No "Kumbaya moments": dissension on the Health Reform Task Force over consultant | Arkansas Blog

Friday, May 15, 2015

No "Kumbaya moments": dissension on the Health Reform Task Force over consultant

Posted By on Fri, May 15, 2015 at 8:08 AM

click to enlarge PROCUREMENT DRAMA: The Stephen Group's leadership testifies before the Legislative Council Executive Subcommittee yesterday.
  • PROCUREMENT DRAMA: The Stephen Group's leadership testifies before the Legislative Council Executive Subcommittee yesterday.
One simple lesson from the last week: legislative bodies should probably not be in charge of a procurement process! 

Yesterday, as I explained in a quick wrap-up, the hot mess brewing in the Health Reform Legislative Task Force over the contract for a consultant spilled out publicly in the Legislative Council Executive Subcommittee Meeting. The task force's co-chairs are not satisfied with the task force's choice — on a 9-7 vote — to recommend a $1 million contract to the Stepehen Group. One of the chairs, Sen. Jim Hendren, explained the recommended contract to the subcommittee but testified that a number of task force members had grave concerns about it, and requested that no contract for any consultant move forward until the task force could reach a broader consensus. This infuriated task force members who had been on the winning side of the vote, who believed the task force leadership was trying to usurp the process.  

The meeting wasn't pretty: Hendren called the Request for Proposal (RFP) process on this contract "one of the most frustrating and disgusting things I've seen down here in a long time." Sen. Linda Chesterfield, meanwhile, said, "The committee was not designed to have kumbaya moments…I'm quite frankly disappointed that when the majority speaks, it's not respected." She added: "I don't understand this delay. I don't understand why we're talking about it and I don't understand how we're going to get a Kumbaya in a week that you didn't get in the last week."

Rep. Charlie Collins apparently plans to run through the same show this morning before Legislative Council. I have to wonder whether someone will talk him out of it — this appears to be a doomed effort, with most expecting the Council to easily approve the contract. At this point, whatever one thinks of the consulting contract, continuing the fight appears to be an embarrassing distraction likely to increase the bad blood. 

This is a process fight and a procurement fight. I think there's a plausible argument to be made that the Public Consulting Group (PCG)'s proposal was more comprehensive and offers a better path given the task force's goals, but ultimately I'm skeptical that the substantive outcomes in terms of the final task force recommendations will be wildly different regardless of which finalist was picked as the consultant (indeed, I think it's worth asking whether the task force really needs a consultant at all). That said, the dissension that has exploded over the first significant task force decision — and the apparent failure of leadership around building coalitions and clearly articulating shared goals — does not bode well for the effectiveness of this body. 

That's the biggest fear at this point — not that the task force might pick the wrong consultant, but that the task force becomes so disorganized and contentious that the process gets derailed. There is a tight timeline here, and anyone worried about the future of health coverage for 230,000 Arkansans should be worried about this mess. 

After the jump, some highlights and lowlights from yesterday's meeting: 

 * Hendren said that he made his comments not as chairman but as an individual member of the task force, member of the Legislative Council, and senator. Hendren said that the proposals from PCG and the Stephen Group were "apples and oranges," calling them "two dramatically different presentations." The Stephen Group's proposal, Hendren said, would present a report on October 1 — the bulk of the work would be done over the next four months. "[PCG] presented a 19-month comprehensive plan that went far beyond an audit and far beyond a report on October 1," he said. He predicted that the task force would either need additional help or have to increase the payment to Stepehen Group in order to fulfill the demand of the contract. Hendren noted that in addition to the recommendation the task force is required to make at the end of this calendar year, it is also mandated to make a report and recommendation at the end of 2016 — the task force could be left stranded if the consultant's work was primarily over on October 1, Hendren said. 

* Hendren did say that if the Legislative Council approved the contract, he and the other task force leaders would accept the decision, work with the Stephen group, and perhaps explore additional options to "alleviate [their] concerns."

