How I'd Fix HealthCare.gov: Extend Health CEO

Healthcare Robotics: Patently Incredible Inventions

To Extend Health founder Bryce Williams, the right fix to HealthCare.gov is obvious: Offload more of the work of enrolling consumers to his firm and others like it.

"The point is to get enrollments, through whatever means necessary," said Williams, who runs the largest private insurance exchange for Medicare Advantage plans, founded in 2004 and acquired last year by Towers Watson. which made him managing director of exchange solutions. "For the last eight years, since we built Extend Health, there's also been a government site, Medicare.gov, where you could do the same basic things. But nobody enrolls at it. When people enroll, they want help. They want experts to guide them to the right plan."

With the Obama administration declaring victory in its push to get the website working by the end of November for the majority of citizens who try to enroll, InformationWeek sought a variety of opinions from leaders with relevant experience on how they would recover from an IT flop on the scale of HealthCare.gov.

The website performance is certainly much improved, Williams said. "It's gotten better every day -- more functionality and more accurate data. The problem is now it's December 2, and we're out of time," he said in an interview on Monday. The website problems and related political drama are causing "massive confusion" among consumers who don't know what to believe about the real deadlines for enrollment and whether they will be able to keep their existing policies. The government still needs to do a better job of putting out a clear, consistent message on what to expect, he said.

Private firms like his could help sort things out, Williams said.

The strategy of getting private exchanges to take on some of the HealthCare.gov workload has also been promoted by EHealth and other firms. "They've started that, they've dipped their toe in the water, but it's something they should embrace headlong," said Williams. The government should focus on providing services only it can provide, and "not on providing a spectacular customer experience -- that's not government's traditional focus or what it's good at," he said.

Of course, this solution is also self-serving because it would funnel more transactions through firms like Extend Health, which today primarily gets its business from companies who use it to assist their retirees and workers who are nearing retirement. Extend Health has also assisted with several hundred Obamacare health plan enrollments, both through state and federal exchanges, but has had to resort to "workarounds" to do so, Williams said.

When pressed, Williams acknowledged that HealthCare.gov needs to be more fully functional in its own right to get the introduction of the Obamacare insurance marketplaces back on track. Despite the Obama administration's talk of a "tech surge," throwing more people at the problem isn't really the answer, he said. "You need to look at what are the two or three things that are killing you and how can you fix those?" The situation cried out for an intense focus on core functionality, he said.

"The guy they put in charge, he's a friend of ours," Williams said, referring to Jeffrey D. Zients, the Obama adviser who was drafted to lead the HealthCare.gov turnaround. Zients, a former deputy director of the Office of Management and Budget, has been running HealthCare.gov on an interim basis, but is scheduled to become director of the National Economic Council at the White House on January 1. He is also an investor in Extend Health, Williams said. An accomplished entrepreneur and management consultant, Zients is a former CEO of the Advisory Board Company, known for providing analysis and advisory services to hospitals and healthcare firms, and of the Corporate Executive Board.

"He's one of the smartest guys we know in this space, and I think he's doing what needs to be done," Williams said. The key errors happened prior to Zients' arrival, he said.

"The up-front mistake is they tried to do too much in too little time," Williams said. Making things worse, "they were changing the rules while the system was in development, which is never a good idea." In other words, there was too much "late-breaking regulatory input" that altered the way the system would have to function, making the software development task much harder.

As the October 1 launch date approached, the website seems to have had "theoretical high scale," Williams said, meaning that the optimistic estimates of how different components would function must have added up to someone's satisfaction. But this optimism ignored the reality of how much interconnectivity would be required with other government and insurance company systems, which "starts to really narrow what your effective scalability is," he said. "That's what happens when you have that many interconnects, that many cooks in the kitchen."

Because Extend Health has access to the federal data hub that integrates data feeds for HealthCare.gov as well as the state exchanges run by individual states, Williams said he can report that that component has improved over the last seven to ten days. About three weeks ago, there was a period when it was failing about 25% of the time, he said. The government should be focusing on providing good data that can be used by HealthCare.gov but also by external insurance brokers, he said.

"They should be providing accurate rate and benefit data across all the exchanges," Williams said.

One suggestion made by some computer security experts, both in interviews with InformationWeek and Congressional testimony, was that HealthCare.gov should be shut down to avoid risk of a breach while repairs were underway.

Williams disagreed, saying, "I'm not sure what that would have bought you." A business that was experiencing website performance issues could not have afforded to go offline while it addressed those issues, and neither could HealthCare.gov. The more common pattern, which the HealthCare.gov developers seem to have followed, was to push new code to development servers for quality assurance, while continuing to operate the site. "They were probably doing nightly software releases where they knew they could fix big problems," said Williams.

Those incremental improvements have been adding up, he said.

Follow David F. Carr on Twitter @davidfcarr or Google+. He is the author of Social Collaboration For Dummies (October 2013).

Though the online exchange of medical records is central to the government's Meaningful Use program, the effort to make such transactions routine has just begun. Also in the Barriers to Health Information Exchange issue of InformationWeek Healthcare: Why cloud startups favor Direct Protocol as a simpler alternative to centralized HIEs. (Free registration required.)