By Katie Kerwin McCrimmon

The young lawyer and mother of two wheeled herself into the ER at Swedish Medical Center, suffering from severe pain after the amputation of her lower right leg earlier this year.

Jessica Peck, right, once met a client in the hospital. The conservative activists does civil rights law and has added disability rights to her specialties after getting an amputation earlier this year.

She was in no condition to be defending herself against a worker’s demand a short time later that she fork over a $400 “deposit” from her hospital bed.

Jessica Peck, the famed conservative activist, was diagnosed at age 5 with a condition known as vascular malformations. Then in 2013, she learned she had a rare neurological condition known as Reflexive Sympathetic Dystrophy. Together, the diseases trigger aggressive destruction of bone, muscle and tissue. She also suffers from tremors that come on without warning.

She’s had approximately 50 surgeries, including the amputation and the earlier implantation of a spinal stimulator that proved unsuccessful.

At times, she’s had to suffer indignities like having to let her 10 year-old daughter take over laundry duty or allowing both girls — the younger one is 7 — haul her 40-pound wheelchair in and out of the car.

“I’m like an 80-year-old, but I’m 36,” says Peck. “Some days I’m mobile and great, but it’s getting tougher with time.”

Despite all the physical challenges and the financial ruin of ongoing medical bills, Peck tries never to take a sick day. She has paid off tens of thousands of dollars in medical debt and is in court on behalf of clients multiple times a week. This week, she has been busy working on a case involving international child abduction.

Born in Virginia and raised in Colorado, Peck specializes in civil rights and family law, often defending young African American and Hispanic boys who she believes have faced disproportionate discipline in schools.

Jessica Peck pulls her wheel chair out of her car as she picks her girls up from school.

Along with her law degree from the University of Denver, she has a graduate degree from Johns Hopkins, where her dissertation focused on the role of race and gender in higher education.

“I have no intention of slowing down and will adapt to current and future limitations,” Peck says.

Last week, however, Peck was feeling lousy, so she went to Swedish where she’s been a patient for 25 years. She’s at high risk for blood clots and wanted to be sure her increased pain was not the result of a clot.

Soon after she arrived and was settled into a room receiving medication, a worker from the registration department came into the room and demanded that she pay a “deposit” for her care.

“I was groggy from meds in a dark room resting and this stranger came in and demanded $400,” Peck said.

It was money she didn’t owe.

Back in January, she had reached her out-of-pocket maximum for the year, then spent most of the month of February at Swedish when she had her lower right leg amputated.

“I met my co-pay obligations eight days into 2015,” Peck said.

The worker relented, but still insisted that unless patients have proof that they’ve met their deductible, the hospital requires a payment on the spot.

“I do not owe this and I will not pay this,” she said.

Peck wonders how the worker decided to charge her $400 and what happens to all the people who aren’t lawyers and might feel bullied into forking over cash they might not owe.

Jessica Peck, with her two daughters, ages 10 and 7. The divorced mom and lawyer has fought to keep working despite two severe illnesses that make her feel like an 80-year-old. During hospitalizations, friends step in to help with the girls. While it was tough to opt for an amputation of part of her right leg earlier this year, Peck said she’s now suffering less.

She said Swedish admissions staff should look at their own records before patients are ever billed, saying they should have known that she’d had extensive care in 2015.

“To arbitrarily demand payment of $400 is not acceptable,” Peck said.

Adam Fox, an advocate with the Colorado Consumer Health Initiative, said his group occasionally hears from consumers who are facing increasingly aggressive hospital billing agents.

Fox said it’s wrong for hospitals to hit up patients for cash when they are at their most vulnerable.
“When someone is in a hospital bed, that’s not what they should be thinking about. It’s not a fair practice. They’re trying to get money out of somebody when they’re at their most vulnerable, when they’re in a hospital and suffering what is potentially a major medical condition. That’s not the time for the hospital to be asking for payment,” said Fox, director of strategic engagement for the consumer advocacy group.
He said hospitals should be negotiating with insurance companies, who should then bill patients later. Under the Affordable Care Act, patients who need financial assistance are supposed to be getting more help from hospitals and Colorado also has a law requiring reasonable payment plans.
“It comes down to consumers being aware of what they are being charged and when,” Fox said.

