MNsure, it's time to get a divorce

The vision was flawed. The IT strategy was a disaster. MNsure needs to change — and I should know. I’m a MNsure board member. What’s the definition of madness? We’ve spent $140 million. We’re about to spend $89 million more. To show for it, we have a mediocre MNsure website and an IT mess at the Department of Human Services (DHS). Plowing millions more down the same path? Let’s talk about that.

Sen. Tony Lourey, DFL-Kerrick, has a bill that would do away with the MNsure board and make MNsure a state agency. I would argue that’s where the problem began.

The vision for MNsure was the Legislature’s — and it was grand.

MNsure would not only serve the function of an exchange under the federal Affordable Care Act — determining eligibility for premium subsidies and helping Minnesotans shop for health plans — but it would also replace and integrate the antiquated DHS computer system in one grand new IT marvel.

Importantly, it would be paid for almost entirely with federal money — and that was the beauty of it. Such was the Legislature’s vision.

The strategy for implementing that vision came when MNsure was operating as a state agency. Before MNsure legislation was even passed, the commissioner of the Minnesota Department of Commerce, in 2011, contracted with four firms to customize and combine four different off-the-shelf software platforms to replace the DHS computer system and build the new exchange. It was to be a symphony of information technology, a wonder to behold.

But the IT tasks were more difficult than agency staff members envisioned. Progress was slow. The technology outline on which MNsure was to be based came months too late from the federal government, just as the strategy of four different vendors building disconnected pieces of software was dissolving predictably into a full-blown IT disaster.

It gets worse. In February 2013, still acting entirely as a state agency, MNsure ousted its general contractor, deciding with hubris that its staff could better lead the project. MNsure the state agency had set the fateful course to manage one of the largest and most complex IT projects in state history — by itself.

And the seven-member MNsure board? We’d not yet been named and wouldn’t be for months.

The rest of the story is painfully well-known. Deadlines passed. Software went untested. And when MNsure opened for business on Oct. 1, 2013, it went badly. Key aspects of the software didn’t work. An understaffed call center was overwhelmed. Minnesotans sat on hold.

We’ve been digging out ever since — with the board holding MNsure firmly by the lapels. Of course, hundreds of thousands of Minnesotans have also been subsequently insured.

But now the Legislature is in session — and a scapegoat is required. Frankly, no one involved should even offer a defense.

Eliminate the board? Go ahead. But let’s be honest. That flawed vision? That was the Legislature’s. That disastrous IT strategy? That came in the two-plus years when MNsure was acting as a state agency, as the legislative auditor’s report lays bare.

That’s the past. It’s not a solution. What’s needed is a change:

Let’s admit that MNsure and the DHS need a divorce. Papering over massive IT needs at DHS and calling it MNsure isn’t accurate. It never was. The DHS computer system is not MNsure — and it shouldn’t be. Federal funding or no, that legislative vision of one massive IT system doing all things for all people was a terrible IT blueprint.

You want to fix things? You want clarity and accountability? Have the DHS build and run its own IT system. Have MNsure run the exchange.

Share what we should. One front door, one call-center number — we should agree to live together for the sake of our fellow Minnesotans. Let’s share the front-end website. Let’s share communications and outreach. These shared efforts have successfully reduced the number of uninsured Minnesotans to among the lowest in the nation. But let’s separate and clarify what each of us is accountable for doing thereafter. DHS should operate the public programs. MNsure should help Minnesotans compare and buy insurance.

We need to live our separate lives. MNsure needs to date someone other than DHS. There are many successful exchanges. There are private-sector solutions that do comparative shopping better. Going our separate ways could be cheaper for both of us. And the DHS will be fine. Remember, we have $89 million to get us both on our feet. We should be able to make do.

But let’s be honest. This isn’t working. The vision was flawed. The strategy was terrible. It’s time for change.

Eliminate the board if you like. But what’s needed is a shift in strategy — not another state agency.

That’s the kind of thinking that got us into this mess.

 

Tom Forsythe is vice president of global communications for General Mills and a member of the MNsure Board of Directors. His opinions may not be shared by other board members.