Three things, seems to me, were important for Governor Deval Patrick to address at his public event on Thursday concerning the enormous problems with Massachusetts' rollout of the health coverage under the Affordable Care Act:
1. Recognition of the real distress the rollout failure has created;
2. Change in operations to turn this disaster around as rapidly and well as possible;
By my scorekeeping, the Governor did well on all three counts. Though getting to where we need to be still won't be quick and easy, the Governor deserves recognition for making significant changes to get things on track. I'm not convinced, and I'm hopeful.
On the first point, here are the Governor's words:
"To the people whose transition has not been smooth, I join my colleagues from the Connector and MassHealth in apologizing to you for the inconvenience, and I want to thank you for your patience," Patrick said. "I also want to assure you that we are not going to let anyone slip through the cracks."
Good words, Governor, and thank you. Let's not forget, for a LOT of Massachusetts residents who are experiencing distress in getting needed medical scare because of this mess, it's been far more than an "inconvenience." Here's what one knowledgeable person on the ground told me on Friday:
"There is currently no solid process to get urgent medical need cases processed in a timely fashion. Uninsured consumers that have applied and are waiting an eligibility determination have two options to get needed health care right now: 1) Delay your appointment or 2) Pay out of pocket. To give you an example, a man with cancer had a kidney and part of his liver removed in December at a major hospital in Boston. He had a post-op appointment scheduled in early January and was told by his surgeon's office that he couldn't come for the appointment until he 'got his MassHealth figured out.' The 'solution' he was given was to delay his appointment or pay out-of-pocket. We're hearing stories like this regularly at the advocate and provider tables.
"We have been given 'contacts' at the state to help us 'resolve' issues and get people coverage, but the system is so, so broken, to the point where these contacts take many days to find applications and then many days to process them. Also, we are seeing erroneous eligibility determinations come out of the new clunky systems they've built."
Immediate attention to the immediate needs of people at risk has to be a top priority. And please don't go shooting the messengers.
On the second point, the appointment of Sarah Iselin, according to the Governor's press release, to be a "temporary new Special Assistant to the Governor for Project Delivery to lead the consolidated state government management of website functionality, and the formation of a new technology and policy partnership with Optum to complete the Health Connector website" is an excellent step forward.
Read the February 4 report by the MITRE Corporation for the US Centers for Medicare and Medicaid Services (CMS) if you would like to see the blow-by-blow diagnosis of a catastrophically bad project. According to the review, it was a massive screw-up by the vendor, CGI, and a massive screw-up in project oversite by the Connector, MassHealth, and their project management team at the University of Massachusetts Medical School.
Though Sarah Iselin is not a household name by any means, those of us in the Massachusetts health policy community know her well as a first class talent with exceptional skills. She is walking into an odd and difficult situation as a "special assistant," though with a direct pipeline to the Governor. The new contractor, Optum, inspires confidence. The stakes are now high for just about everyone; so let's hope the right team is in place. We know the federal system has been substantially improved; we know other states made this work; let's keep our fingers crossed.
On the third point, the commitment by Sarah Iselin to have weekly wide-open briefings on the status and progress of this work is essential. For people who need this system to work, trust has been broken, people have been really hurt, and mistrust needs to be repaired. That can only happen with an unprecedented level of accountability and transparency on the part of the state.
Good luck to all.
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