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12/2/2013
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HealthCare.gov Hitting Performance Targets, Says Zients

User-facing components performing well, says project overseer Jeffrey Zients. But questions remain whether the back end will work for insurers.

 7 Portals Powering Patient Engagement
7 Portals Powering Patient Engagement
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The Obama Administration announced over the weekend that it has met its self-imposed deadline of November 30 to make critical repairs to HealthCare.gov, the federal website for individuals to buy health insurance.

Downtime, error messages, and incorrect data dogged the site from the moment it went live on October 1. During some weeks in October, the site was down an estimated 60% of the time, according to the Progress and Performance Report released December 1 by the Department of Health and Human Services (HHS). But HealthCare.gov's performance has improved steadily following a series of congressional hearings; an overhaul of the team of vendors developing the site, whereby Columbia, Md.-based Quality Software Services Inc. was named general contractor; and the installation of Obama go-to performance official Jeff Zients as project overseer.

"The site is now stable and operating at its expected capacity," Zients said in a Sunday morning conference call with reporters. By "expected capacity," Zients was referring to a target of 50,000 users per hour, 800,000 in a given day.

[ Want more of InformationWeek's in-depth coverage related to HealthCare.gov? See Obamacare Tech Saga: Special Report. ]

Site fixes and improvements continued up to the November 30 deadline. "More than 50 bug fixes were installed [Saturday] night, many for improvements in the backend of the system," Zients said. In all, contractors working on the site made more than 400 fixes and software improvements since the October 1 launch date, he said.

The troubleshooters installed dedicated hardware to eliminate the bottleneck for the registration database, achieving a fourfold performance improvement, Zients said. The core database now runs on 12 dedicated servers with upgraded storage.

Jeffrey Zients addresses the possible government shutdown earlier this year.
Jeffrey Zients addresses the possible government shutdown earlier this year.

Another significant improvement was to the system's firewall. "The firewall was a constraint on capacity and throughput, so it was upgraded," achieving a five-fold improvement, Zients said.

When HealthCare.gov was launched on October 1, the average time for the system to respond to user input was eight seconds; for the past three weeks, the average response time has been under one second, Zients said. Site errors were occurring 6% of the time in October; as of November 29, errors were occurring 0.75% of the time, he said.

Questions remain, however, about backend components of the site. Are insurers receiving the correct information from consumers for plans they're enrolling in? Is the government providing the correct information about subsidies consumers might be eligible for? And is the government ready to pay those subsidies to the insurers? The New York Times and others reported that Zients' team prioritized improving the citizen-facing portion of the site, deferring repairs and improvements to the backend components.

Karen Ignani, CEO of the trade group America's Health Insurance Plans, acknowledged that "Healthcare.gov and the overall enrollment process continue to improve," but she said the most significant backend issue that still must be addressed is "the ongoing problems with processing 834 enrollment files" -- the forms that give insurance companies basic information about would-be customers. 

With most HealthCare.gov insurance plans set to go into effect Jan. 1, 2014, the biggest question will be whether the troubleshooting team can make all needed improvements in time, especially as Zients is moving on in January to become the director of the National Economic Council.

Speaking on NBC's Meet The Press on Sunday morning, Rep. Mike Rogers (R-Mich.) focused on the security of HealthCare.gov. "The security of this site and the private information does not meet even the minimal standards of the private sector, and that concerns me," Rogers said.

"I don't care if you're for it or against it, Republican or Democrat," he continued. "We should not tolerate the sheer level of incompetence securing this site. And remember how much personal information is not only there, but all of the sites that the hub accesses would expose Americans' personal information in a way that is breathtakingly bad."

But Ezekiel Emanuel, a former health policy adviser to President Obama and now a professor at the University of Pennsylvania, called the recent site improvements "good enough progress."

"Clearly, just like Google and Facebook and all the other Internet sites that are constantly tweaking their sites, constantly improving them, this one still has a ways to go," Emanual said. "I, in particular, want the 'shop and compare' [feature] to improve. That's a key area where people can see what's available, what the prices are."

