Delivery of Care

Tanzi: We need a human being [to talk with] at DHS or EOHHS

The latest oversight hearing to check up on UHIP reveals that behind the number crunching, human stories of desperation are still getting lost in the shuffle

Image courtesy of RI Capitol TV

Rep. Teresa Tanzi, a member of the House Committee on Oversight, raised questions about one of her constituents, who had recently given birth but had been unable to have her SNAP benefits renewed, despite more than six weeks attempting to do so.

By Richard Asinof
Posted 5/29/17
The report by the R.I. Office of the Auditor General about the Unified Health Infrastructure Project, or UHIP, confirmed many of the deficiencies of the previous management team and the continued escalation of costs, now at $407 million and slated to go to $443 million in the next year. Despite “improvements” in the reduction of the backlog of cases, there are still many cases that slip through the bureaucratic cracks.
Will the news media grow tired of covering the continuing story of the UHIP snafu? What will be the political consequences, if any, for Gov. Gina Raimondo and her mismanagement of the disastrous UHIP implementation? Is there a basic fallacy about the idea that a single portal software system can achieve efficiency in a human-driven enterprise of delivering benefits to the state’s most vulnerable residents? How will the draconian budget cuts proposed by the Trump administration further increase the demand for benefits? When will stakeholders have a seat at the decision-making table?
As the 2018 election approaches, the connections between achieving economic prosperity and the consequences of failed policies in health and human services have not yet been driven home in Rhode Island. The number of overdose deaths keeps increasing, now at 336 for 2016 and counting, with no public conversation about the diseases of despair. The recent failure of DCYF to protect vulnerable children at risk from harm and death is scandalous. The failed, costly implementation of UHIP is a fundamental lesson in poor management, over-aggressive PR, and the limits of technology as a magic bullet in the human enterprise. Access to healthy, affordable safe housing never seems to make it to the top of the economic development agenda.
It shouldn’t take the incident of a reporter being body slammed by a Congressional candidate for asking respectful questions about health care to wake up the electorate that we are living in dangerous times.

PROVIDENCE – Hawaiian shirts and flip flops? It was a strange anticlimax, as Rep. Patricia Serpa wrapped up the latest hearing by the House Committee on Oversight on May 25, delving into the mess with UHIP, wondering out loud after more than two hours of testimony by Dennis Hoyle, the R.I. Auditor General, and Eric Beane, soon to become the new secretary at the R.I. Executive Office of Health on Human Services on June 1, whether to call the committee back during the summer recess.

House Speaker Nicholas Mattiello “had not nixed the idea,” Serpa said, who suggested that the committee might get together during the summer, on a Thursday afternoon or night in late July, for a couple of hours to get an update on UHIP.

One of her committee members asked, in an awkward attempt at levity: “Are Hawaiian shirts appropriate?”

Serpa responded: “[You can wear] Hawaiian shirts and your flip flops; these gentlemen [Beane and Zack Sherman, director of HealthSource RI] can come in Hawaiian shirts and flip flops, too.”

Translated, what you wore did not matter as much as showing up and answering questions. In the last eight months, Serpa has been vigilant in her role as chair of the Committee on Oversight, demanding answers and accountability from Gov. Gina Raimondo and her management team.

“I hear I am not very popular in state government these days,” Serpa told ConvergenceRI in a brief interview after the hearing. “But that's OK; I have a job to do.”

The high cost of managing the poor
The Hawaiian shirts and flip flops moment followed an emotional exchange between Rep. Teresa Tanzi and Beane, in which Tanzi got to the heart of the issue about UHIP, also known as the Unified Health Infrastructure Project.

Up until then, much of the conversation had been about the amount of money spent on the project, as detailed in a report by Hoyle. The project now has a new price tag: $407 million, as of April 30, 2017, according to a report by the R.I. Office of the Auditor General. By the end of FY 2018, that price tag will hit a projected $443 million, according to the report.

Included was an eye-opening list of costs, detailing the 20 largest project vendors – the contractors that received more than $1 million in payments from the state, broken down by expenses incurred during the two phases of the project: HealthSource RI and UHIP.

While Deloitte Consulting, the builder of the software system, received the largest total amount in disbursed payments, $202 million, the $11 million figure for Deborah T. Faulkner/Faulkner Consulting, caught the eye of many members of the committee, who were unaware of the prominent role that the consulting firm had played in the development of HealthSource RI.

Tanzi, in contrast, told the story about a call from a constituent, who had just given birth, a nursing mother, who said she had not received her SNAP benefits for six weeks.

Apparently, the constituent’s application had been “lost” or “misplaced” by the R.I. Department of Human Services, and she had called Tanzi out of desperation.