Spokeswoman Nicole Williams said Swedish uses a computer program common in Colorado and around the U.S. called “Passport” that shows how much a patient will owe.

Williams said it’s standard practice for workers to collect payments in the hospital. Even as a hospital employee, she said she had to make a payment during a recent visit to Swedish after a minor car accident.
She said workers would not have made any exceptions for a patient in a wheelchair or someone with an amputation. If a patient is comatose, can’t breathe or is having a heart attack, hospital workers stabilize the patient first, then work on registering and billing them later.

“If we don’t standardize (the process), then it’s not fair,” Williams said. “It’s part of the process of coming into the ED (Emergency Department) anywhere in Colorado. At some point, you will hit admissions and be told what your deductible is. We don’t look at someone and say, ‘Oh, they’ve had a hard run.’ If someone says, ‘I can’t make a payment,’ we say, ‘OK.’ Everyone does have a different situation. We work very closely with our patients and obviously do a ton of charity care.”

Jessica Peck and her girls took a beach vacation soon after her amputation. She has head to learn to get around with canes and her new bright pink wheel chair.

In Peck’s case, she is insured through the ColoradoHealthOP. Her card does not list an ER co-pay and hospital officials say Passport doesn’t link with the HealthOP’s records.

When Peck asked the hospital worker if he had called the number on her card to find out what she owed, he said he didn’t. She wonders how he came up with the $400 figure and scoffed at a computer system that couldn’t detect any information about her, despite her long history as a patient at Swedish.

“I was there from Feb. 7 to March 3 (for the amputation),” Peck said. “Last summer, I was in for up to 18 days at a time. My body gets atrophied and I can’t move. Maybe their ‘Passport’ should show that I have 25 years of passport stamps at Swedish.”

Fox of the Consumer Health Initiative said it’s greatly concerning that hospitals are using a software system that could be wrong.

“Using a system other than going through the health insurer raises concerns about consumers being incorrectly charged, or, as in the case of this consumer, being charged when they shouldn’t be,” Fox said.
Furthermore, he worries that many patients will simply pay on the spot because they fear if they don’t, they’ll get poor care.

“If they’re feeling vulnerable and concerned about getting the health care they need, they’re probably going to pay whatever is asked of them.”
Williams said billing issues are never tied to care.

“A patient’s ability to pay a deposit or not at the time of service does not impact the care being given,” she said.
Peck said that for the most part, she has received great care from her doctors at Swedish.

But because her pain is extreme, her tremors are hard to diagnose and she needs surgeries twice or more a year, she must use powerful and somewhat experimental medications.

“I was in the ER a couple of years ago at my doctor’s insistence and a staffer said, ‘You’re a junkie.’”

Given that Peck is part of a federally monitored prescription drug program, she is required to provide urine and blood tests, often randomly and at least once or twice a month.

Even a single positive result for an improper medication would mean Peck would be booted from the program. After approximately 36 months of tests since she began the program, she says she has never tested positive for a single drug not prescribed to her.

When the hospital worker accused her of abusing pain meds, she went straight to the front desk attendant and said, “I want a refund. You didn’t provide care and you called me a junkie. That’s not care.”

The worker at the register told her she didn’t know how to give a refund. No one had ever asked for one before and Peck never got her money back.

She did, however, work with staff to create a standard of care whenever she arrives at Swedish.

Jessica Peck picks up her girls from school. Despite her illness, she’s trying to do it all, never taking a sick day and continuing to be the mom who takes her kids to soccer, dance and cotillion.

To navigate all the medical bills, Peck has had to hire a patient advocate to fight on her behalf.
Said Peck: “The billing is worse than anything else in the world.”

That’s saying a lot when Peck has to endure regular treatments during which one of her doctors shoots ethanol into her body to try to break up the malformations and preserve the bones. She jokes that she has had to get used to being a “one-legged rabble rouser.”

