While limping along in the short-run with its troubled website, MNsure must quickly pick a strategy for making long-term software fixes and get beyond the recent "crisis mode" that has dominated program management, according to a consultant's report released Wednesday.
Some improvements can be made in the coming weeks, but the website can't be completely fixed by the March 31 deadline for people to obtain health insurance, according to a report from Optum, a unit of Minnetonka-based UnitedHealth Group.
The company recommended doubling the call center workforce with the equivalent of 100 full-time workers, and utilizing an Optum call center in Orlando, Fla.
Manual workarounds still will be needed to connect many consumers with coverage this year, according to the report.
In the long run, the report suggests picking one of two strategies to remediate the current website, or making more fundamental changes that could involve hiring new software vendors.
The report mentions more than 200 defects found with MNsure's current software.
"Zero defects is not a realistic target," Jim Eppel, a senior vice president at Optum, told MNsure's board of directors during a meeting in St. Paul. "It is a series of trade-offs."
MNsure asked Optum to consult on software troubles that have aggravated consumers trying to use the new health insurance marketplace. Minnesota launched the MNsure website to implement the federal Affordable Care Act, which requires almost all Americans this year to have health insurance or pay a tax penalty.
The company has been lauded by federal officials for helping this winter to improve the healthcare.gov website, which serves as the exchange for 36 states. A 15-member Optum team reviewed the MNsure site this month.
"They brought back some really very robust recommendations," Scott Leitz, MNsure's interim CEO, said after the board meeting.
In the coming days, MNsure will proceed with plans to improve the call center, which likely will include outsourcing some functions, Leitz said.
Decisions on how to fix the website, based on Optum's recommendations, will come over the next few weeks.
"We do intend to take action on this report," Leitz said.
People can use the exchange to buy commercial health plans and learn if they qualify for federal tax credits that can discount premium costs. MNsure also tells people whether they qualify for the Medicaid or MinnesotaCare public health insurance programs.
As of Jan. 18, more than 80,000 people had enrolled in public or private plans through MNsure, according to numbers released Wednesday. That's a jump of 11 percent from about 72,000 enrolled as of Jan. 4.
Starting next year, MNsure must fund its operations by withholding up to 3.5 percent of the value of premiums for commercial policies sold on the exchange. The current pace of enrollment is falling below targets, which means the health exchange could face a budget deficit starting next year.
Improving the MNsure website, as well as the ability for consumers to get timely help from the MNsure call center, are key to getting more people to buy coverage through the online marketplace.
"In its current state, the existing MNsure system will not support enrollment expectations," the Optum report stated.
"The only option available to complete the 2014 enrollment period through the (first) quarter is to continue utilizing the existing system," the report stated. "Some improvements can be implemented during this time. However, the majority of attention must be focused on interim actions and manual efforts required to meet enrollment targets."
Hundreds of Defects
Optum documented more than 200 defects in the MNsure software, including 108 related to software developed by IBM Curam -- one of four primary vendors on the information technology project. Late last year, IBM sent dozens of workers to MNsure's headquarters in St. Paul after a letter from Gov. Mark Dayton detailing more than a dozen problems with the company's software.
Their first two options take different approaches to reworking the website over the next two years. The third and more dramatic suggestion put forth Wednesday would have the state create new software architecture for the MNsure website. Consumers would continue to use the current website, with minimal improvements, during 2014 and 2015; that would let the state launch a "parallel" effort to begin a "green field," or entirely new solution that would be ready for 2016, the report stated.
One downside is that the "asset may need to be written off -- sunk costs," the report stated.
As of Jan. 8, MNsure had paid software vendors $25.4 million to develop its website. Maximus Inc. has served as general contractor on the project, with a total contract value of $46.2 million. The Optum report noted that "additional resources are required" to implement any of the three options for the MNsure website.
The report recommended a new program management structure for MNsure because the current structure and process is "nonexistent." It added: "Management/leadership/decision making is occurring via crisis mode."
"Based on Optum's initial review, we are able to conclude that, while MNsure will fall short of achieving its original enrollment goals and consumer satisfaction levels, continuous improvements can be made in both the short-term and long-term," the report stated.
At the conclusion of Wednesday's meeting, board chairman Brian Beutner said the option to "re-architect" the MNsure website wouldn't mean the state is completely starting over.
The current website is constructed from various software "modules" for different functions. In developing new software architecture, MNsure might decide to use some of its current software, Beutner said, along with modules from elsewhere, such as the federal government's HealthCare.gov website.
"I view them as another vendor," Beutner said of the federal government. "I don't necessarily want to limit our three choices as a board to the three options that Optum laid out. ... Maybe we're not good at it, and HealthCare.gov is -- maybe there are parts that we can subcontract to them."
Christopher Snowbeck can be reached at 651-228-5479. Follow him at twitter.com/ chrissnowbeck.
The Optum report identified eight steps for improving MNsure. They include:
- Reducing call center wait times and improving customer satisfaction with more staff and process improvements
- Reverting to the governance structure that existed before Oct. 1, when the health exchange adopted a crisis mode
- Improve software testing and create a quality assurance team
©2014 the Pioneer Press (St. Paul, Minn.)