Wednesday, December 25, 2013

Globe Xmas Gift: To Your Health

"White House again stretches deadline for healthcare; Website taxed as millions try to get coverage" by Robert Pear |  New York Times, December 25, 2013

WASHINGTON — The Obama administration said Tuesday that it would provide more time for people to sign up for health insurance if they could show that they missed the Tuesday deadline for applications because of problems with the federal health care website.

In effect, the administration was stretching the deadline once again, after a last-minute surge of interest among people seeking coverage. The administration hailed what it described as “amazing interest” in new health insurance options, and said the federal website alone received 2 million visits Monday.

The original deadline was Dec. 15 for people to sign up for coverage that takes effect in January; it was later extended by eight days. On Monday, the White House added a 24-hour grace period, to 11:59 p.m. Tuesday.

Then Tuesday, in another bid to expand coverage, the administration provided details of a “special enrollment period” for people who would miss the deadline.

*****************************

Republicans said the latest move showed that President Obama was desperate to increase enrollment, widely seen as a measure of the success of the health care law.

But administration officials said the move was a common-sense response to heavy website traffic, which they cited as evidence of the need for more affordable insurance.

Some 48 million Americans are estimated to be uninsured.

Obama said late last week that more than 1 million Americans had enrolled for coverage since Oct. 1. The administration’s estimates call for 3.3 million people to sign up by Dec. 31, and the target is 7 million by the end of March. After that, people who fail to buy coverage can face tax penalties. The revamped website was heavily tested Tuesday as record numbers of Americans rushed to beat the extended deadline for enrolling....

Traffic was not as heavy on Tuesday but still high, the Associated Press reported. White House spokeswoman Tara McGuinness had no immediate estimate of visitors or how many succeeded in obtaining insurance before the midnight deadline. Error rates were lower than 1 in 200, and pages loaded quickly, in less than a half-second, officials said. For various reasons, including technical problems or trouble understanding the instructions, thousands of people sought telephone help and wound up waiting on hold on Christmas Eve at the government’s call center. 

But it's all good!

Ian Stewart of Salt Lake City said he and his wife, both students, had been trying for weeks to complete their application on the federal site, thwarted by computer error messages each time.

On Tuesday morning, while visiting relatives in Colorado for Christmas, they reached a call center counselor who succeeded in enrolling them. The ‘‘silver’’ plan they chose will cost them $241 a month after a cost-lowering tax credit.

“We’re relieved that we got it working, elated that we got insurance again, and very frustrated that it took this long,” Stewart said.

More than 110,000 people had called the government’s help line by Tuesday afternoon, with wait times averaging 27 minutes, officials said. On Monday, the call center received more than 250,000 calls, a one-day record.

While there were no immediate reports of any major glitches, the White House said that people who can show they missed the deadline because of problems with the website may still be able to get covered by Jan. 1 on a case-by-case basis. Those who try to sign up for the first time after the deadline passes can still get coverage, but it won’t start until Feb. 1.

The one-day grace period was the latest in a string of delays and reversals, and critics of Obama’s signature program seized on it as more evidence that the overhaul is in trouble.

Other than the sign-up requirement meant to bring in tax loot, the whole thing has been delayed.

“The amazing, ever-expanding deadline? It’s clearly a sign of desperation by the administration to do everything they can to increase the number of people signing up,” said health economist Gail Wilensky, who ran Medicare for President George H.W. Bush.

That's the range of debate? Bush to Obama?

--more--"

So which plan do you want?

"Big deductibles in cheaper health plans cause worry; Can mean high outlays for buyers" by Carla K. Johnson |  Associated Press, December 23, 2013

CHICAGO — As a key enrollment deadline hits Monday, many people without health insurance have been sizing up policies on the new government health care marketplaces and making what seems like a logical choice: They’re picking the cheapest one. 

It's all we can afford.

Increasingly, specialists in health insurance are becoming concerned that many of these first-time buyers will be in for a surprise when they get medical care next year and discover that, because of high deductibles, they will be on the hook for most of the initial cost.

That will make the law even more unpopular. What a disaster this thing has become.

For most Americans, Monday is the deadline to sign up for health insurance policies that take effect Jan. 1. The prospect of sticker shock after the start of the year is seen as a looming problem for the federal health care system. 

This after the premiums for those with care have zoomed!

The program has been plagued by trouble since the new marketplaces were launched in the states in October, and some problems are expected to continue despite a series of adjustments and extensions put in place by the Obama administration. 

It was supposed to be fixed by November 30.

For those without insurance — about 15 percent of the population— ‘‘it’s important to understand the total cost of ownership of a plan,’’ said Matt Eyles, a vice president of Avalere Health, a market analysis firm. ‘‘You just don’t want to look only at the premium.’’

Counselors who have been helping people choose policies say many are focused only on the upfront cost, not what the insurance companies agree to pay.