Amputation was always in the cards and part of the discussion with Peck’s parents and doctors when she was a child. This year, she felt she had no choice, but to part with her right leg from the knee down.

“The pain was so extreme that I had begged for the amputation after a 2014 that included three months in and out of the hospital I thought, ‘the only way I can get out of here (the hospital) is if I cut the leg off,’ ” Peck said.

“The amputation has saved my sanity. I spend less time in hospitals now.”

Despite her frustration over the recent demand for cash, Peck says she’s doing relatively well at the moment.

“Things are calm, but in a split second, it could get out of control. The malformations are in my hip and my tremors are progressive.”

At risk now is her pelvis and spinal cord. Peck could be in deep trouble if her diseases strike either part of her body.

“They used to give a prognosis. Now, they don’t any more. It’s a strange way to live. Am I going to die or live to be 100? I don’t think I’ve ever taken a day for granted.”

By Katie Kerwin McCrimmon

Summer is officially over, but with temperatures approaching 90 degrees and bright sunny September days, you still might be able to dose up on some vitamin D.

That raises a health conundrum, however.

Sharon McKenna spent her childhood getting blistering burns before she’d get tan. She survived melanoma and now advises people to protect themselves from potentially dangerous sun exposure. Source: U.S. Centers for Disease Control and Prevention.

On the one hand, skin cancer is the most common cancer in the U.S. and dermatologists would much prefer if we stayed out of the sun altogether or remain well covered with sunscreen, hats and long sleeves during peak sun hours. New research has found that melanoma, the deadly form of skin cancer, is striking younger people — especially teen girls — in much higher numbers.

At the same time, researchers say Americans are chronically deficient in vitamin D. The name is misleading. Vitamin D is a hormone, not a vitamin, and we get it by converting UV rays into the hormone. Vitamin D is crucial to bone health and may have all sorts of other benefits from preventing some types of cancer to thwarting infections.

With seemingly incongruent advice to stay out of the sun because it causes skin cancer while finding ways to get adequate vitamin D, what do doctors advise?

Skin cancer experts are adamant. They say UV radiation is a known carcinogen, and potential harm from sun exposure is too great to risk spending time outdoors without sunscreen. People who need vitamin D should get it through fortified foods or supplements.

But vitamin D experts say that some individuals may decide to load up on vitamin D by spending very short periods of time outside on sunny days without sunscreen since sunlight gives much bigger boosts of vitamin D than people can get through food or supplements.

“I’m not personally making this recommendation, but the amount of vitamin D that a light-skinned individual in the summer in Colorado would get wearing short sleeves for about 10 to 15 minutes would be as much vitamin D as you’d get in 30 glasses of (fortified) milk,” said Dr. Adit Ginde, an emergency room physician at University of Colorado Hospital and an associate professor of emergency medicine at the University of Colorado School of Medicine.

“The darker your skin tone, the more likely you are to need vitamin D,” Ginde said.

“It’s a personal decision. If you want to raise your vitamin D levels and you want 0 risk, taking a supplement is probably the safest way to do that,” he said.

For those who want some vitamin D through minimal sun exposure, Ginde said you’d never want to stay out to the point of getting a sunburn. Rather, you’d absorb some rays for less than half the time it would take to get any kind of burn.

The complication is that individuals are so different. Some people have a greater risk of getting skin cancer, so they should be very cautious. Skin tones vary, as do exposure levels depending on the latitude. In Colorado, it’s very difficult to get any exposure to vitamin D in the winter and you don’t absorb much during off-peak hours.

Ginde was the lead researcher of a 2009 study that found that three out of four people are deficient in vitamin D and that deficiency levels are growing.

Deficiencies among African-Americans and Hispanics are particularly high, according to the study, which was published in the Archives of Internal Medicine.

Ginde is completing a study now on the role that vitamin D might play in preventing infection. He can’t share those results yet, but said researchers may find that lower vitamin D levels in the winter may make people more vulnerable to colds, the flu and respiratory infections.

