From the New York Times: “Nearly 70,000 agents and brokers have been certified nationwide to sell health insurance on the federal exchange. Many say they could be the troubled health law’s best ambassadors with the potential to boost lackluster enrollment figures.”
At some point along the way, the folks implementing the health care law decided that things had to get fancy — tech fancy. Rather than focusing on what really mattered to consumers — understanding their options and getting a health care plan that doesn’t suck — they instead decided to focus on tech bling: things like real-time results and deep integrations with all sorts of horrendous, archaic systems across dozens of states.
I make no pretenses to fully understand the ACA or the technical requirements it spawned. That said, it’s quite possible that with the right leadership, vision, and understanding of consumer needs, healthcare.gov could have been built in a day.
Let’s start with some of the faulty biases upon which it was built:
It’s the interwebz! Therefore it has to be real-time! When making an important decision like which plan best protects the health of your family, is it that important to have instant search gratification? I’d wager that most people take some time to think over their options and get advice from friends and family. Even for those who might make a snap decision, their experience buying health care isn’t going to suffer that much if they can’t BUY! IT! THIS! SECOND!
It has to integrate with…EVERYTHING! Integrating with a single, modern, well-documented app can sometimes be challenging. Now imagine integrating with dozens of different health care providers in different states with different technologies, many of which are old and crusty. Insert Marlon Brando: “The HORROR!”
It’s important to appreciate that these two premises don’t solve the actual problem of helping people pick a good insurance plan. Instead, if you can actually get the technology to work, the problem it solves is helping people see a set of options quickly. That may seem like semantics, but actually it’s fundamental to the misfire that is healthcare.gov: it’s solving the wrong damn problem.
Let’s return to the fact that there are 70,000 Obamacare-trained insurance brokers out there waiting to help. These are people who understand the nuances of health insurance. They understand how to help people pick the right plans. And they can probably explain the details of a plan better than a website that requires people to read lots of fine print.
So, drumroll, here’s how to build healthcare.gov in a day:
1. Build a simple website focused on a highly optimized web form for consumers to enter their information and needs.
2. Tee up the army of 70,000 insurance brokers to build a menu of options for each consumer who fills out the form. Then call people to walk them through their choices.
Rather than worrying about a zillion archaic APIs, the emphasis could have been on A/B testing and building a great user experience that made it incredibly easy to understand what to do. A simple web form would say something like, “Hi, Welcome to HealthCare.gov. Please give us some basic information. Within 24 hours, a friendly human being will call and walk you through some awesome new plans.”
The airline industry and sites like Priceline set an important precedent for this. As I understand it, in its infancy, Priceline was simply a form into which you submitted a request. Behind the scenes, legions of human beings were calling the airlines trying to find the fare you wanted. Priceline would get back to you in 24 hours with your ticket. It wasn’t real-time, but it was still a great experience for customers. It was so good, in fact, that it completely upended the old way.
It could be argued that healthcare.gov might make insurance brokers go the way of the dinosaur like Priceline, Orbitz, and Kayak did to travel agents. The difference is that health insurance is complicated. Buying it with the help of a consultant makes a difference. You don’t need much consulting when it comes to buying an airplane ticket from Denver to San Francisco.
It would be fascinating to find out the conversion rates on healthcare.gov. Of those few lucky people who are actually able to perform a search, how many actually buy a plan? How many actually buy a plan immediately relative to those who keep the browser window open for a few days while they think about it and seek consultation? And a level deeper, what subset of those people actually get a plan that best fits their needs?
Sadly, as is too often the case, the allure of hot technology trumped the possibility that a simple solution was there, right in front of our face. For $300 million, healthcare.gov (hardly) solved the problem of serving up real-time results of health care options. What it failed to do was help people actually get appropriate health care — which is something that could have been done in a day using simple technology, a measured approach focused on a specific goal, and a vast amount of infrastructure that was already in place.