Health overhaul to be complex

A large number of frustrated customers cheered when the state decided to dump Xerox and move to a healthcare exchange that relied on the much more successful federal website to provide insurance under Obamacare.

Unfortunately, according to Mike Willden, chief of staff to Gov. Brian Sandoval, it isn’t going to happen overnight because there’s a lot more to the switch over than just flipping a switch.

“Try to think of three calendar years of activity,” said Willden, who until recently was director of Health and Human Services and in charge of the trouble-plagued Nevada Health Link exchange.

To accomplish all the work needed to make the switch, the Board of Examiners and Interim Finance Committee have approved a $28 million contract to make the necessary changes. Deloitte Consulting will get $15 million of that with the rest paying to build a new call center and make other necessary changes.

“They’ve got to run fast because it’s all got to be ready for open enrollment November 15,” he said.

Willden said things are moving along well with the process and “the feds are being very cooperative, very helpful to us.”

The Xerox website and call center had so many problems only about one third of the number of people originally expected to successfully sign up for insurance have made it through the system — 37,696 out of 118,000.

There were glitches at every step of the process from creating an account to selecting a plan to paying for it and actually getting the insurance cards.

While the total contract was worth about $75 million, Xerox was only paid a bit more than $12 million before being terminated.

Willden said for the rest of the 2014 plan year, customers will continue to be served by Xerox, signing up through NevadaHealthLink.com.

He said Xerox isn’t going away until well after the first of the year since it will still be servicing existing customers.

But in the 2015 plan year, he said there will be numerous changes that, hopefully, fix most of those problems and allow people to smoothly sign up.

All those people who have signed up will have to sign up again — this time using the new front-door website being developed by Deloitte.

“They have to reapply and file a new application,” he said. “But we’re keeping control of the front end of the system.”

That website will direct customers who need a Qualified Health Plan to the federal website at HealthCare.gov. Those who qualify for Medicaid will be directed to the state’s Medicaid website for service which Willden said is the only part of the current system working smoothly.

Willden describes it as “uncoupling” from Xerox and “coupling” with the federal system.

The new website, he said, should be a simple site with just a couple of buttons to direct people in the direction they need to go.

“They will go to the web page and a simply designed application will direct them to Medicaid. If their income is over Medicaid, click, they’ll be connected to HealthCare.gov. If they don’t know, they will be routed to HealthCare.gov to determine eligibility.”

The health plans available will probably look a lot like what Nevada offers now since the state is keeping control over what health plans are offered in the state.

Deloitte must build an interface that directs customers either to Xerox or the federal exchange. At the same time, the state has to build the new call center replacing the Xerox center for people who need help getting through the system.

Willden said call center duties will likely be handled through his existing Medicaid support operation that employs 1,500 people.

One key change, he said, is designed to fix an ongoing problem with the Xerox program. Instead of billing customers and forwarding their payments to the insurance companies providing the health benefit plans, the insurance companies themselves will take over billing and payments.

“The carriers will be doing direct billing,” he said.

But, in plan year 2016, Willden said the entire system may change again, requiring another uncoupling/coupling if the state decides to move away from the federal exchange to another system.

He said the plan is to run an RFP for 2016 and take a look at whether any vendors have a better solution for Nevada. He said he expects there will be other good options.

“By the time we get to plan year ‘16, the bugs and kinks should be pretty well worked out,” he said.