The optimal level of vitamin D in the blood ranges from about 30 to 40 nanograms per milliliter, he said.

Ginde and his fellow researchers found a marked increase in people who were deficient. The population of people who were severely deficient with levels of less than 10 nanograms per milliliter had gone up from 2 to 6 percent when the researchers compared vitamin D levels in people in the late ’80s and early ’90s compared to those tested between 2001 and 2004.

Since Ginde’s study, the Institute of Medicine issued new guidelines ecommending 600 IUs per day for adults ages 70 and younger and 800 IUs per day for those 71 and older. Those recommendations were controversial as soon as they came out in 2010 and some researchers have said people should be getting much more vitamin D.

“It’s clear that the rates of deficiency are high and increasing,” Ginde said. “Increased sunscreen (use) has some part of it, but also becoming a more indoor population has played a big role.”

Ginde said that 80 to 90 percent of vitamin D intake is related to UV exposure and that outdoor exposure is the “primary determinant of vitamin D levels in people.”

If most of the exposure to vitamin D happens outdoors, that brings back the concerns about skin cancer.

Melanoma surged into the news recently when former President Jimmy Carter revealed that he had been diagnosed with melanoma that had spread to his brain.

While Carter is 90, researchers at a New York cancer center have found staggering increases in melanoma rates among young patients.

Researchers at the Roswell Park Cancer Institute in Buffalo, N.Y., earlier this summer unveiled a study that found that the number of cases of melanoma in children, adolescents and young adults increased by 253 percent from 1973 to 2011. Survival rates linked to much better treatments for melanoma have also increased.

But the disease still can be deadly or require extensive, costly treatments. Young people who get it are shocked to have cancer at such an early age. In particular, melanoma cases have shot up among young women. Risky behavior including the use of tanning beds is a likely culprit for the increase in cases among younger women.

Dr. Demytra Mitsis, a fellow at Roswell Park and lead author of the study, said she often meets young patients who wish they could turn the clock back.

“They say, ‘I thought I was invincible. If I could go back and talk to my 16-year-old self, I would do things differently.’ It’s hard for them to understand that something like this can happen,” said Mitsis.

For her study, she analyzed data from 35,726 people who had gotten melanoma between 1973 and 2011. Before 1980, females represented 57 percent of cases. That percentage rose to 65 percent from 2001 to 2011.

While survival rates have improved, about 7 to 10 percent of people diagnosed with melanoma will die, Mitsis said.

Dr. Ilene Rothman, chair of the dermatology department and Mitsis’ colleague at Roswell Park, said she used to see one or two patients a month with melanoma.

“Now we’re seeing them all the time. One American dies from melanoma every hour. It’s still quite common and quite serious,” Rothman said.

“Skin cancer is the most common (cancer) in the U.S. One in five Americans gets some kind of skin cancer. One in 58 gets melanoma,” Rothman said.

Rothman said vitamin D is very important to bone health. Other potential benefits haven’t been proven yet, so she sees no conflict between the need to get vitamin D and the importance of preventing skin cancer.

“There are excellent sources of vitamin D that don’t cause skin cancer. Any UV exposure — whether it’s from the sun or tanning beds — can cause cancer. We already know that. We can get vitamin D from our diet, from fatty fishes like salmon and tuna. And supplements are readily available.

“I do not recommend that people get their vitamin D from the sun,” Rothman said.

She said the jury is out on exactly how much extra vitamin D people should take. Rothman recommends getting your levels checked, then mapping out a plan with your doctor.

And she says skin cancer can be prevented.

About 24 states have some kind of ban for tanning beds for teens. (Colorado does not.)

Adults and young people need to use sunscreen properly and more often. The U.S. Centers for Disease Control and Prevention found that only about 30 percent of women and 15 percent of men regularly use sunscreen.

“It’s abysmally low,” Rothman said.

Even when people use sunscreen, they often don’t put it on properly or forget to reapply it.

