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10/24/2013
03:07 PM
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Why HealthCare.gov Failed

Experts say a lack of consumer-centric development and user testing led to the disastrous rollout of the government's Obamacare portal.

10 Mobile Health Apps From Uncle Sam
10 Mobile Health Apps From Uncle Sam
(click image for larger view and for slideshow)

President Obama's speech Monday addressing Healthcare.gov's let-down of a debut was full of emotion. Obama is angry. He's requesting patience. He's faithful the glitches will be fixed.

Although those sentiments are nice to hear, the speech noticeably lacked any specific details on what went wrong and how exactly the government will address problems, other than a team working overtime "24/7".

The marketplace's failure lies in the lack of a consumer-centric approach, experts say. The system was tested prior to its launch, but not at the scale it needed to be.

"You have to generate voice and data traffic simulating interaction, flow and length of interaction," said Tim Moynihan, VP of marketing at Empirix, a network performance company that provides testing and monitoring services for Web systems. "These things combined at volume begin to affect one another."

[ What did state online marketplaces do to help ensure their success? Read Obamacare Health Exchanges: How Oregon Got It Done. ]

About a third of the 3.7 million Americans who attempted to register the first week after the marketplace's Oct. 1 launch were successful. Seven million Americans are expected to be insured under the Affordable Care Act, and they must enroll using the marketplaces by Dec. 15 in order to have coverage start on Jan. 1.

Administration officials estimate the number of health insurance applications received through the exchanges at 476,000. To date, Healthcare.gov has been visited nearly 20 million times, Obama said.

"Amazon handles more traffic in a few hours than Healthcare.gov handled at its highest point," said David Lloyd, CEO of IntelliResponse, a customer service technology provider. "Obama says the product is good. You can have the best product in the world, but if no one can buy it, it really doesn't matter."

The first step shouldn't be engagement, it should be education, Lloyd said. Basic features such as the search box didn't function as intended, with search queries returning irrelevant results. Much of the educational material about different coverage options could be accessed only after registering. This is a major roadblock not only because it prevents easy access to information, but because registration failed for millions due to glitches in the system.

The failure (and resulting political storm) is exacerbated by the lack of options out there—Healthcare.gov is all that's offered. Consumers are locked in. When you have a single option for a large marketplace, its failure is that much worse and hits that much harder.

Obama offered two alternatives to registering through the site: phone hotlines and in-person consults. These aren't bad options, considering the ease of picking up the phone -- an in-person application process is another story. But they're also last resorts. There's no way around it: The Healthcare.gov blunder is embarrassing and could have been avoided.

"When building a site of any scale, you must create and emulate the customer experience as closely as possible," Moynihan said. "You have to look at it from a customer experience point of view. You must understand how it works and appears from the customer side of the equation, not the inside, IT side of the equation."

Continual testing, not just pre-launch evaluations, is needed to ensure continued success of any site. This can be accomplished by installing a monitoring package on the live system that provides alerts for traffic or data surges, Moynihan said.

There are various "low-hanging fruits" the developers could have picked up on to prevent some of the problems, said Steve Tack, VP at Compuware APM, an application performance management company. Optimizing bandwidth could have been achieved with the merging and minifying JavaScript and CSS files, as well as compressing images. Implementing a CDN or additional Web performance optimization rules also could have saved bandwidth and round trips to improve the user's experience. All of these fixes can enhance application delivery across the infrastructure without a code update, Tack said.

"High-performing applications are not just something nice to have," he said. "Businesses can be halted without them."

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J_Brandt
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J_Brandt,
User Rank: Ninja
11/14/2013 | 9:28:29 PM
re: Why Healthcare.gov Failed
I don't think it's unfair comparison either. Amazon built it from the ground up, suffering all the slings and arrows of the trail blazer. That makes it even more ridiculous to have HHS/CMS blaze another trail along side Amazons. I thought we were supposed to learn from history, not be doomed to repeat it.
WKash
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WKash,
User Rank: Author
11/1/2013 | 4:44:25 PM
re: Why Healthcare.gov Failed
There's is a lot of chatter about the failure of management here, and
where the CIO was in all this. That this was a management failure is
indisputable. Whether it was the CIO's failure is less clear.

Many
projects in government are led by program managers Gă÷ call them the
business owners Gă÷ who frequently have greater authority, and are often
under pressure to defend that authority, making it much harder than it
would seem for a CIO to have an impact on the architecture and
technology recommendations on a project, especially ones that ties
together so many players. This is why governance Gă÷ having defined roles
and ground rules Gă÷ for dealing with competing interests in a shared
project is so important.

The question here is not so much where
was the CIO (though it does need to be asked), but where were the
leaders who oversaw the program manager? Where were the governance
controls that might have given stronger advisory roles by the CIO Gă÷ or
CIOs from the playersGăÍ whose systems were being connected together
behind Healthcare.gov?

The battle of expertise and authority
between program leaders and IT leaders within a federal agency or
department are epic, and the source of continuing debate in Congress as
to whether the CIO has the authority necessary to control agency IT
projects. With few exceptions, they donGăÍt.
thephilsimon
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thephilsimon,
User Rank: Apprentice
10/28/2013 | 1:31:21 PM
re: Why Healthcare.gov Failed
50 or so vendors is a recipe for disaster.
thephilsimon
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thephilsimon,
User Rank: Apprentice
10/28/2013 | 1:30:53 PM
re: Why Healthcare.gov Failed
Nice piece. The lack of testing is appalling. A marketplace like this Healthcare.gov should not be confused with traditional IT projects. Yes, "platforms" share similarities with enterprise systems (read: ERP, CRM, etc.). Still, tens of millions of people do not concurrently use these applications. We're talking about differences in orders of magnitude.
Alex Kane Rudansky
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Alex Kane Rudansky,
User Rank: Author
10/27/2013 | 8:40:49 PM
re: Why Healthcare.gov Failed
Thanks for your comment, BGreene. While I understand Amazon has 17 years of experience under its belt, I don't think it's unfair to draw a comparison between Amazon.com and Healthcare.gov. With a project of this scale, the expectation is for HHS/CMS to put together a team and produce a product that can provide a similar level of service and usability as Amazon.
BHauptCISSP
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BHauptCISSP,
User Rank: Apprentice
10/26/2013 | 10:56:47 PM
re: Why Healthcare.gov Failed
Please? Maybe... in NY, CO, RI, OH & NJ since everywhere else people are going to be gobsmacked by the increases they see. (Chart comparing the impact to a single male aged 27 and 50 and a
typical family of four -
http://www.heritage.org/multim...

