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What really happened to human services in RI – Richard Asinof

by Richard Asinof, ConvergenceRI

The current disarray is a function of terrible investments made in UHIP, putting technological fixes over investments in human capital

The gaping holes in the safety net for the most vulnerable Rhode Island residents keep unraveling faster than the Gov. Dan McKee’s administration can try to stitch them back together.

Celia Blue, the interim director appointed by Gov. McKee in May of 2021, announced her resignation, effective at the end of February. Blue had replaced Courtney Hawkins, who had resigned earlier. Yvette Mendez, the chief of staff for R.I. Executive Office of Health and Human Services Secretary Womazetta Jones, has been appointed as “acting director” in wake of Blue’s pending departure.

The musical chairs at the R.I. Department of Human Services followed a news conference held by two unions at the Pawtucket DHS office on Wednesday, Feb. 2. Matt Gunnip, president of SEIU Local 580, and Rafael Martinez, president of AFSCME Local 2882, complained that the state had not yet filled some 78 frontline worker vacancies that were funded in the current state budget, dating back to June 1, 2021.

In the month of December of 2021, the DHS call center had received approximately 575 calls per hour, resulting in 82,299 calls, according to the DHS Call Center Data, as reported by WPRI. In turn, the backlogs in services due to vacancies at DHS, Gunnip said, have led to delays in obtaining SNAP benefits for food security, child care benefits, health insurance coverage, and cash assistance.

The R.I. Department of Human Services office on Pond Street in Woonsocket had been closed for in-person services for 22 months, since the onset of COVID, according to Sen. Melissa Murray, who held a news conference on Jan. 5, 2022, to highlight the problems, as reported by Uprise RI. Murray was joined by Secretary of State Nellie Gorbea, and Sens. Alan DiMario and Jonathan Acosta.

Where are they now?
The roots of the problems with staffing the R.I. Department of Human Services go back to the botched launch of UHIP, the Unified Health Infrastructure Project, in September of 2016, six years ago.

Here is the reporting by ConvergenceRI about a news briefing held by Michael DiBiase, then the director of the R.I. Department of Administration, and Melba Depeña Affigne, director of the R.I. Department of Human Services, discussing the proposed layoffs of 70 state workers related to the implementation of a new single online portal for processing eligibility of benefits. [Editor’s Note: DiBiase is now the president and CEO of the R.I. Public Expenditure Council; Affigne was forced to resign.]

The future was bright, according to Department of Administration officials, who detailed that the new software system would come with projected cost savings of some $15 million in FY 2017 and $40 million in 2018, not so much from decreases in labor costs but from decreases in waste and fraud and great efficiencies in business systems practices. [See link below to ConvergenceRI story, “Navigating the system: Artificial intelligence vs. people skills.”]

As ConvergenceRI reported: The common entry point for poor, needy and frail Rhode Islanders who qualify for government services and benefits will soon be a single online portal, supported by a new software system, what is known as the Unified Health Infrastructure Project, or UHIP, which cost some $364 million to build and install, paid for by mostly federal dollars.

Whether it be for health care under Medicaid, EBT cards for food benefits under SNAP, cash assistance, child care or long-term care services and supports, the new software system comes with the promise by government officials that it will provide seamless integration to make it “easier and more convenient” for Rhode Islands to apply for and track their benefits, and to enable benefits to be delivered more quickly.

At the same time, perhaps equally important, the state will have access to “real time data” to tighten down on any duplications, waste and fraud, to determine who is eligible and when they may no longer be eligible for benefits, according to state officials.

The launch of the new state-of-the-art technology system, which earlier this year had been re-branded as Rhode Island Bridges, is scheduled for Tuesday, Sept. 13 – primary day for the 2016 elections in Rhode Island. Was this a coincidence?

But, for some state workers, mostly social workers and their supervisors at the R.I. Department of Human Services, the new software system may also serve as an exit door: last week the R.I. Department of Administration announced that 70 state workers were being laid off, first in a media advisory, then in a detailed news briefing.

[Many will be able to exercise their rights to “bump” other workers as part of their union contract; others may transition to open state jobs at the R.I. Department of Children, Youth and Families, state officials said.]

Yet, for some advocates, particularly those involved with long-term care and nursing homes, the layoffs a month in advance of implementation raise serious concerns.

More than, say, a changeover to online banking services and the resultant layoff of bank tellers at neighborhood branches, the new system may create its own set of worries and problems, particularly for long-term care patients [and their caregivers] attempting to negotiate the complex application process for Medicaid services, once their Medicare benefits have been exhausted, particularly for patients that may be suffering from dementia and have behavioral health care issues.

“Why not implement the new program, and have it up and running and working appropriately, making sure that that all the bugs are worked out, before deciding how many staff can be assigned elsewhere?” asked Virginia Burke, president and CEO of the Rhode Island Health Care Association, told ConvergenceRI. “To do it a month before you’re going to implement this new program doesn’t make any sense.”

Burke continued: “Why have the people with the most experience gone by the time the new system is implemented, when the inevitable bugs are going to occur?”

