled many of the problems that plagued the system early on.
One information technology problem that's largely been addressed is the infamous "black hole," where thousands of applications for coverage were lost in the system. The problem involved software from the Curam division of IBM, which dispatched workers to MNsure's headquarters in St. Paul during December to help tackle the problem.
On Dec. 21, there were more than 12,000 applications that were stuck in the eligibility determination system. By March 1, the number was 983.
"Where we were challenged in December is that we didn't always know a person was stuck in the system, unless they told us they were stuck in the system," Leitz said. "It's not that we perfectly know everything now, we just know a lot more about who the people are and we're able to reach them."
In a prepared response to questions, IBM said: "We're continuing to see improvements working with MNsure as Curam performs at a high level, processing more than 180,000 applications to date and a 98 percent success rate without need for intervention."
MNsure more than doubled its call center capacity by hiring an outside vendor, making 100 workers available. Call center statistics show the impact.
On Monday, the call center fielded 4,222 calls, and the average wait time was 4 minutes, 33 seconds. Back on Dec. 20, the call center had received 2,037 calls by 2 p.m. that Friday, and the average wait time was two hours.
More than 60 percent of calls were abandoned at one point in December, and the abandoned rate hit 77 percent in early January. On March 4, the abandoned call rate was less than 2 percent.
"There were some very dark days in the call center," Leitz acknowledged.
MNsure also has a better process now for directing people to paper applications, Leitz said, if people can't get coverage to work through the website.
Paper applications have been a helpful backup, particularly when website errors increased earlier this month because of a software update, said Rebecca Lozano of Portico Healthnet, a St. Paul-based group that employs health insurance navigators, who help consumers sign up for coverage.
Navigators have a better understanding of how the system works than they did a few months ago, Lozano said, and more consumers are realizing they need help.
"We know what to expect and how to interpret certain error messages," Lozano said.
MNsure officials say improvements are showing up in enrollment statistics.
At the end of Monday, 125,011 people had signed up for coverage through MNsure from either state public health programs or private insurance companies. By Friday, the total enrollment tally surpassed 130,000.
Not all Fixed
Despite the noted improvements, some MNsure problems remain.
Health insurance agents continue to have frustrations, said Alycia Riedl, president of the Minnesota Association of Health Underwriters, a trade group.
MNsure is now more responsive to concerns raised by agents and brokers, Riedl said. But the execution still isn't there, she said, saying agents and brokers feel they haven't been engaged by MNsure to join the final push to enroll people before March 31.
And technology remains a persistent problem, Riedl said, noting that agents still can't create an account on behalf of an applicant. Instead, they can only provide "over-the-shoulder" assistance as a consumer goes through the online process.
"We're ready and able to try to get people enrolled, but we don't have the tools to do it," Riedl said. "We can't create accounts for people - the technology just doesn't exist."
And the system for sending information about enrollees from MNsure to health plans still isn't working well, industry officials say.
"MNsure has a lot of tough work ahead," said Scott Keefer, vice president of policy and public affairs at Blue Cross and Blue Shield of Minnesota. "In my opinion, the platform is still not working - it's simply not, the back end especially.
"The front end is better for what the consumer sees," Keefer added. "But the back end for getting people enrolled, there's still a lot of work that's got to get done for 2015."
©2014 the Pioneer Press (St. Paul, Minn.)