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HealthCare.gov goal: 80 percent able to enroll for insurance through website

President Barack Obama arrives to speak about his signature health care law, Thursday, Nov. 14, 2013, in the Brady Press Briefing Room of the White House in Washington. Bowing to pressure, President Barack Obama intends to permit continued sale of individual insurance plans that have been canceled because they failed to meet coverage standards under the health care law, officials said Thursday. (AP Photo/Charles Dharapak)

President Barack Obama arrives to speak about his signature health care law, Thursday, Nov. 14, 2013, in the Brady Press Briefing Room of the White House in Washington. Bowing to pressure, President Barack Obama intends to permit continued sale of individual insurance plans that have been canceled because they failed to meet coverage standards under the health care law, officials said Thursday. (AP Photo/Charles Dharapak)

As many as 1 in 5 Americans who want health care plans through the new federal insurance marketplace may be unable to sign up online even if the Obama administration meets a Nov. 30 deadline for fixing the website, according to government and industry officials familiar with the project.

Under the administration’s best-case scenario, many Americans will not succeed in purchasing insurance online, whether because their personal cases are too complicated or simply because the website remains defective, according to an internal target that administration officials have not made public.

The measure, which is the first concrete performance standard since the government began to design the system, was defined by a group of federal health officials and technical experts in late October and is now guiding the work of hundreds of government employees and contractors racing to try to repair the balky website.

The goal is that 80 percent of people going to HealthCare.gov should manage to enroll electronically, but that means many others will be unable to get in.

Whether the government meets the benchmark – and whether the public regards it as adequate – will be a central factor in President Obama’s efforts to increase support for the controversial health care law and lure customers to the federal insurance marketplace. It puts more pressure on the administration to fix technical problems that have made it difficult for people to sign up for coverage by other routes, including federally sponsored call centers and insurers themselves.

Administration officials acknowledge that until recently, they had no concrete definition for how well HealthCare.gov should work, but they say one would not have made sense before the site went live Oct. 1.

“We are very focused on measuring performance of the site now and moving forward and making sure we have ways to demonstrate progress,” said Julie Bataille, communications director for the Center for Medicare and Medicaid Services, a branch of the Department of Health and Human Services with responsibility for the insurance exchange. “That is a focus of the team that is in place now.”

The internal 80 percent target is the basis of a promise that has become an administration mantra in recent weeks: HealthCare.gov will “work smoothly for the vast majority of users” by the end of November.

The catchphrase was coined by former presidential management official Jeffrey Zients shortly after the White House assigned him to oversee the website’s repairs, according to an official with knowledge of the project who was granted anonymity to speak about matters that are not public.

To assess progress toward the goal, administration officials have developed two new measurements, appearing in reports generated each morning, that show how long consumers must wait for pages to load on HealthCare.gov and how often they get error messages, government and industry officials said.

The “vast majority” phrase has been invoked repeatedly by Obama, Zients and other administration officials, with little explanation of what it means. In a news conference Thursday, while apologizing for the health care law’s rollout problems, Obama omitted the word “vast,” saying that “the majority of people who use it will be able to see it operate the way it was supposed to.”

Zients, however, revived the “vast majority” phrase in comments to reporters the next day, adding that “most users will be able to navigate the marketplace from account creation, through the application, all the way to enrollment.”

But Zients also said that “new bugs and other glitches will surface” in December and beyond that and will need to be fixed. Even if the site works well, he said,”that doesn’t mean that the site will be sufficient for 100 percent of users or consumers to use for enrollment.”

The Washington Post reported last week that the federal exchange is unlikely to be working fully by the end of the month. The uncertainty over the site’s future performance stems from the fact that it is currently malfunctioning when more than 20,000 to 30,000 people – about half the intended capacity – try to use it at the same time.

According to a government official familiar with the new target, the 20 percent who are unlikely to be able to enroll online are expected to fall into three groups: people whose family circumstances are so complicated that the website cannot determine their eligibility for subsidies to help pay for health plans; people uncomfortable buying insurance on a computer; and people who encounter technical problems on the website.

Performance benchmarks

Until last month, no concrete performance measures had been developed for HealthCare.gov, the first-ever government computer system for consumers to buy private insurance, several officials confirmed.

“Many asked about benchmarks,” said a senior administration official who spoke on the condition of anonymity because of the topic’s sensitivity. But there was “no schedule of them.”

When DHHS in 2011 invited contractors to bid on the chance to build HealthCare.gov, the department’s “statement of work” did not include requirements typical of many IT contracts in which interested companies must spell out how the system would perform, according to an industry representative close to the project, who spoke on the condition of anonymity in order to speak frankly. The agreement that CGI Federal, the company chosen as the main contractor, signed Sept. 30, 2011, also did not contain specific performance criteria, success measures or response times.

The meaning of success was defined for the first time during the panicky days of October, when White House officials belatedly recognized that the federal exchange had serious software and hardware defects.

At a meeting late in the month at CGI Federal’s offices in Herndon, Va., White House presidential innovation fellows assigned to help repair the exchange presented estimates of how quickly people would need to get from one web page to the next in order to reach the 80 percent goal, according to a government official familiar with the discussion. They calculated that the system would need an error rate of less than 1 percent and a typical wait time of no more than 500 milliseconds – half a second – no matter what part of the website they were on.

The metrics were written on a wall, according to an industry official familiar with the meeting. Officials from the Medicare and Medicaid center “later came into the room, heads nodded, and the CMS team rallied around the measures,” said the official, who spoke on condition of anonymity to describe a private meeting.

Accuracy questions

The new performance measures address how easily consumers should be able to progress through the website. But there are still no concrete goals for the site’s accuracy, including whether users are correctly informed if they are eligible for federal help in paying for health plans or whether insurance companies are given correct information about their new customers.

Bataille, the Medicare and Medicaid center communications director, said that focusing on improving the system’s performance “will make a difference for consumer experience and accuracy of transactions.”

Administration officials have talked publicly in recent days about one of the measures: a reduction in errors that freeze web pages or otherwise hinder the ability to sign up for insurance. They have said the error rate has dropped from up to 6 percent a week ago to less than 1 percent now.

“That is something we need to continue to drive lower,” Bataille said. “We need to have lower error rates. We need to have a fast site.”

On the other measure – which assesses how quickly people can move through any part of HealthCare.gov – one official said that the website has performed close to the 500 millisecond goal on most days.

But the current load on the system is light because many people are staying away in the wake of the rollout problems. Even then, the official said, “swings from good performance to bad performance have been frequent.”

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