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Consultant details major flaws in state health insurance exchange rollout

The Silver State Health Insurance Exchange board today will get a detailed consultant’s report on problems with its troubled Nevada Health Link website and consider fixes that could include firing the firm that built it.

Whatever action the board takes, the transition won’t be glitch-free, and any path could require more federal money on top of the $84 million the state already has received from the Centers for Medicare and Medicaid Services.

Deloitte Consulting expressed little confidence in the website builder, Xerox, and found plenty wrong with the health link’s rollout, which began Oct. 1. About 30 pages of the consultant’s 99-page report listed website or procedural flaws in areas ranging from project management to technology.

For starters, Xerox repeatedly brought in new teams and subcontractors during the six-month open enrollment period without developing transition plans between the new consultants. Xerox also has an organizational structure that could “cause communication barriers” and inconsistent customer service training protocols. Help-desk tickets often get reassigned to multiple groups before they’re addressed.

Worst of all, the website is confusing for consumers. It asks applicants if their 3-year-old daughters are pregnant, and it asks individual enrollees if they want a group plan. It requests applicants’ birth dates multiple times, and it doesn’t let them revisit previous pages to edit details. Nor do online premium payments appear in consumers’ pending payment sections.

Deloitte suggests three alternatives that include keeping the current system or dumping it for another state’s platform or for the federal version.

The exchange board could continue to use the system’s current technology but “undertake significant remediation and enhancements.” It could import a functioning marketplace from another state-run exchange. Or it could transition to the federally run healthcare.gov system.

Despite its enrollment troubles, sticking with the current system would have its advantages, Deloitte said.

There’s an existing contract, and the state would keep control of its marketplace — the reason Nevada opted for its own exchange in the first place. Also, keeping the aspects of the site that function would give Nevada a start on repairs ahead of the next open enrollment session in November.

But those benefits seem far outweighed by negatives listed in the report.

There is no plan to fix the system, Deloitte said, and making the repairs would require an “aggressive timeline.”

Patching the marketplace could also require more federal funding as well as additional exchange resources. New technical problems might emerge during remediation.

Deloitte also expressed little confidence in Xerox.

“The current project team has not proven they can successfully deliver the required management, processes or solution to successfully deliver an operational exchange,” the analysis said.

Using another state exchange’s system software would also demand an aggressive timeline and potentially require more federal funding as well as a public-education program to guide enrollees through enrollment changes.

Still, Deloitte called the alternative “a good strategic fit, satisfying business and functional requirements for the exchange.”

Nevada also would be sure to get a proven, functional system with existing training and operational procedures in place.

Moving to the federal version would give the state an operational marketplace as well. But Nevada would lose control of its exchange, and regulatory delays could hurt the system’s ability to meet enrollment goals in the next sign-up session.

The consulting firm also recommended adding nearly 25 more exchange staff, including a project manager, technical employees to oversee design, performance and security and 15 people to perform and log system tests and defects.

To develop its recommendations, Deloitte did a detailed analysis of 41 areas including eligibility determinations, financial management, employee management, facilities, website design and development and security architecture. The study included 109 interviews, a review of more than 100 documents, end-to-end system testing and a study of call center operations.

The exchange board retained Deloitte in March for guidance on fixing Nevada Health Link.

Officials set a target of 118,000 sign-ups in the system’s first year, but only 32,365 people had bought and paid for plans through the site by April 19.

The exchange is in the middle of a special enrollment period for consumers who couldn’t sign up because of technical problems.

The board will discuss Deloitte’s report at noon today. Consumers can watch the meeting at exchange offices, 150 N. Stephanie St., or listen by calling 877-402-9753 and using the passcode 2459998.

To read the report, visit tinyurl.com/nvexchange.

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512. Follow @J_Robison1 on Twitter.

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