“You need water-resistant sunscreen if you’re active, and try to avoid the middle of the day. Seek shade. Wear hats. Think of enjoying yourself outside, but not trying to get a tan,” Rothman said.

The non-melanoma skin cancers are directly linked to sun exposure. Causes for melanoma are more complex.

“We can’t say for sure, but many patients recall those blistering burns as children,” Mitsis said. “They could have actually prevented this. It can be very frustrating for patients.”(Click here to see the video Dear 16-year-old me.)

“There are a lot of factors we can’t do anything about. We can’t change our genetics. One thing we can change is our behavior,” Rothman said.

Telling young people that they might someday have cancer doesn’t always resonate. But teens who want to be beautiful sometimes heed warnings if they hear that sun exposure could make their skin look bad.

Colorado has a higher rate of melanoma than the U.S. average, but surprisingly some northern states have higher rates. Colorado’s rate is 21.6 per 100,000 people compared to the U.S. average of 19.7. By comparison, Vermont has a rate of 28.1 while in Minnesota the rate is 27.5 per 100,000 people.

For Ginde, the vitamin D expert, health choices are always about tradeoffs.

“Certainly by using sunscreen all the time, you increase your risk of vitamin D deficiency and you have some protection from skin cancer,” he said. “Perhaps for an individual, there’s some middle ground.”

By Katie Kerwin McCrimmon

Child poverty rates and the percentage of children without health insurance continue to decline in Colorado, giving advocates hope that the economic recovery is finally beginning to reach the state’s lowest income families.

Emmanuel Arroniz, 4, gets a checkup at the Rocky Mountain Youth Clinics’ Kids Clinic at Crawford Elementary School in Aurora. The clinic provides care for children in one of the highest poverty areas in Colorado.

The percentage of children living in poverty has declined for the second year in a row and poverty rates for families with children finally reached pre-recession levels, according to new data from the U.S. Census Bureau’s 2014 American Community Survey.

The 2014 rate was 15.4 percent, down from 16.9 percent in 2013.

The decreases two years in a row mark the first time Colorado has seen continuously declining child poverty rates since the survey started in 2000.

“We’re pleased that things are heading in the right direction,” said Sarah Hughes, research director for the Colorado Children’s Campaign. “We are hoping this marks a turnaround.”

The recovery has not been even across the country or in Colorado. Colorado had the sixth-largest percentage decline in 2014 and was one of just 10 states to see a statistically significant drop in child poverty rates for 2014. Hughes said many rural areas of the state are still struggling with a less-than-stellar recovery. County level poverty data will come out later this year, but some parts of the state, like the San Luis Valley, have seen persistent, multi-generational poverty rates that can leave up to one-third of children living in impoverished families.

Even with the recent declines, about 190,000 children live in impoverished families, up from 104,000 in 2000. Poverty is defined as annual income below $23,850 for a family of four.

On the health insurance front, the new census data confirm newer information from the Colorado Health Access Survey, which came out earlier this month and is based on a 2015 Colorado survey conducted by the Colorado Health Institute.

The census numbers from 2014 show that just 5.6 percent of Colorado children lacked health insurance, down from 8.2 percent in 2013. The newer data from the 2015 Colorado Health Access Survey showed an even more dramatic decline in uninsured children, down to 2.5 percent.

Hughes said timing explains the difference in the survey results. Census officials gather data throughout 2014. Some of the early numbers would not have reflected full implementation of the Affordable Care Act. Colorado has seen some of the largest jumps in the country in its Medicaid enrollment and health experts have said that as adults got health coverage, so did their children.

“Kids in Colorado are among the biggest winners in health reform,” said Chris Watney, president and CEO of the Colorado Children’s Campaign. “Expanding Medicaid access for whole families and establishing our own, state-based Colorado (exchange)… are among the reasons that Colorado experienced the nation’s second-largest percentage point decline in the rate of kids without insurance.”

Hughes said health insurance for families allows children to get preventive care and immunizations. They also have a place to go if a child gets sick.