‘‘I am so deeply clueless about all of this,’’ acknowledged one new buyer, Adrienne Matzen, 29, an actor in Chicago who’s mostly been without insurance since she turned 21. Though she needs regular care for asthma and a thyroid condition, she says she’s looking for a low monthly premium because she makes less than $20,000 a year.

Hospitals are worried that those who rack up uncovered medical bills next year will not be able to pay them, perpetuating one of the problems the new health care system is supposed to solve.

This thing has been a disaster, and it's going to cost Democrats the Senate.

The new federal and state health insurance exchanges offer policies ranked as bronze, silver, gold, and platinum. The bronze options have the lowest monthly premiums but high deductibles — the amount the policyholder must pay before the insurer picks up any of the cost of medical care.

On average, a bronze plan’s deductible is more than $4,300, according to an analysis of marketplace plans in 19 states by Avalere Health. A consumer who upgrades to a silver plan could reduce the deductible to about $2,500. A top-of-the-line platinum plan has the lowest average deductible: $167.

Comprehensive data on premiums isn’t available, but in one example, a 30-year-old in Chicago would pay an average of $222 per month for a bronze plan, $279 for a silver or $338 for a platinum.

The complexities of insurance are eye-glazing even for those who have it. Only 14 percent of American adults with insurance understand deductibles, according to one recent study.

The danger of a wrong snap judgment is great for those under financial pressure — especially those with modest incomes who make too much to qualify for the government subsidies available under the new health care system. Subsidies aren’t available for individuals making more than $45,960.

Most of the uninsured make less than that, but many still pick the cheapest plans.

‘‘Price rules,’’ said John Foley, a Legal Aid counselor in Palm Beach, Fla., who has been helping people enroll.

Some applicants see the catch.

‘‘The real big surprise was how much out-of-pocket would be required for our family,’’ said David Winebrenner, 46, a financial adviser in Lebanon, Ky., whose deductible topped $12,000 for a family of six for a silver plan he was considering. The monthly premium: $1,400.

While the health law makes many preventive services free — such as vaccines, blood pressure screening and mammograms — most medical care is paid out of pocket until the deductible level is reached.

Some of the new plans offer limited coverage for certain services before a patient has met the annual deductible. These services can include primary care, some prescription drugs and routine care for common chronic conditions such as high blood pressure and diabetes.

It’s unclear how many plans provide this feature, and it may not be easy for consumers to tell.

Great.

******************************

To be sure, the new health law did away with the whopping deductibles in plans previously offered to people without employer-provided coverage. Out-of-pocket costs are now capped at $6,350 for individuals and $12,700 for a family.

But some people who have been paying their own medical bills, or leaving them unpaid at the hospital, seem surprised that health insurance doesn’t cover more of the costs.

‘‘They previously had no insurance coverage at all and so they might not be happy,’’ said Cynthia Rahming, an enrollment counselor in Houston.

Fearing the price backlash, Loyola University Health System in Chicago is offering payment plans to spread the out-of-pocket costs.

Some who had private insurance policies that were canceled may find that keeping the same deductibles they had may mean higher premiums.

And that already has people furious.

In California, Diane Agnone complained in an online post on her state’s health marketplace. ‘‘How is this affordable? I am a healthy 62-year-old single woman and these new premiums will cost me over $200 more per month than my existing plan.’’

Cash grab! 

The new insurance system requires policies to cover more services than some consumers had chosen to buy in the past.

‘‘It’s all a matter of having a budget and it only goes so far,’’ said Agnone, an executive with a nonprofit charity based in Fairfield, which is about halfway between San Francisco and Sacramento. ‘‘There is no winning in this.’’ 

I was told we would all be winners.

--more--"

"Despite push, US employers wary of health incentives" by Tracy Jan |  Globe Staff, December 18, 2013

WASHINGTON — Would $1,700 a year motivate you to drop a few pounds? How about $3,000 to quit smoking?

That is how much, on average, the government is allowing employers to reward their workers beginning in January 2014 for doing things like losing weight, lowering their cholesterol, and keeping their blood pressure in check. A new, little-known provision of the Affordable Care Act boosts the maximum incentives for workplace programs that encourage employees to get healthier in hopes of lowering insurance costs.

Most large companies already offer programs to keep their employees healthy, but on a far more modest scale, such as on-site gyms and stressing healthy eating.

Related:

"Many employers, insurers, and Internet programs dangle dollars to try to change bad habits like smoking or not exercising, but most studies have found this does not work very well or for very long. The new study, done with Mayo Clinic employees, succeeded because it had a mix of carrots and sticks."

Nothing like throwing more money into failure.

Taking the next step — paying workers to reach specific health goals — has been far more controversial. Rewarding those who maintain the ideal body mass index can seem like a penalty for those who don’t, raising the potential for discrimination claims and negative publicity.

Related:

"Researchers calculated the body mass index - a standard measurement of size.... There is growing debate about the accuracy of the standard method of calculating whether someone is overweight.... the system would put nearly half of NBA players in the overweight category"

Americans are the most lied to people on the face of the planet!