In the other 45 states the rates have skyrocketed (and will continue thus in the out-years) even while, in just the last three weeks, over a million people got dropped by their insurers who either stopped selling in their state altogether or killed the currently offered packages as is happening to 800,000 affected in NJ, according to The Star Ledger. (http://www.nj.com/news/index.s...

Meanwhile, Kaiser Health News (note that I'm not quoting Fox or other supposedly right-wing outlets) reported, "Florida Blue, for example, is terminating about 300,000 policies, about 80 percent of its individual policies in the state. Kaiser Permanente in California has sent notices to 160,000 people G㢠about half of its individual business in the state. Insurer Highmark in Pittsburgh is dropping about 20 percent of its individual market customers, while
Independence Blue Cross, the major insurer in Philadelphia, is dropping about 45 percent." (http://www.kaiserhealthnews.or...

A broken website full of vulnerabilities begging to be hacked, Navigators with little training and no background checks, the evisceration of HIPAA and the invasion of financial records by 16,000 new IRS agents are the least of our problems! (#WhatPrivacy) It's the implementation of the program that is going to overwhelm the system (read: delivery mechanism) and crash it. The ACA requires funding by "young invincibles" who have no impetus to sign up when they're covered until they're 27 on Mom & Dad's health plan... assuming that Mom & Dad's work isn't dropping them or chopping their hours back to less than 30/week. What we have in the ACA is an inverse Robin Hood scheme where the under-employed or low-wage-earning youth with mountains of college debt are stolen from the pay the medical costs of the older high-wage-earning folks. And the fines that these young invincibles will doubtless opt for in the first two years are magnified greatly in the third and following years when it will be too late for them to complain.

So much for the mantra "If you like your insurance plan you can keep it!" As to the other mantra, "If you like your doctor, you can keep him/her," I personally have lost three critically important specialists in the last two months who all, rather apologetically, told me to my face that they were leaving their practices due to the impending application of the law. They were already acting more like insurance administrators and less like physicians BEFORE this debacle so ACA was just a bridge too far!

Health INSURANCE is worthless when you have no one to provide the health CARE! But I guess that's just a minor point that seemed to be lost on many who championed this baby step toward socialized, aka "single payer", medicine. It doesn't work in the UK, Canada or anywhere else, so why are we so arrogant to think it will work here? Well... because this is what Progressives have been pushing for since Woodrow Wilson and whether it kills the patient or not they're not going to let it go now! Generations yet unborn will look back on this time and wonder just what in the the Hell we were thinking!
BGREENE292
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BGREENE292,
User Rank: Strategist
10/26/2013 | 11:13:38 AM
re: Why Healthcare.gov Failed
Thoughtful analysis, but questions naturally arise--

(1) There were more than six large contractors involved, not only one Canadian firm.
(2) What evidence suggests the project was pushed beyond the 2012 election to avoid political damage? Had the project begun in 2012, results still were not necessarily due until after that election.
(3) Retaining appropriate control is the nature of oversight, especially on a project of this dimension. Only a closer review of HHS decision-making offers insight into why the decision was made-- but probably according to a calculus more complex than you suggest. Obviously, that will come out later.
(4) Retaining CMS could be understood as cost-saving, common sense and building with a proven track record of service delivery
(5) On state exchanges, sticker shock has not been a problem, so why should it be on the federal exchange? "Free flow" of policy information is not impeded by information about subsidies, since subsidies are an obvious and frequent consumer question, with subsidy calculation ranked accordingly.
(6) Would be interested in the HHS logic behind its system testing and problem-flagging. Only 24 hours before launch, a network reported an HHS spokes-person was confident the system was ready, which set off my alarm because no qualifiers that might be expected were even mentioned.
BGREENE292
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BGREENE292,
User Rank: Strategist
10/26/2013 | 10:35:23 AM
re: Why Healthcare.gov Failed
Or, extremely pleased, as they case may be. On state exchanges, the low prices on industry-competitive policies surprised even GOP critics.
BGREENE292
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BGREENE292,
User Rank: Strategist
10/26/2013 | 10:33:06 AM
re: Why Healthcare.gov Failed
Due to circumstances, this article is virtually a two-source interview and predominantly speculative, not a more comprehensive look at what happened. Presumably, that will come later.

Rather than post-game quarterbacking from one or two selected sources, it would be valuable to wait for (1) more sources, including those from the administration (2) more (well-established) facts. As associate editor, you already may have the groundwork for that in preparation.

To compare healthcare.gov with Amazon.com is misleading in the extreme-- the Amazon site went live in 1995, and has had nearly 17 years to refine itself into a good model for web business.
Alex Kane Rudansky
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Alex Kane Rudansky,
User Rank: Author
10/25/2013 | 9:52:07 PM
re: Why Healthcare.gov Failed
So many missed opportunities to get the site right from the get-go. A delayed launch that went smoothly would've trumped this mess.
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