How A Series Of Mistakes Hobbled Minnesota's Health Exchange : Shots - Health News The difficulty states have had getting their marketplaces working has been one of the biggest setbacks for Obamacare. Miscommunication, technology failures and management errors all hit in Minnesota.
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How A Series Of Mistakes Hobbled Minnesota's Health Exchange

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How A Series Of Mistakes Hobbled Minnesota's Health Exchange

How A Series Of Mistakes Hobbled Minnesota's Health Exchange

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Minnesota's health insurance marketplace has had its share of problems. A new lead contractor is expected to be picked in the coming weeks. The first few months after its launch, the exchange website was difficult if not impossible to use.

Minnesota Public Radio interviewed some of the key players and reviewed state documents to figure out what went so wrong with MNsure. Elizabeth Stawicki reports.

ELIZABETH STAWICKI, BYLINE: Tom Baden, the state's lead IT expert, remembers when the real fear hit. It was the end of July, only two months before MNsure had to go up, and he and his team were still waiting for a key piece of software from a vendor.

TOM BADEN: And it being so close to October 1st, and looking at our ability to get it in, get it installed, test it and go live 10/1. If there was a moment where I didn't sleep a wink that night, that was my night.

STAWICKI: On October 1st, MNsure did go live but many consumers couldn't create accounts. The site would throw them off or lock up.

Becky Fink had undergone specialized training to help others enroll on MNsure. But because of bureaucratic delays, she didn't receive MNSure's permission to sign people up until December. The first day she could, she made appointments with five people.

BECKY FINK: It never worked for me.

STAWICKI: After trying for about 12 hours, four of them still couldn't sign up.

FINK: It was hard to know that I had done my best and not be very competent. You know, the people that I said, come in, I can help you do this - and I couldn't get past the first page.

STAWICKI: Fink's experience was common. But the extent of MNsure's problems was hidden from the public for months. Three weeks into the website's bumpy roll-out, MNsure's executive director, April Todd-Malmlov declared all was well.

APRIL TODD-MALMLOV: At this stage, I think the website is doing a very good job. Does that mean that it has everything in it that we ultimately want it to have? No.

STAWICKI: An independent review in January, found that behind the scenes, Todd-Malmlov and other MNsure leaders were in crisis mode after October 1st. The site was buckling technologically under the massive onslaught of traffic. Consumers flooded the call center. Hour-long waits were the norm. April Todd-Malmlov resigned in mid-December.

What Minnesotans did not know is they were testing the site. There wasn't time for consumer testing before the site went live.

MICHAEL KRIGSMAN: That is so screwed up. You can quote me on that.

STAWICKI: Michael Krigsman is a consultant who specializes in diagnosing and preventing IT project failures. He says testing is key.

KRIGSMAN: This is one of these things that's so foundational, it's like why do we need to breathe the air?

STAWICKI: But the lack of consumer testing is just one reason why MNsure sputtered. There were others including the state couldn't decide on a lead contractor to build MNsure, which burned up valuable testing time. In January 2013, the feds issued 70 function benchmarks for MNsure that had to be completed in six months. And Minnesota had adopted one of the nation's most ambitious plans for its marketplace.

Dannette Coleman, of the health insurance company Medica, sees another problem. People with expertise in health policy, not IT, largely directed the project.

DANNETTE COLEMAN: Incredibly dedicated and committed people who really believed strongly in the work. But they didn't really have the background to understand what it was it was going to take to get this project done on time, on budget.

STAWICKI: In hindsight, MNsure's board of directors say they should have demanded more information from MNsure's then-executive director. MNsure's board chairman, Brian Beutner, now regrets the agency wasn't more forthcoming about the system.

BRIAN BEUTNER: If I could point to one of the largest failures of MNsure, it's been a communication failure. It's been managing the expectations of what was actually being built, when it was going to be delivered and what was that functionality.

STAWICKI: Meanwhile, the MNsure site limped along and sucked up thousands of staff hours, fixing problems and developing workarounds. On New Year's Eve, the last day to sign up for coverage that would take effect the next day, Becky Fink called in the four people she'd tried and failed to enroll through the MNsure website.

FINK: I gave them all coffee and we made copies of the paper applications and we got them all done and we faxed them in.

STAWICKI: MNsure leaders will decide soon whether to build a new website or try to improve on the current site. But officials say it is stable enough now to handle an expected increase in traffic in the next few weeks.

For NPR News, this is Elizabeth Stawicki in St. Paul.

BLOCK: This story is part of a partnership with NPR, Minnesota Public Radio and Kaiser Health News.

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