“The incentives help get people’s attention, but companies worry about how their employees will perceive them playing such a paternalistic role,” said Kristin Van Busum, who coauthored a 2013 RAND report to Congress on workplace wellness programs that was commissioned as part of the Affordable Care Act.

The three-year RAND study found that fewer than 10 percent of companies with employee wellness programs use results-based financial incentives. Even among the ones who do, the size of the incentives come nowhere close to next year’s federal limit of 30 percent of the total premium cost.

“Many employers are hesitant to penalize and differentiate employees based on their personal health habits,” said Cathy Hartman, vice president of prevention and wellness at Blue Cross Blue Shield of Massachusetts, whose team of consultants help employers design such programs. “But we expect to see more of that in the future.”

A 2013 National Business Group on Health survey showed that 47 percent of companies indicated they are considering rewarding employees who hit certain cholesterol, blood pressure, and weight index goals in 2014.

The theory behind the push for incentives is that building a healthier workforce will curb the use of expensive medical care and hold down overall health plan costs. Having fewer obese people should reduce heart and diabetes treatments, for instance.

Maybe the chemicals and poisons in the food and environment have something to do with it.

President Obama’s health care law raises the incentive discount limit next year from 20 percent, where it has been since 2006. For smoking cessation, the incentive can rise to 50 percent of the total premium.

The law allows incentives to be introduced as penalties, rather than discounts, but that has proven even less popular.

“Some studies show more success with sticks, but that’s not something most corporations feel comfortable doing. It’s a very tricky area,” said Nancy Chockley, chief executive of the National Institute for Health Care Management.

EMC Corp., a Hopkinton-based information technology company, encourages healthy eating in the company cafeteria, where salad bar tongs are color coded — green for veggies, red for blue cheese dressing and bacon bits.

EMC also encourages its 60,000 employees worldwide to take swimming, yoga, and meditation classes during lunch. Just for participating in activities like getting flu shots and meeting with a lifestyle coach, employees will get a 20 percent discount on premiums, which is equal to $700 for employees with individual coverage. That is an increase from the current 12 percent discount. About 70 percent of EMC’s US-based employees already receive the reduction, and the company is hoping to increase participation to 80 percent.

So far the company has not yet rewarded people based on outcomes, said Lauri Tenney, EMC’s director of benefits and programs.

“We thought it would be a good time to turn up the dial to continue to engage more people,” Tenney said.

Many researchers have found that society is more accepting of charging smokers more for coverage than it is of discriminating against people who are obese. More companies reward or punish workers based on their tobacco use, with 42 percent of companies currently doing so and 62 percent saying they plan to in 2014, according to the National Business Group on Health.

One of the few companies that reward employees for meeting goals is SPS New England, a Salisbury-based road and bridge construction company with more than 350 employees. Wayne Capolupo, chief executive, said healthy workers were being penalized with constantly rising premium costs, in part because of the strain caused by unhealthy colleagues, he said....

What do you know, another way to divide labor.

Such measures can create a public backlash. Faculty at Pennsylvania State University over the summer revolted against the school’s plan to have nonunion employees go to their doctors, complete biometric screening measures, and fill out a lengthy online health risk survey. The penalty for noncompliance would be a $100-a-month deduction from their paychecks. The university shelved the plan following protest from professors who complained that it violates their privacy.

CVS Caremark, based in Rhode Island, faced similar problems in March when it announced that employees who did not go through a confidential health screening that measured height, weight, body fat, blood pressure, glucose, and body lipids would pay $600 more in insurance premiums. 

Related: "CVS earned $1.25 billion in the quarter ended Sept. 30."

Even though participation remains low across the nation, companies say they want flexibility to put teeth into future incentives. Business groups objected after the Obama administration said workers who cannot meet health targets can still qualify by meeting a “reasonable” alternative — such as taking part in a smoking cessation class or diet program, even if they never stop smoking or lose weight.

“You try to encourage people who have a [body mass index] twice as high as it should be to lose 2 pounds a week, but then you have to create an alternative for everyone who gets a doctor’s note saying, ‘I’m just big boned,’ ” said Katie Mahoney, executive director of health policy at the US Chamber of Commerce. “Regulations that water down the ability to offer those meaningful incentives will also water down the ability to change behavior, and that’s unfortunate.”

--more--"

Let the campaigning begin!

"Early start to TV ads war in midterm elections; Using health overhaul as a cudgel, GOP takes aim at swing states" by Matt Viser |  Globe Staff, December 15, 2013

WASHINGTON — The barrage of TV advertisements sponsored by a well-funded conservative group features the beginning of the 2014 midterm election season....

Republicans are trying to sway crucial female voters away from incumbent Senate Democrats in key states....

The activity previews the debate that will unfold throughout the country in the coming year....