* The Republicans who backed the Stepehen Group were clearly largely motivated by the group's promise to "scrub the Medicaid rolls" (verify eligibility for current Medicaid beneficiaries). Hendren said this was an important goal but tangential to the big-picture reform that the task force should be focused on. "About half of the task force was very interested in cleaning up the current program and spending the dollars in the effort to do that," he said. "The other group—while they thought that was important—was more focused on a more comprehensive approach."

* A number of members of the Executive Subcommittee made versions of the obvious political point: whether or not Hendren was right on the merits, it just looks ugly to overturn a majority vote. “What you’re asking this committee to do is usurp the ruling of the entire body?” Sen. Bill Sample asked.  Rep. Mark Lowery asked about the potential implications of this wrangling going forward: "Obviously in a perfect world, we would hope that an ongoing entity like the task force would make most of their decisions by consensus. Can you enlighten us as to your perception of what basically overturning a 9-7 vote would do to damage the ability to have consensus in future decisions?"

* Hendren acknowledged the problem: "obviously it’s not a unifying thing for us to voice our opinion which is contrary to the will of the majority of the task force." He said that it "already has" caused dissension in the task force. But he said that after spending six years at the Capitol in the minority party, he thought it was important for the minority to voice opposition. He noted that the task force was merely giving a recommendation, just as any committee gives a recommendation to a standing body: “At the end of the day it doesn’t matter what the task force says, it doesn’t matter what this committee says, it matters what Legislative Council says.” He said that his concerns were serious enough that he felt compelled to give Legislative Council context to make its decision. Sen. Jonathan Dismang added that the task force wasn't empowered as the final arbiter — ultimately, any plan for the future of health reform needs supermajority approval in the House and the Senate.  

* "This whole RFP process has been one of the most frustrating and disgusting things I've seen down here in a long time," Hendren said. "It's unfortunate that decisions that are so important get hijacked for silly reasons. This is an important decision. … I saw more dynamics at play in this decision and people making decisions based on faulty information or other agendas than what's best for Arkansas. … We've already been divided and we've got some recovery work to do." 

* As you can see from the above quotation, Hendren probably needs to work on his bedside manner. His career in the legislature (with the notable exception of his work on the teacher insurance crisis) has been marked more by throwing mud as the minority than building majority coalitions. Hendren later clarified that he  meant that the involvement of special interests, lobbyists, stakeholders, etc. in the procurement process was "disgusting." The task force members themselves, he said, were acting in good faith. But it's easy to see how the folks that read 3,000 pages of proposals, listened to 18 hours of testimony, and ended up voting the opposite way would take offense. Rep. Reginald Murdock said that he and others were "concerned" by the "pretty strong...words that were used."

* John Stephen, the director of the Stephen Group, testified that the Medicaid "scrub" only made up 10 percent of the firm's proposal, and argued that they in fact did offer a comprehensive plan to evaluate future options for health care reform in Arkansas.  

* Dismang, Hendren, and others expressed confusion and skepticism that it was possible to do a thorough audit of the state's 800,000 Medicaid beneficiaries for $100,000 (Hendren called it "pretty shocking"). Every other consultant testified that a comprehensive audit and "scrub" of the Medicaid rolls would be orders of magnitude more expensive. A number of legislators expressed doubts that the Stephen Group could provide a significant money-saving audit given the budget, time constraints, and other duties under the contract. 

* Stephen promised to save the state money by identifying "leakages" in Medicaid eligibility. Given that the state's Department of Human Services has yet not re-verfied eligibility for private option beneficiaries who have been with the program for a year, there is obviously room for work on this front. However, some lawmakers argued that this task was tangential to the goals of the task force. Dismang argued that a Medicaid scrub was a "service" that could be tackled by a vendor or directly by a state agency. "I don't see where an audit fits in to what you've been challenged to do," Dismang said, addressing the task force. "The goal of the task force was to figure out a way to reform our Medicaid program."