“It’s not just about the system functioning,” Tanzi continued. “We are leaving people in a vulnerable place. We’ve [been] talking about a lot of numbers [today]. I want us to not lose focus on the fact that there is significant suffering [as a result of the botched UHIP rollout]. It’s our own failure as a state. We have failed.”

Beane thanked Tanzi for her comments, and responded, saying that the desire to provide “timely access to benefits” was “front and center in my mind” every day going to work.

Tanzi told Beane that the House leadership was now tracking these constituent calls more closely and categorizing them. “We will be following things much more closely,” she said. “These stories are piling up. They are weighing on the consciences of my colleagues as well.”

Tanzi continued: “What used to feel like an immediate response has been made bureaucratic,” talking about the vagaries of the ongoing operation of the “escalation” team to address emergencies. “We have to email someone to await a response [that will take] from four to seven days.”

With all due respect, Tanzi said, “When someone finds themselves in a crisis, and they find themselves calling their state rep, and then waiting for four to seven more days, frankly, it’s not an escalation.”

“We’re in the muck again,” Tanzi said, with emotion. “We need a human being [to talk with] at DHS or EOHHS. This woman did not know if she would be able to produce milk to feed her child. It’s bad.”

Serpa, in an interview following the hearing with ConvergenceRI, said the escalation unit didn't seem to be doing its job. “When I think of escalation, i think of the most critical cases reaching the top,” she said When you have a nursing mother going without food stamps for six weeks, Serpa continued, “That is critical for herself and her infant."

Serpa also raised questions about how much money was being spent on consultants, rather than investing in permanent, inside talent.

High-level observations
The report by the R.I. Office of the Auditor General offered what it called some high-level observations about the implementation of the UHIP system, without naming names or the desire to hold anyone accountable for their mistakes. They included:

A single point of contract authority was never clearly defined and varied based on the stage of the project. The process for acceptance of project deliverables was not well defined and consistently observed over the life of the project to date.

[What was not said was that the person overseeing the UHIP contract under the direction of the former director of the R.I. Department of Administration under the Chafee administration, Richard Licht, had also been overseeing the implementation of the contract with Hewlett Packard Enterprises for the problem-plagued new software system at DMV. That person was let go in 2015 by the new Raimondo administration.]

[What was also not said was that the implementation of the UHIP rollout, which had been postponed from its initial launch date of July 1, 2016, to Sept. 13, 2016, had been largely managed under the direction of Elizabeth Roberts, the former secretary at the R.I. Executive Office of Health and Human Services, and her former deputy director, Jennifer Wood.]

There was a likely over-emphasis of purported savings in the near-term that would accrue from the implementation of the UHIP system. Expectations were unrealistic that all the known defects in Phase I [the launch of HealthSource RI] of the system were to be resolved upon implementation of Phase II. This likely resulted in deferred recognition of those system defects and delays in escalating certain known issues to resolution after the Phase II implementation.

[What was not said was that the defects – and the costs of those defects, amounting to some $9 million during 2014, had been detailed in a report by outgoing director of HealthSource RI, Christine Ferguson, in a briefing book presented to Gov. Gina Raimondo, as covered by ConvergenceRI in January of 2015.]

[What was also not said was that the messaging employed by Raimondo’s communication team played a key role in building up the expectations of the purported savings.]

[Further, that numerous stakeholders, particularly from the long-term care community, raised serious, continued objections to the planned rollout of UHIP, beginning in February of 2016, only to be discounted and ignored.]

The independent verification and validation contractor provided regular reporting of system progress and repeatedly highlighted system deficiencies and warnings of potential problems… It was not clear how these issues were addressed/resolved by the prior project management team.

[What was not said were that questions raised by key managers about the capabilities of the Deloitte software system were consistently thwarted by the previous management team, according to sources.]

Validation that lies had been told
Rep. Michael Chippendale praised the report, saying in stark language that it validated the concerns raised by the Committee on Oversight that they were not being told the truth by the former team of the Raimondo administration that had been administering the UHIP project.

“I was fairly vocal that I felt we were being lied to by the former team in charge of this implementation,” Chippendale said.

This report, he continued, “validates and articulates every assertion that this good committee made relative to those lies that were told to this committee as we repeatedly probed through this.”

Moving forward
The hearing, held on the Thursday before Memorial Day weekend, had only a few of the stalwart reporters who have been covering the debacle that is UHIP for the last year, including WPRI’s Susan Campbell and ConvergenceRI. No one attended the hearing from The Providence Journal.

The messaging from both Hoyle and Beane was that communications were improving, as a new team was how in place, and the recommendations in the auditor’s report were being taken to heart.

But, as Beane acknowledged in responding to questions from Serpa and Tanzi, “Even though, by some objective measures, the backlog of pending applications continues to go down, stories like this are a reminder that we are not there yet.”

The system, Beane continued, is still overloaded, it was difficult to keep up with the volume. “There’s a lot more work to do.”

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