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Glitches with Federal Health Care Exchange Website Cause Concern

By ThinkReliability Staff

The website to allow individuals to sign up for the federal Health Care Exchange created as part of the Affordable Care Act opened at midnight on October 1, 2013.  Delays and glitches with the site itself caused difficulties for many trying to enroll.  Three million visitors are said to have visited the site between midnight and 4 p.m. on opening day, though the numbers of how many were actually able to enroll will not be released until November.

This creates a problem not only from a customer service perspective (though that is certainly an important impact to the federal government’s goals of trying to create a consumer-friendly website), but also with regard to the mission of providing affordable healthcare to the population and the labor and time required by federal workers for its success.  Because the cost for healthcare is more for older, sicker parts of the population, more younger, healthier people will need to sign up for the exchanges to keep the insurance affordable.  Some people who go to the website are now being directed to apply by phone, or mail, but because the site incorporates automatic verification of personal information, that will need to be done manually by employees when people apply in other ways, this increases the cost of the program.

Though specific details on some of the issues facing the exchange have not yet been released, there are some known issues that have been discussed in the media.  One of these is the available capacity for the site.  The site was planned for a maximum of 50,000 simultaneous users.  During the first day of the exchange, the site saw up to five times that many simultaneous users.  The numbers are presented as being based off the 30,000-maximum simultaneous users to the Medicaid site, but how the actual number was determined is unknown.  An increased burden on the site due to the 36 states that decided not to create their own state-run exchange contributed to the high number of users.  It was thought that the promise of federal money to support the state-run exchanges would encourage more states to participate.

The requirements for the website have been described as “unprecedented” – not only was the website designed to handle a high number of simultaneous users, it also has to share information from multiple data sources, including the Internal Revenue Service, Social Security Administration, and Homeland Security to verify information and determine access to plans and tax credits.  Based on the number of glitches and delays seen in the first weeks of the exchange website, the testing of the launch appears to have been inadequate.  Factors that may have played a part are lack of funding due to lack of support for the Affordable Care Act by Congress, and a delay in creating the infrastructure of the system over a concern that the Act would be overruled by the Supreme Court or Congress.

Information technology experts say that lessons learned from other sites – such as state-run exchanges that have already been successfully operated, or even the Medicaid site – were not applied effectively to the exchange.  The organization tasked with oversight of the exchange – Centers for Medicare and Medicaid Services (CMS) – has little experience with managing a website of this magnitude.  It has also been suggested that the contractors hired to support the site may be less able to react because government contracting can be preferential towards older, more entrenched companies.

As more information is released, the analysis of an issue becomes more detailed and allows for more effective, deliberate solutions.  The information that is currently publicly available was used to create an initial, high level Outline and Cause Map.   (To view the Outline and Cause Map, please click “Download PDF” above. )

As an immediate, but temporary solution, an online waiting room was created in hopes that it would allow an increased number of users to be on the site at the same time.  Additionally, the ability to browse anonymously – without creating a profile – was incorporated, in hopes that this would decrease traffic to parts of the site that require personal information verification for those who are just looking at the site.

A team of experts has been tapped to fix the glitches with the site.  It’s not clear who will ultimately be responsible for the fixes, though many have recommended the creation of a new position to oversee the entire exchange.  If issues with the site continue to cause delays, the sign-up period may be extended as a back-up solution.  The administration will be watching the fixes to the site carefully and determining what more is needed.  However, they’ve got to hurry – the enrollment period ends December 15 for coverage by January 1, 2014.

To view the Outline and Cause Map, please click “Download PDF” above.  Or click here to read more.