Politics & Government

Health insurance exchange contractor catches flak for glitches

The information-technology firm that designed Washington’s health insurance exchange came under fire Thursday from the exchange’s governing board — especially on the question of whether Deloitte Consulting can actually fix errors in the payment and billing system by the end of August.

That is when insurance carriers want problems ironed out before they prepare for the next round of enrollments for coverage in 2015. But Benush Venugopal, a principal with Deloitte, was only able to say he thinks the problems afflicting payments and invoicing on 6,000 accounts can be solved — far short of the guarantee some hoped for.

“I think that the end of August is … our Maginot line,” said Ron Sims, chairman of the board that oversees the Washington Health Benefits Exchange, evoking a French line of defense against Germany during World War II. “We’re backed in a corner and ... we don’t like being in the position we are in.’’

About 6,000 individual accounts at any time have problems that include payments not reaching insurance carriers and consumers’ insurance status not being up to date. This has led to patients unable to get prescriptions at pharmacies and doctors and insurance brokers not being paid, according to testimony given last week to the Legislature’s health care oversight committee.

The 6,000 accounts represent a fraction of the more than 160,000 private-insurance accounts handled by the exchange, but Venugopal and exchange chief executive Richard Onizuka say fixing the payment problems is their No. 1 priority.

Venugopal spoke to the exchange board at its meeting Thursday, telling members that his firm has “150 people working night and day” on the problems. He and exchange staffers said Deloitte plans to bring together experts, exchange officials and insurers together soon to look at the problems.

But on the more pointed question posed by Sims and others — can the exchange be assured problems will be fixed — Venugopal was not so firm. He said that investigators have still not been able to determine what is causing a recurrence of voucher and payment issues, which appear to be fixed for some accounts, only to spring up with others.

He also noted the exchange had been touted as one of the best in the country.

The lack of a firm promise to deliver a fully performing system appeared to anger one board member, Ben Danielson, medical director for the Odessa Brown Children's Clinic, who said he was “still feeling frustrated and not very helped” by the board’s conversation with Venugopal and exchange officials. He said he didn’t see a strategy much different than the one that led to two separate repairs to the system in May and another in late June, none of which completely fixed it.

“I just feel like we don’t know exactly the denominator or numerator. We don’t agree on the problem. There are differences in understanding the problem. We clearly do not understand the problem,” Danielson said. He added in comments directed at Venugopal that he “can’t answer a question because you really don’t understand the problem … This is a really disappointing lack of information to me.”

One other board member, Teresa Mosqueda of the Washington State Labor Council, said the board should consider giving paper credentials to people who have paid into the system using the exchange. This would let patients prove to a doctor or pharmacy that their insurance is current.

Several exchange board members expressed concern that the Wahealthplanfinder.org reputation or “brand” name was being damaged by the ongoing glitches.

On a brighter note, officials reported that more than 1 million people have been enrolled in Medicaid or private insurance plans using the exchange since it opened Oct. 1 under the federal Affordable Care Act.