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Health Exchanges

Drugstore Rx
Back in 1995 when my team at IBM was building a website for the 1996 Summer Olympic Games, we learned many lessons about websites. Back then, we said that we had no idea how many people would visit the site, when they would visit, how long they would visit, or what they would do when they visited. The second lesson we learned was to think big, start simple, and iterate fast. The more traditional approach, which I call the “grand plan” approach is to think big, start big, and disappoint. The other lesson we learned was to not use large multicolored images that take a lot of bandwidth to deliver and add no value to the functionality of a webpage. It is clear which approach the federal health insurance exchange has taken.
I stopped by the healthcare.gov website yesterday and was greeted with an enormous multicolor image nearly filling the entire page. Experts who have reviewed the site say the government and their contractors did everything wrong. When I clicked to enroll (just to see what would happen), I was asked to choose a state. After doing so, I got a message saying that the Federal government would be providing the enrollment process. When I clicked to continue, the page said “We have a lot of visitors on the site right now. Please stay on this page. We’re working to make the experience better, and we don’t want you to lose your place in line. We’ll send you to the login page as soon as we can. Thanks for your patience!” But, here is the amazing part: “In a hurry? You might be able to apply faster at our Marketplace call center. Call 1-800-318-2596 to talk with one of our trained representatives about applying over the phone.” Can you imagine eBay or Amazon suggesting that it is faster to call than to use their web site?
Unfortunately, these failings are not unique to the Federal government or the state governments that are also having problems with their sites. Many companies are turning to private health insurance exchanges as a way to simplify the access to healthcare insurance for their employees and/or retirees. My former employer, IBM Corporation, has more than 100,000 retirees in the United States, and the company has turned to ExtendHealth, a Towers Watson company to provide an online exchange for IBM retirees. The site provides details about insurance plans and prices for coverage in four areas: Medigap or Medicare advantage, prescription drug plans, dental plans, and vision plans.
My wife and I enrolled on the site and provided our personal details. So far, so good. The next step was to have a conference call with an expert at ExtendHealth. The call took place on Friday and lasted three hours and 40 minutes. It was the most painful administrative process I have encountered in my life. The prices and plans the expert described were different than what appeared on the website. Perhaps the government shut down prevented certain data becoming available from Medicare. For each of the four areas of coverage, my wife and I had to repeat all of our personal details that were already recorded at the website. We then had to listen to audio recordings of legal details concerning what is included and excluded in the various plans and then record our own voice providing a consent. The complexity of the various choices is mind numbing. A government study found that more than 20% of adult Americans were not “able to locate information in text”, could not “make low-level inferences using printed materials”, and were unable to “integrate easily identifiable pieces of information.” How are they going to understand health insurance choices?
Many people say the solution to the complex healthcare system is to have a single payer instead of the many insurance companies. Does the federal health insurance exchange offer confidence that the government could operate a single payer system? I don’t think so. Who is to blame for the complexity I faced? Is it IBM? No. IBM is providing a fixed amount of money for each retiree toward their healthcare cost. Many, perhaps most, companies provide no assistance to retirees for healthcare. IBM has turned to ExtendHealth as a way of administering the program in the best possible way. Even though it was painful, it likely is the best possible. Is ExtendHealth the culprit. No. They have created a business to help IBM et al cope and provide a service to the retirees. Is it Medicare? No. They are trying to reduce healthcare cost while increasing quality and patient safety (more on that in another post). How about Congress? Bingo! I blame congress for allowing thousands of lobbyists to convince them to insert exceptions in thousands of pages of legislation that become tens of thousands of pages of regulations. I am convinced that Congress (both parties) is focused primarily on remaining in office and do so by insuring that pharmaceutical companies and health insurers get what they want, not what is best for consumers and patients. The examples abound. More on that later too.

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