“We’re on the right track. We have more kids covered by health insurance in Colorado than ever before,” Hughes said.

Coverage does not guarantee a child will have a provider, but school based clinics and community health centers are helping provide access for newly covered children in some parts of the state.

Children from Latino families continue to struggle the most. While many more African American and Native American kids got health coverage, Hispanic kids still are most likely to be uninsured. The census data showed that 9.6 percent remained uninsured in 2014, down from 13.1 percent in 2013.

The 2015 Health Access Survey showed similar trends for Hispanics of all ages. Hispanics had the highest uninsured rates overall. About 11.8 percent of Hispanics remained uninsured in 2015, compared to 21.8 percent in 2013, according to the Colorado Health Access Survey.

Geographic and ethnic disparities remain a challenge for the state.

Said Hughes: “We still have work to do to make sure all kids can access high quality coverage.”

By Katie Kerwin McCrimmon

Colorado’s health exchange board unanimously voted on Monday to give its chief strategy and sales officer a contract that could pay up to $150,000 for six months of work.

On an annual basis, that’s a higher rate of pay than the interim CEO for the exchange who receives $199,200 a year and more than triple what the governor of Colorado receives: $90,000 a year.

Marcia Benshoof will get paid $120 an hour and up to $150,000 over six months at Colorado’s health exchange. Lawmakers are questioning her lucrative contract.

The lucrative contract comes after exchange managers earlier this year hiked costs for customers to fund a ballooning budget and vowed to operate more efficiently with fewer highly paid contractors and more salaried employees. The previous head of Colorado’s exchange, Patty Fontneau, incurred the wrath of some critics when she sought a raise and bonuses when the exchange was performing poorly.

The exchange board met in secret during an executive session on Monday, then voted in public on the contract for Marcia Benshoof. She will receive $120 per hour and up to $150,000 during the next six months. A spokesman called Benshoof’s work “invaluable.”

Altogether over the past three years, Benshoof has received $542,880 for consulting work and expenses. On top of that, she worked for seven months in 2014 and early this year as an exchange employee. During those seven months, she earned $165,000 a year or about $96,200 in additional pay.

She’s not alone in receiving a high-paying contract. Another high-level exchange manager, Adele Work, worked as a contractor from spring of 2012 to spring of this year and the exchange paid North Highland Consulting just over $1 million for Work’s services. Earlier this year, Work became an exchange employee — chief information officer — and now earns $165,000 a year.

Among other work, Benshoof has overseen the small business exchange. As of April of this year, the small business exchange had only attracted 329 employer and 2,589 individual customers. In a report to board members at that time, Benshoof conceded that the small business exchange was “underperforming” and was at a critical juncture. Managers promised to make the system easier to use, but have shelved any fixes until spring.

Benshoof also oversees brokers working with the exchange, does outreach and eligibility work, partners with insurance carriers and federal officials, and is the official “insurance license” holder for the exchange, according to interim CEO Kevin Patterson.

In presentations to the board about enrollment projections this year, Benshoof has said that the exchange will have to perform much better in 2016 than it has in previous years. She predicted individual sign-ups closer to 217,000 for 2016, compared to about 143,000 for 2015. And she is gambling that the small business exchange will cover nearly 7,000 people by the middle of next year, compared to over 2,500 this year.

So far, the health exchange has not managed to attract the majority of customers in the individual market. The Colorado Health Access Survey released earlier this month found that Colorado’s exchange so far has captured 42 percent of the individual market.

After the Monday vote, the exchange’s lawyer, Alan Schmitz, and spokesman Luke Clarke both tried to stop Benshoof and board members from commenting on the contract.

Benshoof declined to comment.

Board Chair Sharon O’Hara said that the contract amounted to “appropriate spending” and “is necessary.”

Adela Flores-Brennan, a board member and former Connect for Health employee who now represents consumers as head of the Colorado Consumer Health Initiative, declined to explain why she voted yes.

Patterson said he recommended that the board approve Benshoof’s contract.

