In the nearly three years since the botched launch of Healthcare.gov as the federal government’s main e-commerce site for enrolling uninsured consumers into a health insurance plan, the government continues to add a slew of new features and functions.
In the last six months Healthcare.gov has been updated with several new features that the Center for Medicare and Medicaid Services, the branch of the U.S. Department of Health and Human Services that oversees the site, contends makes it easier for uninsured consumers to research, compare and shop for health insurance.
For example a new pilot program just now getting underway on Healthcare.gov would simplify the site’s search engine and search results. In prior enrollment periods, a query for health insurance plans would yield a complicated set of plans, prices and coverage options that made it difficult for users to quickly and easily compare results, says Healthcare.gov CEO Kevin Counihan.
But under the pilot program and leading up to a full rollout for the next enrollment period beginning in November, a better site search engine and updated taxonomy will deliver users more easy-to-understand results.
For example a user may type in queries such as “co-pays $50,”“highest to lowest fixed deductibles,” or “compare out of pocket limits” and the updated site search engine will deliver back results grouped by health plans. It will also offer faster ways to compare results and broaden or narrow site search queries. “We are testing display options and descriptions so that consumers can best understand what they offer and make a clear, easy-to-understand choice,” Counihan wrote in a recent blog post on Healthcare.gov.
CMS says Healthcare.gov is being updated with seven major upgrades all designed to generate and handle bigger numbers of consumers enrolling and re-enrolling for health insurance. “We’re continuing to learn how to make the consumer experience even better, Counihan wrote.
But even though CMS says improvements to Healthcare.gov are ongoing, healthcare e-commerce analysts and government watchdog groups such as the General Accountability Office say CMS still has its work cut out making the e-commerce site easier and safer for consumers to use.
“Healthcare.gov is the national automated health plan enrollment system and a high-profile part of Obamacare and healthcare reform,” says Patrick Kennedy, founder of PJ Consulting, a healthcare insurance technology consulting firm for several Blue Cross and commercial insurers. “But it’s still a poorly designed and operated site that is not easy for insurers to participate in and complicated for consumers to use.”
Today more than 1,000 insurance companies participate in Healthcare.gov, which during the last open enrollment period from November through January signed up or re-enrolled 9.6 million consumers for health insurance, an increase of 9.1% from 8.8 million, says CMS.
But Kennedy who consults with multiple big health insurers on issues such as automated eligibility information and benefits enrollment information processing, says the data several of his unnamed clients receive from Healthcare.gov is often incomplete or full of coding mistakes related to the consumer’s personal information or the coverage they selected. “Most of the major health insurance companies have a better automated enrollment system than Healthcare.gov and many insurers tell me they get a lot of bad data from that exchange,” Kennedy says. “In a lot of cases many insurance companies have to re-contact the consumer and go through the whole enrollment process one more time.”
CMS contends it has come a long way in overhauling Healthcare.gov since its highly publicized but hugely troubled launch in October 2013. The fall 2013 debut of Healthcare.gov was plagued by slow web site performance and outages because of the site’s inability to handle larger-than-expected traffic volume, according to the GAO.
The original projection was that when Healthcare.gov launched daily web site traffic would be 50,000 to 60,000 visitors. Instead as many as 250,000 visitors per day overwhelmed the site. By the end of the first month only about 27,000 consumers had enrolled. The government had expected as many as 500,000 consumers to enroll in the first month Healthcare.gov went live, says the GAO.
In the past two years, the federal government poured more than $800 million into rebuilding the site, brought in 20 new contractors including Amazon Web Services, the cloud computing arm of Amazon.com Inc., to develop or operate new back-end systems. The project also overhauled the procedures for how Healthcare.gov is operated and updated, says the GAO.
Healthcare.gov has an operating budget for the government’s 2016 fiscal year ending Sept. 30 of $1.99 billion, which will rise to $2.14 billion in fiscal 2017. Healthcare.gov is now robust enough to handle nearly 2 million daily visitors per day and CMS has implemented much tougher web site performance and overview procedures, according to GAO.
CMS also says that as more consumers take to the web to shop for health insurance and to see if they qualify for a federal government subsidiary of their health insurance they will continue to see more improvement to Healthcare.gov features and functions.
Before insurance enrollment season last October, Healthcare.gov was updated with new tools to enable consumers to see if their doctor participated in a particular health plan and see what plan covered their prescriptions and at what price. Other updates took return users faster to the previous year’s enrollment information and provided easier ways to determine out-of-pocket costs for each insurer.
Over the next year CMS also will work with participating health insurers in Michigan, Ohio, Pennsylvania, Virginia and Wisconsin to roll out a pilot program for a rating system of 1 to 5 stars to rate participating plans on factors such as the quality of care provided by individual physicians in a particular plan. CMS says it is working with various unidentified healthcare quality experts to develop surveys insurers will deliver to their plan enrollees and then collect the results.
The final results will then be formatted and updated periodically on Healthcare.gov. “The information provided through the rating system can inform consumers about the quality of healthcare services and enrollee experience, as well as assess the overall patient and consumer experience, for health plans offered on the marketplace,” Counihan wrote in Healthcare.gov.
But Healthcare.gov still has other ongoing operations problems to fix, including needing better data protection. In a report released in March a GAO review of the Healthcare.gov web site and database found that hackers attempted to illegally access Healthcare.gov 316 times in the last two years. While the GAO says hackers failed to gain access and that no data was stolen, the incidents does demonstrate Healthcare.gov is frequently subject to ongoing potential threats such as hackers that want to plant a virus or initiate a denial-of-service attack. A denial-of-service attack is an assault on a web site that is designed to significantly slow down or crash the site by flooding it with useless traffic.
The GAO says CMS is currently implementing more than 20 system changes such as stronger encryption of more data and initiating tougher and more frequent monitoring requirements to protect the Healthcare.gov database from unauthorized access.
But given its relatively short history of dealing with major operational issues including new ones involving security Healthcare.gov still has its work cut out convincing consumers and the broader healthcare industry it can operate consistently and reliably as the biggest web-based health insurance enrollment system.
“Healthcare.gov needs to get better at a lot of things,” says Jeff Donlan, co-founder and president of Chicago-based ConnectedHealth, which operates a private healthcare exchange and employee benefits management technology company. “Healthcare.gov is high profile and has the ability to really impact how people now and going forward will be shopping for health insurance.”