The consulting firm Deloitte told MNsure's board of directors that its review of the health exchange website's 73 components found that only 26 worked as expected.
Deloitte said its review highlighted three critical missing functions that are repair priorities before Nov. 15, the start of the next open enrollment period.
In highlighting the issues, Deloitte provided a workable plan, said Scott Leitz, MNsure's chief executive officer.
"I don't think anybody is kidding themselves; there are some challenges ahead to make sure we are ready for fall open enrollment," Leitz told board members in St.
Paul. "But we're going to continue to work closely with Deloitte and the vendors ... so that the site is easier to work with, more efficient and more effective for consumers the second time around."
Improvements won't come soon enough for some consumers, many of whom face ongoing problems.
Larry Struck, 65, of Minneapolis offered a stinging rebuke during the public comment portion of Wednesday's meeting, saying his fiancee has struggled since October to obtain insurance.
The experience has featured "every sort of problem," Struck said, including misinformation from MNsure employees and interminable waits on the phone.
"I think that if I were sitting on this board I would feel deep regret and real sorrow for not meeting the expectations of this program -- for the failed experience and the miserable performance of MNsure in the past," he said.
"It makes me wonder: Are you the right people in this position? Are you the ones who ultimately should be accountable for this?"
Board member Phil Norrgard said board members do feel shame and are working hard to bring about improvements. Board member Tom Forsythe called Struck's commentary a "very serious upbraiding," probably deserved.
"I don't know if the more honorable thing is to hang in there because I'm partially responsible -- and try to fix it -- or to walk away because I'm partially responsible," Forsythe said.
Minnesota launched the MNsure health exchange last year to implement the federal Affordable Care Act, which requires almost all Americans to have health coverage or pay a tax penalty.
Problems with the MNsure website frustrated thousands of consumers trying to obtain coverage last year, and forced many to endure hour-long waits seeking help from an overwhelmed call center. MNsure boosted staffing and made improvements to its system, but it remains far from perfect.
Last week, state officials said they were delaying the transition of 800,000 people now enrolled in public health insurance programs to the MNsure system to allow more time for needed fixes.
The report Wednesday stressed that MNsure must develop a system for handling "life events," such as a marriage or childbirth, that fall outside of the open enrollment period.
People use MNsure to enroll in public health insurance programs or buy commercial coverage, and about 240,000 Minnesotans have now done so. An automated process is needed, however, for renewing all those policies, Deloitte said.
The Deloitte review found that 41 of 47 flawed or missing components of the MNsure system should be addressed before Nov. 15.
While there are plans to provide technical fixes for the problems, Brian Keane of Deloitte cautioned that the exchange might have a "heavy reliance" on manual processes and workarounds, such as paper insurance applications.
"I wish we could sit here and tell you today that it's all on track, it's all going to be delivered, systematically by November 15th," Keane said.
"However, from experience, I think it would be poor of us to start planning that all of this will be delivered systematically."
Where automated processes can't be developed, MNsure must develop or refine manual workarounds. That's one of the key benefits, Leitz said, of the report from Deloitte, which also is serving as lead vendor.
"It was very important to get that lead vendor on, so we could see where those gaps in functionality were and move toward making sure we put in place processes to fill them," he said following the meeting. "And if we weren't able to get there on all of them electronically, that ... we're able to put in place better manual processes than we had last fall."
Deloitte is credited with creating successful health exchanges in a number of states. The company developed the health insurance exchange in Connecticut, which Maryland is hiring to take over for its troubled exchange website.
Leitz indicated Wednesday that Minnesota will continue working with existing vendors, at least in the short-term.
"Maryland had to make their own decisions around what they were after," Leitz said. "We're not going to make decisions based on a single year's experience. We really do think about this in the longer, three- to five-year time horizon."
Leitz pointed out that the Deloitte review showed the MNsure system is accurately determining eligibility for the state's Medical Assistance program, which was one of the health exchange's big failings last year. Plus, the review did not find significant issues or gaps in the underlying technical architecture.
"Right now, we're committed to moving forward with this website," said Joe Campbell, a MNsure spokesman. "We have Deloitte on for a certain amount of time to provide a roadmap forward."
©2014 the Pioneer Press (St. Paul, Minn.)