“When you look at the amount of responsibility and work that Marcia has to do, I think it’s very justifiable,” Patterson said after the board meeting. “She has a unique set of skills and a history of knowing this insurance world extremely well.”

Why not then make Benshoof a salaried employee?

Patterson said it’s unlikely he could replace Benshoof with a single person. He said she has the expertise, knowledge and relationships that add value for the exchange.

“For what she is able to deliver to our organization, I think it’ is the right amount (of pay),” Patterson said.

Exchange critics, however, said that the contract for Benshoof is typical of out-of-control spending at the exchange.

“Unfortunately, I’m not surprised, but I’m deeply disappointed,” said Sen. Kevin Lundberg, R-Berthoud, who sits on the legislature’s exchange review committee. “I’m not surprised because I’ve found that they spend money like water. They’ve already burned through (as much as) $200 million setting this whole system up and it’s still not functioning as expected.”

Lawmakers have tried to more carefully scrutinize exchange managers and board decisions. But Lundberg said the committee has little power over decisions like contracts.

Lundberg is planning to introduce a bill next year that would require voter approval for consumer cost hikes at the exchange that he believes amount to illegal taxes. Unlike a typical fee, Lundberg said all Colorado customers who buy health insurance have to pay to fund the health exchange and he calls that an illegal tax.

He said high pay has been the rule, not the exception at the exchange.

“Everybody who had done anything (for the exchange) has been paid well beyond the scale for state workers,” Lundberg said. “This is part of the state of Colorado. The state seal is on all their letters. They are created by the state. Yet they operate with impunity.”

Connect for Health Colorado is a public entity, but operates independently of state government.

“I believe their entire system is a fantasy. It does not provide affordable insurance for the people of Colorado. It just adds a layer of bureaucracy. They have driven a lot of people into Medicaid, but fewer people can afford to pay their medical bills,” Lundberg said.

Sen. Beth McCann, D-Denver, who is vice-chair of the legislative oversight committee, said that exchange workers have “confronted an extremely heavy work load with many challenges. Overall, they have been successful in signing up large numbers of people both for Medicaid and private insurance.”

McCann said “much work remains to be done” particularly with respect to glitches in the enrollment system.

“Marcia appears to be highly qualified and committed to the success of Connect for Health. The potential of $300,000 a year, if that is in fact the case, is too high. I would hope the Board will monitor her hours so that her compensation remains within reasonable limits, certainly not more than the CFO or CEO are making.”

Benshoof joined Connect for Health Colorado in 2012. She initially worked as a contractor at a rate of $74 an hour, a rate that jumped to $85 an hour, then to $120 per hour this year. Altogether, Benshoof has received $542,880 for consulting fees and expenses over the last three years, according to exchange spokesman Luke Clarke.

For six months last year and one month this year, Benshoof, worked as an employee for the exchange at a compensation rate of $165,000 per year. At the end of January this year, Clarke said she asked to go back to being a contractor.

By Katie Kerwin McCrimmon

Dogged by technology failures last year that snagged at least 10 percent of customers, Colorado health exchange managers promised Monday that they’ll have a new streamlined IT system ready by Oct. 18, just two weeks before the Nov. 1 launch of the next open enrollment season.

In order to get the sign-up system for individuals finished by mid-October, exchange managers revealed Monday that they are delaying any fixes for a poorly performing small business portal until at least February.

The news that the system for individuals won’t be ready until October prompted concerns from consumer advocates at a hearing of the health exchange board on Monday.

“We continue to be very concerned about that timing,” said Deb Judy, policy director for the Colorado Consumer Health Initiative.

For the past two years, exchange and Colorado Medicaid and IT managers have made similar claims that they would be ready for sign-up season and that the IT systems would function well for customers. Each time, the systems have had major failings. The exchange, Connect for Health Colorado, has a new interim CEO and several new board members. Former Chief Technology Officer Proteus Duxbury stayed at the exchange just over a year and left this spring to take another job. But many of the same IT vendors and IT managers who have failed to produce simple systems in the past are trying to make fixes now.