A recent Kaiser poll showed that there has been a sharply negative turn among women’s attitudes toward the health care law. They had previously been evenly divided on it, but in November 48 percent said they had an unfavorable view, while 32 percent had a favorable view. The gap between favorable and unfavorable was up 15 points over the previous month.

And it is only going to get worse.

Both Democrats and Republicans have taken out large numbers of ads on shows that women typically watch more than men. On WSOC-TV, the ABC affiliate in Charlotte, the ads were running this month on “The View,” “Dr. Phil,” and “Live with Kelly and Michael.” On WRAL-TV, the CBS affiliate in Raleigh, the ads were running during shows such as “The Young and the Restless.”

************************

The ads are different from the usual attack ads, tailored for a female audience that is turned off by the typical harsh attacks. While the underlying messages are still negative, they are delivered in sympathetic tones....

In what they call “prioritizing [women] for the messaging.” 

Feels like being propagandized to me.

--more--"

"Poll indicates unease on health law" Associated Press, December 16, 2013

WASHINGTON — Many Americans who already have health insurance blame President Obama’s health care overhaul for their rising premiums and deductibles, and 3 in 4 say the rollout of coverage for the uninsured has gone poorly.

And that will not be changing in the next year.

An Associated Press-GfK poll finds that health care remains politically charged going into next year’s congressional elections. Keeping the refurbished HealthCare.gov website running smoothly is just one of Obama’s challenges, maybe not the biggest.

The poll found a striking level of unease about the law among people who have health insurance and aren’t looking for government help. Those are the 85 percent of Americans who the White House says don’t have to be worried about the president’s historic push to expand coverage for the uninsured.

In the survey, nearly half of those with job-based or other private coverage say their policies will be changing next year — mostly for the worse. And 77 percent blame the changes on the Affordable Care Act, even though the trend toward leaner coverage predates the law’s passage.

Sixty-nine percent say their premiums will be going up, while 59 percent say annual deductibles or copayments are increasing.

Only 21 percent of those with private coverage said their plan is expanding to cover more types of medical care, though coverage of preventive care at no charge to the patient has been required by the law for the past couple of years.

Fourteen percent said coverage for spouses is being restricted or eliminated, and 11 percent said their plan is being discontinued.

‘‘Rightly or wrongly, people with private insurance looking at next year are really worried about what is going to happen,’’ said Robert Blendon, a professor at the Harvard School of Public Health, who tracks public opinion on health care issues.

--more--" 

The ca$h grab destroyed his presidency.

At least the Massachusetts system is working well:

"With health care website troubles, state turns to mail" by Chelsea Conaboy |  Globe Staff, December 20, 2013

The state has temporarily put on hold efforts to fix its balky new health insurance website while it focuses on creating an offline system for processing applications for people who need coverage to start Jan. 1.

Massachusetts officials, exasperated by the slow pace of improvements, have also withheld payments in recent weeks to the contractor that built the system, CGI, the same company that was a major developer of the beleaguered federal insurance website. 

Gee, Mitt Romney was right.

Monday is the deadline to apply for health insurance through the Massachusetts Health Connector that would start next month. Executive director Jean Yang said the first priority is creating a process to get people covered in time.

“Without that, I don’t think we can even talk about IT,” she said.

The Connector’s website, designed to allow consumers to compare health plans and determine eligibility for subsidies, has been troubled since it launched Oct. 1.

The site has locked users out of their accounts and delivered persistent error messages. Parts of the system designed to automatically determine applicants’ eligibility for tax credits and to deliver key information to insurers have not worked.

The website was down last week for fixes. But Yang said the updated version created by CGI was not ready and she feared it would create new problems in the days before the Dec. 23 application deadline, so it was not launched.

“There is no system improvement that we can speak to,” she said in an interview Thursday.

The state has paid about $11 million on a $69 million contract with CGI. Yang and her staff are expected to report to the Connector board next month about efforts to hold CGI accountable to its contract. A spokesman for CGI declined to comment.

Other than bank ATMs, computer software designers seem to put out $elf-$erving $hit.

Linda Odorisio, vice president for communications, said in an e-mail that the company “remains focused on helping Massachusetts residents get insured” and that the Connector’s “complex program is allowing consumers to apply online for coverage thanks to an enormous team effort.”

Meanwhile, Yang said the Connector is developing ways to bypass failed components of the website.

About 104,000 people who were already enrolled in three subsidized insurance programs — the Connector’s Commonwealth Care, insurance for the unemployed, and the Insurance Partnership for small businesses — can keep their coverage through March, three months longer than the state originally planned.

But that extension does not help those who do not have a subsidy now and are applying for one, including people whose commercial plans expire this month or those who have been uninsured. For that group, the state is processing applications using a separate software tool and mailing notices with directions on how to select and pay for a plan, a process similar to what was done before the Connector website’s relaunch.

The site, originally created under the state’s 2006 health care law, had worked well, but was overhauled this year to comply with federal Affordable Care Act and to add features intended to streamline consumer’s insurance shopping experience.

Obummer care wrecked the Mass. website!

