Directors of troubled health exchange weigh dumping Xerox, joining federal system



A failure.

A disaster.

The board of directors of the Silver State Health Insurance Exchange delivered those brutal reviews of the exchange’s Nevada Health Link website and call center Thursday, even as exchange officials and site vendor Xerox said they’re fixing wide-ranging technical problems afflicting the marketplace created by the federal Affordable Care Act.

Also discussed Thursday: More than 30,000 pieces of consumer communications, including emails, letters and faxes, have gone unanswered. And a Las Vegas man testified that he never could verify that he actually had the coverage he paid for, and he has run up $407,000 in medical debt since a Jan. 3 triple bypass.

Board members said it is time for a “disaster recovery plan” with options including firing Xerox, hiring a new vendor or joining the federal exchange.

“We have to have an incredibly candid conversation about what the facts are so we can fix this,” board Vice Chairwoman Lynn Etkins said. “To describe January as a difficult month is an understatement. I think this is catastrophic.”

Etkins was responding to a report from Executive Director Jon Hager, who pointed to three primary errors that have hurt enrollment: a page telling consumers the site was having technical difficulties and to come back later; a “no plans available” error message; and a “generic unresolvable error” that would trap consumers entering inconsistent data. The first two have mostly been patched, and the third is happening less frequently, he said.

He added that website errors kept the exchange from sending enrollee information to insurance carriers and caused invoicing problems in January.

But he said exchange officials have worked with Xerox to cut system problems. Xerox has tripled the developers working on the site, and it has boosted its call center employee count to 188, exceeding the 155 it needs to handle call volumes. The company also has about 80 more customer service representatives in training. Average wait times, as long as an hour in January, have dropped to as little as two minutes. Xerox has also created a separate hotline for insurance brokers staffed by experienced service reps to handle multiple complicated cases.

Xerox, which has a $72 million contract to build the site, also has added project managers and business analysts for the exchange, Hager said.

Still, the disastrous rollout means the exchange won’t meet its March 31 enrollment goal of 118,000 Nevadans, Hager said. He has downgraded the expectation to 50,000 enrollees.

“It’s a much more realistic goal, although it’s still a challenge,” he said. “The corrections and improvements to the website in the last month should go a long way to allowing unfettered access, and the call-center additions should help as well.”

Hager’s comments did not placate the board.

Etkins blasted back, noting that 82,000 people have been deemed eligible for coverage through the site, but only 22,000 have chosen plans, and 16,000 have paid.

“The response we see from you is to reduce the goal by over 50 percent. You don’t just get to move the goalposts,” Etkins said. “I don’t understand why we would announce a new number that we are also saying we won’t hit. What about those other 66,000 people we suggested we were going to enroll? These are not numbers. These are people throughout the state who don’t have health insurance. What has happened to them?”

The target should still be 118,000, Etkins said.

Exchange officials need to prepare a “Plan B,” and look at options including finding a new vendor, Etkins said. Board Chairwoman Barbara Smith Campbell suggested turning over the state exchange to the federal version.

But it could take until October 2015 to go through the bidding and hiring process to replace Xerox, so the best solution is to stay the course, Hager said.

Answered Etkins: “The lead time is always going to be the lead time. We can’t continue blindly down a path saying, ‘It’ll take 12 months to do something different.’ Twelve months is going to pass, whether a plan is in place or not.”

Xerox officials also pleaded their case, apologizing for the site’s performance and saying they were “fully committed” to making it work.

Senior Vice President Kevin Walsh also told the board the company will “redeploy” some of its customer-service reps as a “SWAT team” on the 30,000 pieces of unanswered consumer correspondence over the next three weeks.

Walsh said Xerox has also assigned one of its own “high-end” consulting subsidiaries to help with the site, and an “A-1 (Xerox) SWAT team” to work on financial operations and support.

“We’re approaching a tipping point to be able to get more proactive in our solution,” Walsh said.

Xerox is working to determine why eligible people haven’t enrolled in coverage, he said, suggesting some may simply “not want to flow through” and finish the buying process.

Campbell said she was disappointed with the depth of Xerox’s report.

“We really want to see what the underlying issues are, and we want a clear delineation of all of the issues,” she said. “We want to know the timelines to a cure. We want to know updates on the completions of those timelines. We want to know why those timelines are not met. And we want to know about the backlogs out there in Medicaid, and in the correspondence file.”

Hager said exchange officials are “extensively monitoring” Xerox with “daily, and sometimes hourly, meetings talking about the issues that come up.”

Hager also told the board that Nevada Health Link is financially viable through late 2015, so there’s “plenty of time” to increase enrollments.