Technology Delays Plague Cover Oregon

The same problem that’s plagued the federal health insurance exchange – healthcare.gov – appears responsible for Cover Oregon’s failure to implement its web-based portal on Oct. 1: technology.     Even though Cover Oregon has paid Oracle, the technology giant, $43.2 million this year, the site’s still not working, and temporary workers are processing paper applications. As of Tuesday, Cover Oregon had received 17,000 applications but can’t say how many people may require subsidies, or want to enroll in the Oregon Health Plan, Healthy Kids or a commercial plan, said Michael Cox, communications specialist with Cover Oregon.   Executive director Rocky King is cautiously optimistic that insurance agents and community partners, including navigators, will be able to access the website by Dec. 1, and help people choose a health plan and determine eligibility for tax subsidies. However, the general public will not have access to that website until some future date.     “That’s the deadline Oracle’s executive staff and programmers have given me: we’re two months behind because of a variety of technical challenges and are working with Oracle to get this going,” King told The Lund Report. “Oracle’s given us dates before and not been able to meet them. Until I see it, I continue to emphasize there are other ways to get people enrolled in a health plan.”   Small employers eager to purchase coverage on the exchange will have to wait until some unknown date. Known as the SHOP program, it’s being delayed indefinitely until the individual enrollment is up and running. Several insurance agents, including Richard Skayhan of Leonard Adams Insurance, have heard rumors that the SHOP program won’t start until 2015, but King wouldn’t confirm them.    “There’s not the same urgency with small businesses because they can renew all year,” unlike individuals who have until Dec. 15 to sign up for coverage starting Jan 1, he said.    Cover Oregon also faces a tight budgetary problem, after hiring 100 temporary workers to process applications. “This is creating a two to three to four month expenditure that wasn’t anticipated, and we’ll have to live with the funds available to us,” said King, who undoubtedly will be peppered with questions when he appears before legislators next Wednesday.     The biggest reason Cover Oregon’s website lags behind is because Oracle didn’t meet its deadline and should have begun testing last May, rather than delaying until this summer when it was too late to resolve the problems it encountered, King said. Oracle has been paid handsomely by Cover Oregon for its consulting and software development. It’s received $43.2 million this year – accounting for $11.1 for hardware, $9.5 million for software and $22.6 million for consulting.   And, the Oregon Health Authority, which chose the technology firm, paid Oracle $45.9 million starting in 2011, according to Cox.  By the end of this year, Oracle should receive another $28.5 million from Cover Oregon but may be penalized. The exchange is holding back 5 percent of that payment until the website is functioning.   “The scope of the project, bringing Medicaid, Healthy Kids, commercial and the SHOP program has been a lot more complex and challenging than everyone thought,” King said. “And some of the initial work done by Oracle wasn’t done to the level of quality that was needed to do testing early enough to find out where the problems were.”   Cover Oregon is expected to enroll 217,000 Oregonians – both individuals and small businesses – by the end of 2014, and the exchange must be financially independent of federal and state funding by 2015.    Quality Scores Called Into Question    Unlike other states, Cover Oregon decided to come up with rating scores for each health plan, as a way of helping consumers make more educated choices. Working with the Quality Corp, it looked at three factors to determine those scores -- preventive care, complex care and patient experience – including the percentage of members screened for diabetes, high cholesterol, breast cancer screenings and well-child visits during 2012, along with satisfaction surveys conducted by the health plans.      But since the scores have come out, they’ve created more headache than anyone could have imagine because several of the health plans with the lowest ratings – 2.5 – started complaining, insisting their scores were wrong. So Cover Oregon agreed to raise the scores of LifeWise Health Plan and the Oregon Health Co-op to 3.0, and now other insurers are claiming they want bumped up scores as well.    “Some of the health plans that asked for changes in their ratings had a legitimate point and we made adjustments, but not because someone screamed at us,” King said.  “This is the first time anyone’s tried this,” King said. “No one’s ever done quality scores for the commercial market. California chose not to, and got sued.”    Nora Leibowitz, chief policy officer, said the scores of LifeWise and the Co-op were changed because of miscommunication and changes in their provider networks.     “We want the methodology to be consistent across all carriers and treat everyone the same,” she added. In the Co-Op, for example, they were using commercial claims data, not Medicaid and Medicare, and that was corrected, while LifeWise changed its network to Providence Health earlier this year, which raised its score.    Still, Trillium Community Health Plan and ATRIO Health Plans, which  have 2.5 rating scores, remain convinced Cover Oregon used incorrect data, and have asked to meet with officials.   “We received higher scores from the Centers for Medicare and Medicaid Services on the same items and CMS has been time tested,” said Ruth Rogers Bauman, CEO of ATRIO Health Plans. ”We understand that Cover Oregon did not include non-claims data which CMS does accept. Using only claims data does not reflect the care patients received and perpetuates the fee for service mentality and hinders transformation."   Trillium says its lower score resulted, in part, from Quality Corp’s judging Medicaid and Medicare CAHPS survey results, not comparable to commercial products and excluding them.. “This caused the entire ‘Patient Experience’ domain to be missing from Trillium’s carrier ratings,” said Debi Farr, the plan's public relations specialist. “This is a major disadvantage for us because we typically have a high level of patient satisfaction.”   Trillium has 55,600 Medicaid members and expects a minimum of 7,500 additional members based on the recent Fast Track file released by the Oregon Health Authority.    Meanwhile, the two other health plans with the lowest 2.5 rating are taking it in the chin and not protesting Cover Oregon’s decision – BridgeSpan (an offshoot of Regence BlueCross BlueShield) and Health Net.    “BridgeSpan is working closely with Cover Oregon to understand the ranking criteria and committed to ensuring its members receive access to quality, safe and effective care,” said Regena Frieden, director of public relations for Cambia Health Solutions, its parent company.    According to Brad Kieffer with Health Net, “Consumers can have confidence that Health Net provides access to quality medical care and will be working to improve our scores going forward.” Looking toward fall of 2014, when new rating scores come out, Cover Oregon is creating a work group of insurers and the Quality Corp so everyone understands the methodology and questions can be dealt with ahead of time, said Leibowitz. “We want the methodology to be consistent across all carriers and treat everyone the same.”