Not all applications will be processed in time for January coverage. Yang said the Connector has “a backup to the backup.”

Remaining applicants for subsidized plans will be automatically enrolled in temporary coverage, probably through the Medicaid program, until they receive a notice from the state about their eligibility, which will include directions on how to select a plan for themselves. Yang said details will be mailed soon.

Invoices are being mailed to those who have completed applications for unsubsidized coverage. Once they pay their premium by check or automatic withdrawal from their bank account — no credit cards are allowed — they will be fully enrolled.

The Connector has also created a process to transfer enrollee information to insurers by spreadsheet because the system for sending that data automatically is not working.

Applicants are growing frustrated. Adam Romanow of Boston, who is opening a brewery, said he tried to apply the day he received a notice in October that his unsubsidized Commonwealth Choice plan would expire. He was finally able to file an application about a month ago, but online payment was not working and he has not received an invoice.

“I can’t send a blank check to nowhere,” he said.

It will be harder for the state to help people who have been unable to file an application because of the persistent website problems. Among them is Alison Taylor of Essex, a yoga instructor and antique store owner looking for an unsubsidized plan.

She was locked out of her Connector account when she forgot her password. The link to retrieve it did not work, and when she called the Connector Wednesday, she said a representative told her she would have to submit a paper form to reset the password. She tried to submit her application by phone but the system was down at the customer service office, too.

“It’s just been a very frustrating process,” Taylor said. “I can’t choose a plan and pay for it. I can’t do that online, or with them.”

While no enrollments had been completed earlier this month, the Connector has seen some progress. By Thursday, more than 42,000 applications had been submitted. The total number of enrollments was up to 309.

That seems like a poor ratio.

--more--"

"State extends health insurance deadline" by Chelsea Conaboy |  Globe Staff, December 24, 2013

The state has extended to Dec. 31 the deadline to sign up for health insurance through its online marketplace, allowing an extra week for applicants who have battled a website fraught with technical problems and have spent hours waiting for customer service.

Monday had been the deadline to apply for coverage to start Jan. 1. People were scrambling to meet it. The call center was overwhelmed, and the website was working even more slowly than normal because of high volume, Massachusetts Health Connector spokesman Jason Lefferts said Monday.

Little progress has been made in fixing the website, frustrating thousands of people who are uninsured or whose insurance plan expires this month who may be uninsured in January without coverage through the state. Connector officials said they have put most improvements on hold and have focused on processing applications offline and negotiating the extension with insurers.

“This new timeframe ensures that even more people can get into the best plan for themselves and their family in time for January,” Connector executive director Jean Yang said in a press release.

The decision came on the same day the Obama administration quietly issued a one-day extension for people in more than 30 states who must use the federal insurance website to apply for tax credits created under the Affordable Care Act.

The federal website was plagued by problems at its launch, but has improved significantly in recent weeks. The same cannot be said for the Massachusetts website, once a model for the national marketplace.

The state’s program was overhauled to comply with the federal law and to streamline the application process. But the site has persistently locked users out of their accounts, failed to load pages, and delivered confusing error messages. Major pieces of the enrollment system, including those that would allow people to quickly find out what subsidies they qualify for, have not worked.

The state’s developer, CGI, also played a major role in creating the federal site. The Connector has paid the company about $11 million on a $69 million contract, but withheld scheduled payments in recent weeks because of problems with the website. Yang and her staff are expected to report to the Connector board next month about efforts to hold CGI accountable to its contract.

By Thursday afternoon, just 309 people had paid their first premium to fully enroll in a plan through the Connector. More than 44,000 people have completed applications to date, but many others have faced roadblocks in getting that far.

With the extension, everyone will have until Dec. 31 to complete an application and select the plan in which they would like to enroll.

For the plan to start Jan. 1, those who qualify for new federal tax credits must make their first payment by the end of December, or they will be enrolled in temporary coverage next month through MassHealth.

Those who qualify for ConnectorCare plans, which include some state subsidy, will receive a bill next month for their January and February premium payments.

Most people who fall in the latter group are already enrolled in a state subsidized plan, which will remain in effect through March.

People applying for an unsubsidized plan to begin next month must pay by Jan. 10, a critical deadline. The Connector will not send member information to the insurers until that payment is received, but medical costs accrued at the start of the month will be paid retroactively as long as payment is made in time.

Lefferts said Connector staff worked through the weekend to negotiate the extension.

Once it became clear earlier this month that major portions of the enrollment system, including the automatic delivery of information about new enrollees to insurers, were not working, the carriers began talking with the state about an extension, said Lora Pellegrini, president of the Massachusetts Association of Health Plans.

“Plans are committed to getting this done,” she said.

Though it is not clear whether the extension will help her, Leiha Maldonado welcomed the news.

The 36-year-old music therapist from Boston, who is seven months pregnant, buys coverage through her former employer and received help in paying her premium from the state Medical Security Program for the unemployed.

Maldonado’s premium assistance ends this month.

