Delivery of Care

To renew contract with Deloitte, or not, that is the question

Three years into the UHIP mess, Rhode Island faces a fork in the road

Photo by Richard Asinof

At a Feb. 15, 2017, news conference, Gov. Gina Raimondo, center, announces the resignation of Elizabeth Roberts as secretary of R.I. EOHHS and the demotion of EOHHS deputy director Jennifer Wood, and the appointment of Anya Rader Wallack, left, as acting secretary at EOHHS. At right is Eric Beane, who was eventually appointed as secretary at EOHHS.

By Richard Asinof
Posted 3/4/19
On the cusp of the decision by the Raimondo administration whether or not to renew the contract with Deloitte, which built the faulty UHIP system, ConvergenceRI provides a historical context to what happened, framing the decision.
What have been the lessons learned from the UHIP debacle? Is there a need to invest in a case study about what went wrong? Do such data systems carry with them a structural racial bias in how they analyze data and process information? What is the best way to protect Rhode Island’s most vulnerable residents from the arrogance of decision-makers? Will the management of accountable entities for the managed Medicaid population, the pillars of the Reinvention of Medicaid, encounter similar data glitches because of difficulty in interoperability between health IT systems? What are the demographic challenges for Rhode Island’s population, with the high percentage of “old old” residents – people over 85 years of age? Does more focus need to be paid to those Rhode Islanders who are uninsured or underinsured in terms of access to health care?
Congratulations to Blue Cross & Blue Shield of Rhode Island on celebrating its 80th birthday. In addition to David Levesque moving from Lifespan to R.I EOHHS, there have been some other moving parts in the health care world. Garry Bliss, formerly with the Integra accountable care organization with Care New England, is now the program director for the Medicaid accountable entity at CharterCARE. And Brett Davey, formerly with the communications department at CharterCARE, is now managing communications at South County Health.

PROVIDENCE – Decisions, decisions, decisions. In the next few weeks, Gov. Gina Raimondo and her administrative team are expected to announce their decision whether or not to renew the contract with Deloitte Consulting, which is scheduled to expire at the end of March.

Such a decision may have already been made but not yet announced publicly. [It promises to be the first big decision handled by the new acting director of R.I. Executive Office of Health and Human Services, Lisa Vura-Weiss, and managed by the new communications director at the agency, David Levesque, who recently migrated from his communications job at Lifespan.]

In case you have been in a news coma for the last three years [or find it difficult to remember all the sordid details], here is a succinct overview of the soap opera known as the Unified Health Infrastructure Project, or UHIP, to provide a historical context for the pending decision on the Deloitte contract.

The total cost of the system now exceeds $647 million, including costs for FY 2019-2020, with the state taxpayers on the hook for $138 million of that amount, according to reporting last year by Susan Campbell at WPRI.

Deloitte was responsible for building the flawed UHIP software system, originally as part of the build-out of HealthSourceRI, and then as a larger effort to streamline the benefits system managed by the R.I. Department of Human Services, including food stamps and Medicaid eligibility. The software system was flawed from the very beginning: more than $9 million in costs that occurred in 2014 caused by glitches in the Deloitte software system had been identified by HealthSourceRI. [See link below to ConvergenceRI story, “The case of the missing briefing book.”]

The botched rollout of the UHIP system, which launched on Sept. 13, 2016, proved to be disastrous, as dire warnings about trouble with the Deloitte system from community advocates, from internal staff at the R.I. EOHHS and from the federal government were ignored.

UHIP’s botched rollout created enormous backlogs in processing claims for many of Rhode Island’s most vulnerable residents. Particularly hard hit were SNAP recipients as well as the long-term care industry, where claims to determine Medicaid eligibility for patients had been delayed for six months and longer. A promised online portal to process Medicaid eligibility claims as part of Deloitte’s UHIP system never became operational. Further, many of the most knowledgeable staff at the R.I Department of Human Services had been laid off in advance of the launch.

The breaking point for the Raimondo administration came in the aftermath of a joint legislative hearing held on Dec. 20, 2016, by the House Finance and the House Oversight committees, where the testimony was as surreal as any script from a Eugene Ionesco play, with two competing narratives. [See link below to ConvergenceRI story, “Waiting for a technological Godot or someone like him.”

Service providers offered their views to the legislators as witnesses to – and victims of – the financial chaos and havoc caused the glitches and failings of the new Deloitte software system; Gov. Raimondo’s team testified that how the state was working hard to resolve any outstanding issues and to ensure timely payments, claiming that the state was moving ahead on the right track.

Dismissals, resignations and demotions
Gov. Raimondo finally decided to change her team, saying that she had reached “the end of my rope.” At a news conference on Jan. 12, 2017, she announced that Melba Depena Affigne, director of the R.I. Department of Human Services, and Thom Guertin, the chief technology officer, had been forced to resign. [See link below to ConvergenceRI story, “On desolation row in RI, selling postcards of the resignations.”]