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ChrisMurphy
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ChrisMurphy,
User Rank: Author
12/2/2013 | 3:53:31 PM
Challenge Ahead
To me, this sounds like the real test still lies ahead. Site responsiveness is a known problem in the ecommerce world, but the big, hairy challenge is the analytics engine to calculate subsidies and match people with policy options. Am I crazy to be optimistic about the developers' ability to crack that nut?
Thomas Claburn
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Thomas Claburn,
User Rank: Author
12/2/2013 | 4:24:14 PM
Re: Challenge Ahead
I'm sure they'll get it eventually. I hope this makes politicians more cautious about promising code by a certain deadline. Anyone who writes code learns to expect bugs and missed deadlines. Online applications just can't be delivered very reliably.
WKash
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WKash,
User Rank: Author
12/2/2013 | 4:27:36 PM
Longer term
CMS communications director confirmed Monday that the part of the back end intended to process subsidy payments to insurers is not done. She said the government will use the Medicare payment transaction system while the HealthCare.gov payment transaction system is "built out."  But still, there would appear to a new mountain of issues on the back end that consumers won't see so much, but insurers sure will. 

 
JayA983
IW Pick
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JayA983,
User Rank: Apprentice
12/2/2013 | 4:32:35 PM
Hitting targets are for betas not production
Software that is released to the public should be fully functional. 

Ezekiel Emanuel's comments calling the the recent site improvements "good enough progress" are lame and remind me of the saying "Good enough for government work."

Emanuel should also understand there is a major difference between tweeking a site and making fundamental changes on the fly to get it to work.
Marilyn Cohodas
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Marilyn Cohodas,
User Rank: Author
12/2/2013 | 4:49:11 PM
Re: Hitting targets are for betas not production
I think Healthcare.gov will be playing catchup for a long time, still. On the plus side, it sounds like they've finally given IT a seat at the grownup's table so maybe they will be able to pull this together. Or at least together enough...... Stay tuned. I know I am...
David F. Carr
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David F. Carr,
User Rank: Author
12/2/2013 | 6:29:53 PM
Re: Hitting targets are for betas not production
Was the problem really the lack of a "seat at the table?" Or were there too many people around the table, too many people making big promises?

I think this is more a story of putting someone in charge of all the technologists and holding them to a much higher standard than they would before.
Gary_EL
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Gary_EL,
User Rank: Ninja
12/3/2013 | 12:44:48 AM
Re: Hitting targets are for betas not production
>> it sounds like they've finally given IT a seat at the grownup's table

From the reports that are beginning to trickle out, it sounds as though IT's lack of a voice was the major culprit here. That allowed optimism and unwarranted overconfidence to take their toll. In their defense, Amazon, Ebay, Facbook et al weren't born giants like the heathare.gov was; rather, they started small, so problems could be attacked while they were still localized, affecting few people.

One way or the other, authors and case writers are going to have a field day with this for years to come.
WKash
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WKash,
User Rank: Author
12/3/2013 | 8:35:28 PM
Re: Hitting targets are for betas not production
The fact that there were 400 issues needing immediate fixing is one clear indication that the site was not ready to be released, and that the managment disciplines were clearly not where they needed to be.

 
Charlie Babcock
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Charlie Babcock,
User Rank: Author
12/2/2013 | 5:22:22 PM
When did they discover the B team was in charge?
It seems to me this all-important priority of the Obama administration had the B-team working 9-5 on it right up until the moment of admitted failure. Then a few A-tream members were brought in and lots of belated hard work has begun to set things right. I agree with John Engates comments, elsewhere on this page. 
David F. Carr
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David F. Carr,
User Rank: Author
12/2/2013 | 6:35:53 PM
Re: When did they discover the B team was in charge?
Chas is referring to a related story: Rackspace CTO Engates Analyzes HealthCare.gov Meltdown
David F. Carr
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David F. Carr,
User Rank: Author
12/2/2013 | 7:09:28 PM
Re: When did they discover the B team was in charge?
This doesn't suggest a lot of confidence:

Can HealthCare.gov actually handle 50,000 users at a time? http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/02/can-healthcare-gov-actually-handle-50000-users-at-a-time/
SilenceD518
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SilenceD518,
User Rank: Strategist
12/3/2013 | 8:50:06 AM
ACA
A look at the cost structure of the ACA, for those who are interested. Good luck.
 
Research: Healthcare IT Priorities
Research: Healthcare IT Priorities
Meeting regulatory requirements barely inched out managing digital patient data as the top priority for our 363 healthcare provider IT pros.
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