The Medical Security Program offered enrollment in a single health plan, for little or no cost. But that plan does not cover Massachusetts General Hospital, where she planned to deliver her baby.

The therapists she sees regularly for post-traumatic stress are also not included in the network, she said.

Maldonado submitted an application to the Connector on Oct. 13, but has received no information in return, despite her calls to state offices and messages left on the Connector’s Facebook page.

“I haven’t even received an update on the status of my application,” she said. “Nothing in the mail, at all.

“And it’s been two months and 10 days since I applied. I just have never in my life seen such gross incompetence.”

Just hold on to that baby until they get the site fixed.

--more--"

"Consulting giant becomes a State House fixture; Hired to help revamp technology, Deloitte wins millions in contracts" by Beth Healy and Megan Woolhouse |  Globe Staff, December 10, 2013

Two years into his first term, Governor Deval Patrick launched a sweeping initiative to modernize technology across the state’s agencies. To plot the road map, a dozen people met regularly in an office near the State House through 2009. Half worked for the state, half were employed by Deloitte Consulting.

For Deloitte, the $4.3 million contract was relatively small. But it put the New York-based consulting giant at the center of the conversation about moving government operations online, merging data centers, and cutting staff, while forging relationships that would lead to future business.

The approach is just one piece of a strategy that has helped Deloitte win public contracts across the country and become a virtual arm of Massachusetts government. Its work here is so diverse and sprawling, cutting across so many agencies, that Patrick administration officials could not provide a precise tally of Deloitte’s contracts and their value.

But public record requests, interviews, and other research by the Globe show the company has won at least $330 million in consulting and technology contracts in Massachusetts over the past decade. State officials could not name a firm that has won more business. Deloitte is currently working on at least 12 contracts here, accounting for about $215 million of its business with the state.

After they screwed up the unemployment web site.

Deloitte’s Massachusetts presence has come under scrutiny in recent months because of serious and costly problems with the multimillion dollar software systems it built to manage state unemployment claims and tax collections. The company stands by its work.

The firm’s reach extends from the labor department to human services to transportation. Its projects range from a new child support enforcement system to disaster recovery at a new Springfield Data Center. Among Deloitte’s current jobs: redeveloping the very system the state uses to award contracts.

“When they get the lead-in engagement, they know this is an opportunity for them to manage the majority of the projects that come out of that plan,’’ said Cushing Anderson, worldwide analyst for business consulting services at International Data Corp., a Framingham-based research firm. Armed with an insider’s sense of these projects, Deloitte has an advantage, he said, “because they wrote the plan.’’

Deloitte insists it is careful to follow state rules that prohibit consultants from bidding on certain jobs that result from a prior consulting project.

But Deloitte has often been involved in officials’ early thinking about projects. In 2001, it was hired to perform a $6.8 million assessment of the Department of Unemployment Assistance’s antiquated computer system. The conclusion: “Pursue replacement with full attention,” according to a description in the governor’s capital budget.

Five years later, Deloitte bid on the system overhaul it recommended, but lost out to a higher bidder. Deloitte wound up with the project in the end, however, after acquiring the rival consultant, which went bankrupt.

In 2007, the state hired Deloitte to help plan a major reorganization of the transportation system and cut costs. Last year, the firm won a $77 million contract to build an online licensing system for the Registry of Motor Vehicles. Only one other firm bid on the job.

The IT consolidation project that Deloitte worked on in 2009 led to numerous other jobs, including business from the Executive Office of Health and Human Services and a contract that appears to be its largest ever in Massachusetts, a $114 million makeover of the state tax system. The Department of Revenue fired Deloitte from that project last summer because it was riddled with errors, after paying the firm $54 million.

Gary Lambert, the state’s purchasing chief, said the company’s proposals have always been assessed based on their own specific merits.

“In each instance where Deloitte has been awarded a contract by the state, it was determined, using established evaluation criteria, that they put forward the best response to the solicitation,’’ Lambert said in a statement.

A Deloitte spokesman said the company wins projects because it comes “highly recommended by IT managers inside and outside the Commonwealth based on our years of high quality public sector work.”

In Massachusetts, Deloitte is one of 70 preapproved IT consulting contractors, yet it wins far more business than other firms. Size, without question, is one of the main advantages, providing deep financial resources and a large workforce that few competitors can match. It also has the ability to wait for slow-moving bureaucracies to make decisions, a factor that makes state business unattractive to smaller firms.

As the consulting arm of one of the big-four accounting giants, Deloitte reports nearly $14 billion in annual revenue and has 61,000 US employees. It has 2,000 people in Massachusetts and the financial capacity to respond to complex government proposal requests.

Deloitte also devotes significant resources to state and federal governments, from lobbying to research. It churns out books and white papers — Deloitte calls this “eminence” — aimed at positioning the firm as an expert on everything from US health care reform to banking in Afghanistan.

No wonder both systems are such a mess.