"As much as an audit is needed, as much as scrubbing these rolls is needed, that changes nothing [in terms of the overall health care system]," Hendren said. "If we're going to reform health care, an audit is really not a function of that, that is a corollary."  

"Eligibility verification is something we've been asking for since day one," countered Sen. Terry Rice. "It had to be in there." 

* The irony here is that Democrats, none of whom believe that scrubbing the rolls should be a primary focus of the task force, found themselves in an alliance with folks like Rep. David Meeks, Rep. Kim Hammer, and Rice, who clearly prioritize the issue. Chesterfield and others argued that the Stepehen Group offered many other features in their proposal that appealed to them. "I don't understand why the Stephen Group has been presented as a group that simply wants to scrub the rolls," Chesterfield said. 

* Stephen testified that the group would be available to respond to the task force, including to come to Arkansas to testify, after October 1. "We'll be available all the way through next year if we have to, that's how we operate," he said. But Stephen expressed skepticism that there would be a need for heavy lifting after the fall of this year. He suggested that if a Medicaid waiver was needed, there was no need for a consultant's help — it was as simple as filling out a template on the federal CMS website. This produced guffaws from a few GOPs who have been working closely on health care. 

* Sample proposed giving the task force one more week of "due diligence and maybe come up with a little bit more support for whichever vendor that they choose." This was rejected on a voice vote. 

* Chesterfield pushed back on Hendren's "consensus" argument and gave a colorful and salty speech expressing the anger of Democrats and Republicans alike who had voted for Stephen. "The committee was not designed to have kumbaya moments," she said, noting it was made up of lawmakers who supported the private option and those who opposed it. She expressed skepticism that another week would change any minds and said they had already done due diligence. "I'm not sure how we get to where we need to go by ignoring the majority vote of the task force. … I'm quite frankly disappointed that when the majority speaks, it's not respected.  … Right now, I'm feeling a little put out because we spent all of this time listening to all of these people, and Lord knows that succinctness was not a part of the discussion."

* "I don't understand this delay," Chesterfield said. "I don't understand why we're talking about it and I don't understand how we're going to get a Kumbaya in a week that you didn't get in the last week." She noted the strange bedfellows: "I didn't get with T. Rice to see how he was feeling, and we voted the same way. I certainly didn't get with D. Meeks to see how he was feeling, and we voted the same way. We had some of the most unique votes: there were individuals for the private option and those who were against it, those who were progressive, those who were conservative." 

* Most interesting comment from Hendren was floating the idea of passing on a consultant at all. He said that he and other task force members feared "that this million-dollar expenditure is not going to give us the tools necessary to do real structural changes." He suggested that "we wait and find either a proposal that does that or that we proceed without consultants and do it with the help of a piecemeal approach and the Bureau of Legislative Review and the resources that we have in-house. .. I believe we’ve gotten a little bit crazy with contracts and consultants. This is a million dollars for four-and-a-half months product." 

* I spoke with Hendren after the meeting and he acknowledge the awkwardness of challenging the majority of the task force. "I guess I'm not always thinking about the political side of it, I'm thinking about solving the problem," he said. "My concern is you handicap yourself tremendously on your ability to solve the problem if you don't give yourself the necessary tools. That's my concern and that's why I thought I needed to speak up." 

He said that it remained important to have a team that would work through the end of 2016 (as mandated by the RFP) and reiterated that the talk of scrubbing the Medicaid rolls was a "distraction" which would not generate the long-term savings necessary in comprehensive health care reform.  

"Our job is not to audit health care, it's to reform health care," he said. "It was disappointing to me that we keep going down that rabbit hole here. … I wrote that bill and I know that the charge of the bill is not to go audit DHS, it's to reform health care. And you can see here there's too much focus on that aspect of it."

* After the meeting, Rep. Deborah Ferguson told me that the attempt to maneuver around the majority "taints the process. It is a bad start for the task force." 

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