Then, at that Feb. 15 news conference Raimondo announced that she had accepted the resignation of Elizabeth Roberts as Secretary of R.I. EOHHS and named Anya Rader Wallack as Interim Secretary to be the source of “fresh eyes” sought by the Governor. Raimondo also announced that Jennifer Wood, the deputy director, had been demoted. [Eric Beane would later be appointed Secretary at R.I. EOHHS.]

“We paid [Deloitte] a lot of money, and we didn’t get what we paid for,” Raimondo said at the time “They represented to us that [the new software system] was in much better shape than in fact it was.”

At a March 2, 2017, House Oversight Committee hearing, with a new team on board, more details emerged about the problems that had been encountered with the Deloitte-built UHIP system. They included: the fact that there were some 2,000-3,000 long-term care eligibility cases pending; worse, there was apparently no way to track these eligibility cases, because they had been all lumped together under “medical.” And, despite a state law enacted that took effect on July 1, 2016, which created presumptive eligibility for long-care Medicaid applications that were pending longer than 90 days, such application were “never coded” into the Deloitte software system for UHIP. [See link below to ConvergenceRI story, “More details emerge about the rats nest that is UHIP.”]

At the June 21, 2017, House Oversight Committee hearing, the new management team to oversee UHIP was now in place. Eric Beane was now the secretary of the R.I. Executive Office of Health and Human Services, replacing interim director Anya Rader Wallack, who in turn had replaced Elizabeth Roberts when she resigned; Courtney Hawkins was now the director of the R.I. Department of Human Services, having replaced Melba Depena Affigne, who was fired; and Patrick Tigue was now the director of the R.I. Medicaid Office.

Beane, Hawkins and Zack Shermam the director of HealthSourceRI, all testified. In addition, Beane presented committee members with the latest report on what was termed “UHIP Turn Around Effort,” which included a monthly performance metrics dashboard. Beane, in an understatement, said that it had been a “challenging” year.

Fast forward
For the first time, at an April 12, 2018, hearing of the House Oversight committee, representatives of Deloitte testified, offering an apology, saying they were “very sorry,” but skirted taking responsibility for the UHIP debacle. [See link below to ConvergenceRI story, “Deloitte apologizes, but skirts responsibility for UHIP debacle.”

Deloitte, in turn, said that it had credited nearly $90 million back to the state, and the state of Rhode Island has stopped paying Deloitte since last year.

Although managers of the UHIP program have frequently reported that the state has “turned the corner” in its ability to process claims in a timely fashion, the unintended consequences of the delays in processing Medicaid eligibility claims for long-term care services has created its own long-term problems.

The backlog in processing eligibility claims in 2016 created a crisis in revenue flow for many skilled nursing facilities; in response, as a stopgap measure, R.I. EOHHS began providing interim payments to nursing homes However, none of the lump-sum payments were aligned with individual claims.

The interim payments, which had begun in November of 2016, reached $51 million in March of 2017, according to Beane. In 2018, interim payments were reported to have reached just north of $100 million for services already rendered by skilled nursing facilities.

The interim payments had been made from the state’s general revenue fund, with the expectation that they can be reconciled with the federal Medicaid program. Rhode Island has two years from the date when the payments were made to reconcile the numbers. The need for reconciliation was in part the result that the interim payments were not specifically tied to an individual patient’s eligibility.

At the 2018 hearing, the representatives from Deloitte said that its system had not tracked the interim payments and had no role in tracking the payments, which were the responsibility of the state.

The state is now involved in a lengthy reconciliation process involving the federal government, which Beane, in his exit interview in November of 2018 with ConvergenceRI, said involved meeting individually with each nursing home. [See links below to stories in ConvergenceRI, “An exit interview with Eric Beane, who is stepping down at EOHHS,” and “Changing of the guard.”]

Lessons learned?
Whether or not the state decides to extend the contract with Deloitte, the larger question is: what has the state learned about its competencies in managing complex technology systems. Given the recent problems with the firm, Medical Transportation Management, which the state contracted with beginning Jan. 1, 2019, to provide transportation services to the needy and the elderly, and which is now facing a $1 million for stranding riders, it seems not that much.

What might be appropriate is for the state to commission a case study, funded by the R.I. General Assembly, to be conducted in partnership with a local academic institution, to analyze what happened with the UHIP disaster and to make recommendations how to avoid future problems.

Such recommendations might include: better contract management and oversight, better deliverables, and better technology training for state employees.

The heart of the problem, however, may reside in the fact that technology systems may not provide solutions to human problems – and most benefits distributed by government reflect human needs. There is reason why they call it “health and human services.”

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