One of those books, “Letting Go of the Status Quo: A Playbook for Transforming State Government,’’ lays out ideas for using technology, cost cutting, and other strategies to make state governments more efficient.

Oh, btw, the lobbyists get full state pensions that can not be touched.

The firm has spent $754,530 on lobbying in the Commonwealth since 2009, far more than its chief competitors. IBM, for example, spent $431,736 during that period.

Deloitte says it goes further than other companies in disclosing its employees’ contacts with state officials to discuss possible business. In recent years, the company has simultaneously registered as many as three of its top consultants as lobbyists in Massachusetts.

One of those consultants, Michael Marino, oversaw Deloitte’s Massachusetts government work while the firm won contract after contract. Recently relocated by Deloitte to Raleigh, N.C., Marino did not appear at a State House hearing in October, where he had been asked to testify on Deloitte’s troubled technology projects. He did not respond to requests for comment.

Marino’s successor, Mark Price, defended the firm’s work at the hearing. He said publicity about recent problems unfairly overshadowed Deloitte’s successes in Massachusetts and elsewhere, including some national awards the company has received.

The governor is seeking approval for $800 million in borrowing to finance more technology spending. In October, state representative Antonio Cabral, a New Bedford Democrat who chairs the House Committee on Bonding, added an amendment to the bond legislation to create a seven-member commission to investigate how the state’s technology contracts are awarded and managed. 

The last thing this state needs to do is borrow more money and sell more bonds.

But Patrick administration officials convinced House leaders to kill the measure and replace the commission with a consultant, according to a lawmaker and legislative staffer briefed on the matter. They asked not to be named because of the sensitivity of the process.

Alex Zaroulis, a spokeswoman for the office of Administration and Finance, said the agency supported the change to a consultant because “it provides a streamlined approach to delivering a thoughtful report on a very tight timeline.’’

Unreal!

Patrick administration officials say they have been working behind the scenes for a year to improve the way IT is procured. As old contracts expire, “we will be rebidding services under a new model, which will create more competition and disqualify underperforming vendors,’’ said Jesse Mermell, a spokeswoman for Patrick.

That new model is scheduled to take effect in July. 

Pfft!

--more--"

Related: Done With Deloitte 

They get paid to fix their mistakes, huh? 

Seems like a bit of a conflict of intere$t, no? 

Speaking of conflicts of interest:

"2 Deloitte Consulting ex-staffers hold key state jobs" by Beth Healy and Megan Woolhouse |  Globe Staff, December 10, 2013

Two Massachusetts agencies — the unemployment division and the state’s health insurance marketplace — are headed by former Deloitte Consulting executives, where they oversee contracts managed by the New York firm.

At the Health Connector, where Deloitte has a $12.3 million slice of the new online system for buying health insurance, chief operating officer Roni Mansur was a longtime Deloitte consultant.

And it is a piece of $hit!

Connector officials say Mansur was not involved in the decision to hire Deloitte. He joined the agency in 2010 and was named operating chief in October 2011, a month before the contract with Deloitte was signed. But Mansur, who has reviewed and reported on Deloitte’s performance to the agency’s board, participated in recommending a 16-week extension of the firm’s initial contract, at a cost of $200,000 a month, according to a May 2012 memorandum he wrote to the board and to the Connector’s chief at the time, Glen Shor.

The recommendation included renewing Deloitte’s engagement as a project manager for a year beyond that, exercising an option in the federally funded contract, the memorandum said.

Under state law, officials must disclose whether they have a potential conflict of interest in their jobs, by filing a form available to the public. A potential conflict is anything that might lead a reasonable person to conclude that they could be “improperly influenced.”

But Mansur’s supervisors at the Health Connector didn’t require him to file the disclosure.

“Based on state law and published guidance from the State Ethics Commission, it is the Health Connector’s position that Roni Mansur was not required to take any action with regard to his previous employment at Deloitte,’’ Connector spokesman Jason Lefferts said in a statement. “His prior employment with Deloitte was known to Health Connector leadership and reviewed during his hiring process.”

Mansur declined to comment. His former supervisor, Shor, who is now secretary of the the Executive Office for Administration and Finance — in charge of a large portion of state procurement — also declined to comment, deferring to Lefferts.

At the Department of Unemployment Assistance, former Deloitte executive Michelle Amante was named director in February, as the agency was struggling to rein in the long-delayed online system being built by Deloitte.

Amante did file an appearance of conflict of interest form, saying she was “able to hold Deloitte to higher standards” than other officials had previously.

Her supervisor, Labor chief Joanne Goldstein, said Amante has shown no loyalty to Deloitte. “She is wicked with Deloitte,’’ Goldstein said in a September interview. “We are lucky to have her.’’ 

Must be bad luck.

--more--"

"Problems hinder site Deloitte made in Fla." by Megan Woolhouse |  Globe Staff, December 13, 2013

Deloitte Consulting was fined $1.5 million this week by Florida labor officials after numerous problems in a new unemployment benefits system it created for the state, similar to the one Deloitte unveiled this summer in Massachusetts.

