Outside consultants brought on to review the MNsure health insurance exchange are the newest critics of that agency, joining a chorus of officials from both parties and nonpartisan experts. On Wednesday, MNsure board members were presented with a series of stark conclusions by Optum, a branch of United Health Group that was retained to conduct an extensive review of the exchange website, as well as its broader operation.
The Optum team documented a series of shortfalls in the exchange’s delivery process, which is known to have hampered or prevented thousands of consumers who have tried to register for insurance using the troubled website. Optum’s findings suggest the exchange is likely to fall well short of its enrollment goals due to consistent user interface problems, which can only be addressed if the exchange employs “interim actions and manual efforts” between now and the March 31 close of open enrollment.
The Optum review lays out different options for MNsure in solving its website difficulties, with the most dramatic strategy calling for a comprehensive reworking of MNsure.org, which would involving rebuilding the website from scratch.
Among the other recommendations in Optum’s report is a call for an “aggressive ramp up of flexible call center resources.” The MNsure call center, which has at times forced callers to wait more than an hour before reaching a representative, has been a frequent subject of criticism. As a potential short-term solution, the consulting team recommended that the exchange retain the services of an Optum call center based in Florida.
More than 80,000 Minnesotans finalized their insurance coverage under MNsure between Oct. 1 and Jan. 18, according to updated statistics presented to the board by interim CEO Scott Leitz, who was tapped to replace former director April Todd-Malmlov after she resigned in December. Nearly 28,000 people, or slightly more than a third of that total number, have chosen to purchase private insurance on a qualified health plan (QHP) through MNsure.
Leitz told the board that Optum’s outside perspective was necessary to provide a “clear, unbiased review of MNsure” and its functional difficulties.
“The timeliness of the information they’re bringing back is going to be very important going forward,” Leitz said.
The total enrollment is approaching the exchange’s stated goal of getting 125,000 Minnesotans registered for insurance plans by the end of March. But earlier planning documents had projected that MNsure should aim for nearly 70,000 customers to enroll in QHPs by that date, a figure that seems increasingly out of reach with two months remaining in the open enrollment period.
Leitz, in his own presentation to board members, made repeated reference to the March 31 deadline as a key date for the exchange. Any consumers who have not chosen a plan at that point will face a small penalty, and would need to wait until fall to sign up for coverage that would take effect in 2015. As evidence of interest in the exchange, Leitz pointed out that about three-quarters of the people who had purchased insurance with MNsure were not eligible for federal subsidies, and were paying entirely out-of-pocket for premium costs.
“They’re using it as a marketplace, as we intended it to be,” he told the board.
Board member Tom Forsythe, a vice president with General Mills, Inc., took a pessimistic view of the most recent enrollment statistics, and said he had always doubted that MNsure could even come close to its projections. Forsythe fears that the current rate of enrollment would not be sufficient to fund the exchange’s operation, which is supposed to rely upon a small “withhold” taken from premium fees.
“I’m not sure I bought the… projections from the get-go,” Forsythe said. “I’m very concerned about premium revenue and the amount of people we have, relative to what we need.”
Under the enacting legislation passed by the DFL majorities during the 2013 session, MNsure is expected to be self-sufficient by the start of 2015. Board member and Department of Human Services (DHS) Commissioner Lucinda Jesson said Forsythe’s concerns are well-founded, adding that the board should be mindful of its low enrollment figures as it attempts to craft a budget for the coming year.