There’s never a dull moment at HHS these days. First there was the mad, last-minute “Sign up, sign up, sign up!” rush to the enrollment deadline, then Medicare released all that price data and then Secretary Kathleen Sebelius resigned.
I’m sure everyone in the department is glad they have some time to regroup before the next enrollment period begins, but no one working on any aspect of HealthCare.gov can relax for very long. New problems will crop up between now and the next enrollment, and of course there is the fresh embarrassment of the site crashing on March 31, the last day to enroll for 2014 coverage.
An expert on software and health insurance data has three suggestions for Secretary Burwell’s first to-do list. Kev Coleman, Head of Data and Research at HealthPocket, said Burwell needs to conduct security testing, ensure the right software development method is in place and compile a comprehensive data set for all the insurance plans on the exchange. Coleman worked for PlanPrescriber and Experion before joining HealthPocket 18 months ago. He built an exchange for Medicare insurance policies, so he understands the challenges HHS faces.
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1. Conduct an honest post mortem about the successes and failures of the exchanges
Coleman listed the lack of comprehensive security testing before the federal exchange launched in October 2013 as the biggest problem with the launch.
“There needs to be comprehensive security testing before the next enrollment,” he said. “They need to figure out what code gets remediated and what gets replaced immediately.”
Coleman said that the other big technical task is to make sure back-end connectivity with insurance companies is strong, which has not been the case.
“They’re the people that have to process the data from the applications to make sure people get their info on time,” he said.
2. Keep a close eye on Accenture
Accenture took over the management of HealthCare.gov in January. The company did make enough changes to allow millions of people to sign up, but the site went down briefly on March 31, so there is obviously work still to be done.
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Coleman said another big problem with the initial release of the federal exchange was that the development team used the waterfall method of software development. This involves scoping out the entire project, writing requirements, doing all the coding and then doing Q&A testing.
“Silicon Valley firms don’t use the waterfall method because it greatly increases your risk of failure,” Coleman said. “If you do smaller incremental releases of code, you can identify problems much earlier in the process.”
Most modern software firms use the agile development method to build websites and software. With this approach, the plan for building the software is built as the software itself is built. That way, unanticipated problems or new requirements can be incorporated into the development work as it progresses, instead of having to start writing requirements all over again. Also, testing is done throughout the agile development process, instead of at the end.
“They should do smaller incremental release of code, and identify problems much earlier in the process,” he said.
He also said that if the culture of the team is not right failure is almost guaranteed.
“They had the adequate internal procedures to catch the technical bugs, but they weren’t obeyed by people running things,” he said.
3. Publish the plan data that people need to make informed choices
Many of the insurance plans on the federal exchange did not provide all the relevant information – formulary lists, co-pays, etc. The benefits to consumers is obvious, but having this data publicly available also allows third parties (like HealthPocket) to set up insurance comparison sites.
“That creates a wonderful competition that benefits everyone,” he said. “Not having this data creates an unequal playing field, and does a disservice to the government.”
HHS already has a good model for releasing this information.
“Medicare has an established model for this, all the data – premiums, cost sharing, formulary data – is available to the public,” he said.
HealthPocket has a vested interest in getting this information so they can improve their own database of available plans. Coleman said this information would also help researchers understand how the insurance market has changed since the ACA became law.
Coleman reached out to the founders of HealthPocket — Sheldon Wang and Bruce Telkamp — about joining them when the company was founded.
“The co-founders were visionaries, they understood how much the market was going to change and that consumers needed a custom advocate model,” he said. “We’re very much a child of the big data movement.”
The company claims to be the largest single repository of information about American health insurance policies, gathering data from numerous sources including state health insurance rate filings. The site was definitely designed by people who understand how to organize and present data. Scroll down for several screenshots of the site’s search options and results.