Both systems have been riddled with technical glitches that left some unemployed people without benefits and unable to pay bills.

On Wednesday, Jesse Panuccio, executive director of the Florida Department of Economic Opportunity, told the Florida Sun Sentinel newspaper that the state recovered $1.5 million in “financial restitution” from Deloitte, which created the $63 million site.

“DEO will continue to work nonstop to help claimants and I will not rest until our contractor, Deloitte Consulting, has delivered the system Floridians were promised,” Panuccio told the paper.

Deloitte officials declined to comment to the Globe on the report.

In Massachusetts, Labor Secretary Joanne Goldstein and Deloitte officials have defended the new $46 million benefits system, despite complaints from hundreds of users who did not get their checks as scheduled or were erroneously billed for money they did not owe.

And they wonder why we are so angry?

Between July 1 and Sept. 21, the state paid an additional $800,000 in overtime to state workers to handle user issues.

That is the austerity-strapped taxpayer that it cost.

“The Department of Unemployment Assistance continues to hold Deloitte accountable for its delivery of the UI Online System,” the department said in a written statement, “and we are regularly monitoring the company’s performance to ensure our system continues to function effectively for UI claimants and employers.”

State officials did not respond to questions about whether they had withheld final payments for the system from Deloitte.

Problems with the system prompted the state Senate Post-Audit and Oversight Committee to hold a series of hearings on the system, and more broadly, on how the state buys information technology services.

The committee is expected to meet for a third session in January.

Pfft!

--more--"

At least Deloitte helped us follow state contracts:

"State to fix glitches in spending site" by Beth Healy |  Globe Staff, December 13, 2013

The state’s online Open Checkbook system, hailed as a major step toward transparency in the way Massachusetts agencies spend taxpayer money, offers incomplete information on public contracts and doesn’t work at all if used with the wrong Internet browser.

And taxpayers are out how much for this particular pos?

The website was launched Dec. 5, 2011, after a law signed by Governor Deval Patrick that year called for better disclosure of state spending, including the development of an online searchable database. But the site hasn’t been working recently with some of the most common Internet browsers, such as Google Chrome and Internet Explorer’s version 10.

Almost as if someone was making it hard to find the information.

Following questions from The Boston Globe about the site over the past two weeks, a spokeswoman for the Executive Office for Administration and Finance said the problem was being fixed. She said a note will be added to the site telling people to temporarily use a different browser, such as Firefox.

“Open Checkbook is meant to give details of state spending for taxpayers to easily use,’’ said Alex Zaroulis, the spokeswoman. “We want the experience to be as easy as possible and we’re working to rectify any issues with the site that may have caused frustration.’’

The website, built by Dublin-based Accenture, has a key limitation. Though it contains loads of dollar figures and ways to view and slice agency spending, the website does not allow visitors to look up the total size of contracts. Instead, it provides the state’s actual payments to various vendors, year by year, going back to 2010.

Not all that tran$parent, huh?

For instance, a taxpayer looking up how much business a company does with the state would not find a list of contracts and total dollar amounts. Rather, such a search produces a list of smaller payments to the company, by year.

The Globe learned of the system’s shortcoming when it asked state officials the total amount of business Deloitte Consulting does with the Commonwealth and they were unable to answer the question.

The good stewards of taxpayer money!

Through public records requests and interviews, the Globe found that the New York-based consulting giant that recently revamped the unemployment claims system has at least 12 contracts worth $215 million.

It’s had more than $330 million in contracts over the past decade.

In Open Checkbook, a search for Deloitte finds the state has paid the firm $149 million since 2010, but it is difficult to tell what contracts those payments correspond to.

Zaroulis, the spokeswoman, said Open Checkbook was not intended to keep track of contracts. It is meant to serve as a window more broadly on state spending.

In other words, it was intended to obfuscate, confuse, and hide. 

A press release issued with its launch two years ago quoted the governor, treasurer, and legislative leaders extolling a user-friendly website and an “unprecedented commitment to government transparency.’’

As usual, it was $elf-$erving state bluster!

Several local consumer and taxpayer advocacy groups also backed the launch, including the Pioneer Institute, a Boston think tank.

But the institute’s executive director, Jim Stergios, in a recent interview, acknowledged that the website doesn’t offer a complete picture of large and important contracts.

Who designed this?

“It is absolutely important to be able to roll up the amount of money you’re spending with a vendor,’’ Stergios said. “Not to do so is a missed opportunity to leverage — to negotiate a better deal for taxpayers.’’

Stergios said Open Checkbook is set up as “a cash flow analysis, and that’s not what anybody outside of state government is paying attention to.’’

In other words, the site is useless.

Accenture is still working with the Commonwealth on the website, according to a spokeswoman for the firm, Joanne Giordano. But the state took over general maintenance of the site in March 2012, she said.

--more--"

I'm not feeling so well now.