More tsuris
Burke, of course, was proven correct; DiBiase’s projections of cost savings were wrong. The ongoing snafu that was UHIP resulted in Gov. Gina Raimondo having to accept the resignation of then R.I. EOHHS Secretary, Elizabeth Roberts.

Three years later, however, Gov. Raimondo decided to renew Deloitte’s contract. Here is the reporting by ConvergenceRI about the decision to renew the contract. [See link below to ConvergenceRI story, “When it comes to UHIP, money talks, the needy walk.”]

As ConvergenceRI reported: The decision to renew the contract with Deloitte, which had been scheduled to expire at the end of March, was not really a surprise to anyone. It was not a secret to those involved in the decision-making on either side of the negotiations; rather, it was more a question of choosing what Friday afternoon to announce the decision publicly.

The contract renewal was fully cooked; it was a done deal. It had been shared with, and reviewed by, the Centers for Medicare and Medicaid Services Administrator Seema Verma a few weeks before the news conference.

For better or for worse, the decision means, instead of suing for a divorce, that Rhode Island will be wedded to Deloitte for the foreseeable future. The contract renewal could be seen as a kind of post-nuptial agreement, following a rocky first five years of marriage, with Deloitte vowing to meet strict new performance standards, or else. What happens if Deloitte fails to live up to its end of the bargain was not part of the conversation. [See link below to ConvergenceRI story, “To renew contract with Deloitte, or not, that is the question.”]

The contract renewal was pitched at the news conference as an “unprecedented” victory for the taxpayers of Rhode Island, because the state said it had been able to recoup a $50 million cash payment as well as some $162 million in reduced fees from Deloitte as part of the new contract. [How much, if any, the feds will claw back of that $50 million in cash destined for the general revenue fund is still a matter of negotiation, according to the Governor.]

Accountability
Some would argue that the citizens of Rhode Island deserve a full, public, transparent accounting of what went wrong, and why. However, that is unlikely to happen, so the soap opera saga about UHIP will remain, much like 38 Studios, an untold story for now, with little accountability for what actually happened.

At the news conference announcing the contract renewal, ConvergenceRI asked: “In terms of what you have learned, is there any potential to do a case study about what went wrong, so the mistakes do not get repeated in the future? You have garnered a lot of knowledge, but I’m not sure whether it has been made transparent or whether it has been shared publicly.”

Courtney Hawkins, director of the R.I. Department of Human Services, responded by deflecting the question: “Will you buy my book?” which resulted in much laughter.

Still, ConvergenceRI persisted: “I will buy your book, if you actually write it and publish it.”

Raimondo then jumped in, saying: “I will let Courtney speak to her book, but I will say this: I did meet with the CMS administrator a few weeks ago in Washington to explain where we were [on the contract]. We are in constant contact with our federal partners on this. They tell us that this contract is now essentially best in class. With the key performance indicators in our new contract, essentially the standards to which Deloitte has to perform, [the performance indicators] are really among the best in America.”

Raimondo continued: “The contract we are signing with these new accountability metrics is available to every other state, and I hope that they use it. Because if you look around the country, in Kentucky, in South Carolina, in Massachusetts, in Maryland, every one of these systems is the same movie over and over again. So I hope people can learn from our story and take a look at this new contract, and copy it and use it, to make their systems better for their citizens.”

Later on in the news conference, Hawkins returned to the concept of her “book.” Every decision we make every day, she said, is about “the impact on my customers and my workforce, and ensuring that they have the tools that they need.” [Editor’s note: In rereading the story, the grandiose use of “my” by Hawkins to describe apparent ownership of both the workforce and the “customers” jumps out.]

The effort to do so, Hawkins continued, “is the most complicated case study; my book will have multi-parts and be very long.”

ConvergenceRI asked: “Can I get an advance copy, please?”

To which Hawkins responded, with humor: “I’m going to dedicate it to you.” Not likely.

“It’s not sexy, it doesn’t get headlines,” Hawkins continued, describing the daily grind of the bureaucratic machine at work. “But it is about being able to put one foot in front of the other every day, to be better; that’s what has gotten us to this place.”

From ConvergenceRI’s perspective, the public deserves to know more than just what is contained in new contract metrics, to have a full discussion about what went wrong and why – and not just the way that the contract renewal with Deloitte was being shopped by the Raimondo communications team.

Yes, this particular story is long and involved, but like a hidden family history, it deserves to be seen in bright daylight, to cure the darkness and prevent future trauma.

The history of what went wrong
Like with restaurant and hospitality workers, there is a high turnover in the news media biz, and there are few health care reporters left in Rhode Island who can dig deep enough into the archives to explain what happened.

Here is a detailed accounting that hopefully can provide some perspective. [See link below to ConvergenceRI story, “To renew the contract with Deloitte, or not, that is the question.”]

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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Richard Asinof

Richard Asinof is the founder and editor of ConvergenceRI, an online subscription newsletter offering news and analysis at the convergence of health, science, technology and innovation in Rhode Island.

To read more stories by Richard Asinof: https://rinewstoday.com/richard-asinof/