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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

November 19, 2014 at 5:54 PM

Lively exchange board meeting airs frustrations over system problems

Today’s board meeting of the Washington Health Benefit Exchange, which manages the Washington Healthplanfinder state health insurance exchange, was decidedly lively, with board members expressing frustration on a number of issues.

1. Some consumers have accounts that incorrectly show balances due and are unable to enroll in new plans. When they call the exchange, said one board member, they are being told to either pay the balance or call back in January when there may be a fix. The board member, Teresa Mosqueda, called the situation “unacceptable.” Exchange CEO Richard Onizuka said the issue “is on our agenda.”

2. Frustrated by the technical problems encountered with the opening of enrollments last year and this year, several board members grilled exchange IT staff about why the system couldn’t be tested ahead of time. Exchange staff replied that it tests the exchange software with other agencies systems when it is able, but that the federal hub wasn’t available for testing prior to the open enrollment period.

3. Michael Marchand, exchange communications director, described to the board a new complaint system that has been added to the Healthplanfinder website. According to Marchand, complaints generated by consumers are automatically integrated with the exchange’s case management system, which is used to track trouble tickets. I found the complaint form – which is on the site’s Contact Us page  – a little difficult to locate.

4. Board member Phil Dyer offered a motion that the exchange request “a quotation and qualification to any and all vendors for a complete code and architecture review of the Healthplanfinder system to include findings and potential remediation steps.” The motion was passed.

5. Finally, there was a good deal of discussion about whether the exchange should continue to be the middleman between consumers and insurance companies with respect to payments. Board member Don Conant claimed the board is definitely leaning toward turning over payment management to the individual carriers. Two board members – Teresa Mosqueda and Hiroshi Nakano – quickly spoke up to say that they did not agree with that move.

The exchange has commissioned a report from a consultant due to be delivered next month that is to detail the costs and the pros and cons of moving payment management to the insurance carriers. A staffer noted that such a move may not be as much of a relief as some board members hope, since the exchange would still have to manage applications to ensure eligibility for tax credits and enrollments.

That’s why California, which had not been managing payments, was moving to take control of the process through the first payment. The staffer also noted that there would still need to be a mechanism for continually updating tax credit eligibility and forms with the carriers. Moving payment management out of the exchange, said the staffer, would move consumers closer to the carriers and further from the exchange.



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