MNsure probe finds 'system gaps'

MNsure is still plagued by problems, with nearly two-thirds of its operating systems "absent or not functioning as expected,'' and the glitches threaten fresh trouble for consumers during the coming fall enrollment period, the MNsure board was warned Wednesday.

The assessment came from representatives of Deloitte Consulting in their first major report on MNsure's operations since they were hired in April to help fix the health site's problems. The consultants will present a more thorough analysis of medium- and long-term solutions in a follow-up report that could be presented at next month's board meeting.

MNsure's "system gaps" are extensive, the consultants found. They identified 73 high-level functions and subfunctions that should be present in a "robust" health insurance exchange.

Forty-seven of them — or nearly two-thirds — are missing or not functioning properly, the consultants said. Getting MNsure ready for open enrollment in November will require addressing 41 of the 47 issues.

"If this functionality is not implemented on schedule," the report warned, "there could be a significant adverse impact on MNsure operations during open enrollment."

Despite those findings, MNsure CEO Scott Leitz said contracts with all of the exchange's existing IT vendors, which are set to expire at the end of the month, probably will be extended through the fall open enrollment period. Leitz added, "that doesn't preclude us from continuing to think about how we want to structure the system longer term."

The launch of MNsure was characterized by gridlock in its systems that forced many applicants to rely on phone calls and paper applications. Even then, many had to endure long waits on hold and repeated attempts to get all their paperwork through the system. Still, nearly 238,000 people ended up using MNsure to get insurance, including more than 51,500 who purchased private plans. A recent report found that some 95 percent of all Minnesotans now have health insurance, putting the state second only to Massachusetts.

The consultants also highlighted significant breakdowns with the way MNsure is directed and managed — including in its information technology and by its board of directors.

Their report described the processes as "diluted," creating inefficiencies, confusion and inconsistency.

MNsure hired Deloitte for a nine-month, nearly $5 million contract to assess the state of its system, which aims to be the front door for anyone looking to buy health care insurance under the Affordable Care Act.

Consumers using the site have been able to compare health insurance plans more easily and determine their eligibility for one of the state's public health plans or for federal tax credits.

Problems with software programs and system components have made it difficult for consumers to use the site, and the handoff from MNsure to insurance carriers has not been automated.

MNsure Board Chairman Brian Beutner emphasized that the report "was all about the short-term" and that Deloitte didn't find any structural flaws in the system's underlying architecture.

"That's a big finding for the long term," he said. "It impacts the whole conversation."

Gov. Mark Dayton said that he hadn't read the report in depth, but that he is hopeful that MNsure will resolve its issues by Nov. 15.

"They've got a lot of work to do," he said. "They've known that for some time. But the fact is, despite all those deficiencies and all the problems, we've got 40 percent fewer uninsured Minnesotans. That's a remarkable success considering some of the problems that everybody is well aware of."

Deloitte reviewed contracts and assessed the performance of MNsure's two main vendors, Maximus and PwC, but did not make a recommendation about whether the state should keep working with them.

PwC, which handled security issues, was awarded a $5.5 million contract, and has been paid about $3.7 million.

Both Leitz and Beutner said Wednesday that the state hasn't gotten its money's worth out of the vendors so far, but defended the decision to stick with the current team — for now.

"I think it would be a knee-jerk reaction to say, 'Open enrollment closed, it was a disaster, let's go somewhere else and do something else,' without doing the appropriate analysis," Beutner said.

Staff writer Rachel Stassen-Berger contributed to this report.