Much Progress on Healthcare.gov, But “Back End” Fixes Will Determine Success
Of the many, many things I gave thanks for last week, there was Jeffrey Zients, the White House management guru brought in to sort out the mess that is the launch of ObamaCare, and for his geek squad working feverishly on the fixes. His long-awaited progress report was released on Sunday, and it’s amazingly sanguine for a government document. Knowing big IT projects as we do, it’s impressive how far the fix team has gotten in a matter of weeks, much of it in consumer-facing functionality on the “front end” of the website and the enrollment process. What remains to be seen is what can be done this month on the crucial “back end” functions that connect to insurance companies participating in the exchanges — the functions for which ObamaCare will ultimately be judged when coverage kicks off on January 1, and the true test for Mr. Zients and his geeks.
“HealthCare.Gov on December 1 is night and day from where it was on October 1,” Zients told reporters in his victory lap Sunday morning. “While we still have work to do, we’ve made significant progress with HealthCare.gov working for the vast majority of consumers.” The administration released some geek speak to make its case. Response times, capacity, and system stability are markedly improved, and conventional wisdom is that the consumer-facing functionality — the “B to C” part — is in much better shape.
It’s the “B to B” piece that’s still a problem. The metrics Zients released Sunday focused almost exclusively on the front end of healthcare.gov — there were precious few details on the back end, specifically on the all-important “834” transmissions to insurers that tell them who’s signed up, and which have been problem-plagued since the launch. You’ll recall that last month Henry Chao, who oversaw healthcare.gov’s technical development, said 30-40% of the back end functions remained to be completed, including a system to send payments to insurers. Without timely and accurate 834s from the Federal data hub, coverage can’t be effectuated, members can’t get their insurance cards, insurers can’t get paid, and claims can’t start flowing through the system for the uninsured.
The omission was glaring, and the Administration jumped in to address it. White House spokesman Jay Carney said that 834 fixes were ongoing but that the problems were “vastly improved.” “We believe that the majority of fixes to the 834 forms have been made, including significant ones over the weekend,” Carney said. “We’re going to continue to work with issuers to make sure that the remaining problems for issuers will be fixed.”
“A number of the fixes that went into place this weekend in particular will significantly address some of the highest priority things that we know were a particular concern with those transaction forms,” said Julie Bataille, spokeswoman for CMS.
But there’s still clearly a very long way to go. Administration officials and a new “Payer Exchange Performance Team,” made up of insurance industry leaders, in a meeting on Monday acknowledged that about one-third of completed applications since Oct. 1 contain errors generated by healthcare.gov. The errors included failure to notify insurers about new customers; duplicate enrollments or cancellation notices for the same person; incorrect information about family members; and miscalculated federal subsidies. It’s still bad enough that yesterday CMS recommended that consumers who choose a health plan through HealthCare.gov contact the insurer afterward to make certain they are actually enrolled. “Consumers should absolutely call their selected plan and confirm that they have paid their first month’s premium, and coverage will be available Jan. 1,” Bataille said.
There is no margin for error this month. Deadlines for enrollment are coming up in less than 2 weeks for people to get insured by Jan. 1. If the 834s can’t be fixed by then, and it appears likely they won’t, the next big barrier to enrollment is the ACA’s requirement that eligible exchange customers pay their first month premium before they receive coverage. Without clean 834s, susbidy verification and calculations given to the plans, no one knows what the first month’s premium will be. That may be the next “audible” to be called on the field: the Administration will seek a way around the premium payment requirement, and then ask insurers to take a leap of faith, issue coverage, and hope that premiums and subsidies catch up later. And that’s a real problem that strikes at cash flow for many of the smaller, regional players in the exchanges, and especially for start-ups, like the ACA’s co-ops. Nobody set aside contingency funds for this kind of headache.
So Mr. Zients and his geeks can’t let any grass grow under their feet, and we all ought to spill some Starbuck’s or Red Bull for what lies ahead for them. But to also give some perspective, a hat tip to Dr. J. Mario Molina, CEO of Molina Healthcare: “A few people are going to have data that’s not correct; but compared to the tens of millions of people who don’t have coverage right now, that’s a minor problem.” He’s thrilled with the progress made, and points out “We process a couple million patients through our system the last week of the month as it is.”
Whether you’re a glass half-empty or full type of person, I think we can all agree we are looking at one wild and hairy enrollment reconciliation process in Q1 and 2 of 2014, so grab your shovels. There’s a pony in here somewhere.
Resources
Join us December 11 from 2:00 — 3:30 pm ET for a lively session with Gorman Health Group strategy and data analysis experts who will discuss actual case studies that show how plans can mine data for precious insight that can help improve performance. Register >>
Gorman Health Group’s Valencia, was designed to create workflows organizations need for critical operational functions, and give you insight into where your membership and premium-related data is out of sync. See how Valencia can revolutionize your capitation management >>