Adele Work, formerly a consultant who was the project manager for the exchange and now the exchange’s chief information officer, said she’s aiming for a better experience for customers this year. But she warned that some customers still will have trouble.

“Flawless is a goal that we will never attain,” Work told board members.

Easy sign-ups are critical for the long-term success of Colorado’s health exchange. The exchange is banking on a big bump in sign-ups for 2016 — about 215,000 compared to about 140,000 during open enrollment this year.

Without attracting more customers, the exchange can’t bring in enough cash to survive. A legislative oversight panel has been meeting to decide whether to keep a state-based exchange in Colorado and the state auditor is conducting a broad audit after a narrow review last year found extensive problems and questionable spending.

Work said there’s never enough time to do adequate testing with a system as large and complex as the “Shared Eligibility System,” a combined IT portal for the exchange and Colorado’s Medicaid system. Colorado’s exchange is an independent public entity outside of state government. But customers who want tax subsidies to help pay for health insurance premiums must first show they don’t qualify for Colorado’s Medicaid program. So the exchange and Medicaid systems must work together.

In many states, the state government runs the health exchange. In Colorado, managers for the entities bickered for years. On Monday, managers for the state exchange, Office of Information Technology and the state Medicaid programs attended the exchange board meeting to try to show a unified front. The new interim CEO for the exchange, Kevin Patterson, is Gov. John Hickenlooper’s former chief administrative officer. Board members hope that Patterson can foster better cooperation among the separate entities and score millions in support for the exchange from Medicaid.

Work told board members that “there are a number of risks” to the timeline, so she’s trying to focus on the most critical fixes.

They include:

• Automatically renewing people for the same plan they had the previous year if they don’t take any action. Last year, hundreds of people who browsed for new plans, but didn’t select one automatically lost coverage instead of keeping their old plans.
• Preventing the system from randomly increasing a person’s income. Some customers found that each time they logged in, their income had inexplicably doubled or tripled.
• Improving the call center operations and allowing customers with problems to check their status through an online system, rather than requiring them to wait on hold to see if their problem has been solved.
• Making it easier for people to learn if they’ll qualify for Medicaid or can shop for private plans with subsidies.

Patterson said it was important to delay fixes for the small business system, which has attracted very few customers, in order to make sure the main system is working well.

“We are trying to control how much technology we are changing,” Patterson said. He and other top managers nonetheless promised to increase the number of people using the small business system since that will also help bring in more cash.

Work said testing on the new individual sign-up system will begin in late September.

“We can’t really say how well open enrollment is going to go until we (do key testing) about one month from now,” Work said.

She also warned board members that capacity problems are likely to surface and could require contingency spending since most customers are likely to wait until the last minute to sign up.

The open enrollment season begins on Nov. 1 and ends on Jan. 31.

Work said she expects customers won’t begin signing up in earnest until after Thanksgiving and the exchange will have to brace for as many as 10,000 sign-ups a day during the crunch period just before the enrollment deadline.

When they do shop and buy, she hopes exchange users will be happier.

“It’s all about the customer experience,” Work said. “I believe we weren’t ready to handle the kind of issues that came out of the woodwork (last year).”

Since the exchange has new board members, the board elected new officers and reorganized committees, vowing that the committees would meet more often to try to do a better job of strategic planning.

Sharon O’Hara, vice president of the Colorado-Wyoming chapter of the National Multiple Sclerosis Society, will remain board chair.

Steve ErkenBrack, a veteran of the board since its inception and president of Rocky Mountain Health Plans, will become vice chair.

Eric Grossman, president of NextHealth Technologies and another board veteran, will take over the key board committee that oversees finance and operations.

Newer board members, Adela Flores-Brennan, a consumer advocate; Marc Reece of Aetna; and Jay Norris, an insurance broker, will work on a policy committee with Colorado’s Insurance Commissioner, Marguerite Salazar.

Correction: An earlier version of this story said that open enrollment for 2016 would end on Dec. 15. That’s incorrect. Open enrollment begins on Nov. 1 and ends on Jan. 31.