5:55pm

Sun December 1, 2013
All Tech Considered

The Key Test For HealthCare.gov Is The Part You Can't See

Calling the improvements "night and day" from October, the Obama administration says it has met its goal of getting the troubled HealthCare.gov site working for a "vast majority" of users. But that's only part of a complex technology system that is designed to end with insurance companies providing coverage for millions of consumers.

We've detailed the eight-page HealthCare.gov progress report in a post on our news blog, The Two-Way. In short, it shows dramatic improvements in capacity, processing and speed. In October, only 30 percent of consumers could get all the way through the online application process for the federal insurance exchange. Now, after nine weeks of furious fixes, about 80 percent of users are able to make it through the process.

"It says my application was reviewed and processed, and I can view my results. Before, it always got stuck right here," says Kendalyn Thuma, a Kalamazoo, Mich.-based consumer who had been trying unsuccessfully to enroll throughout October.

Thuma and other consumers we checked in with report a smoother overall experience — but not a perfect one.

"Everything is relative. This is a site that has been plagued with problems from the outset," says John Engates, the chief technology officer at the server and software company Rackspace. He's one of the few outside engineers who's seen the HealthCare.gov command center from the inside.

"I think what they focused on, to a large extent, was the consumer view from the outside looking into this website," Engates says. "I don't necessarily think they've gotten all of the behind-the-scenes connections to the health insurance providers and the work that's necessary behind the scenes to really take this to the finish line. I don't know if that's all done yet."

We don't know how complete the enrollment data getting to insurance providers is, either. The metrics on how well the back-end is delivering data wasn't part of this weekend's progress report.

"We are working with issuers on a regular basis, getting daily feedback from them, and will continue that conversation," says the Center for Medicare and Medicaid Services' Julie Battaile, who says the system will need to see more user volume before engineers will know how well the back-end is working.

Those conversations will need to happen quickly, as a December deadline draws near for those who want coverage to start in January. December is also when HealthCare.gov's chief "fixer,"Jeffrey Zients, is expected to leave his presidentially-appointed role.

While outside tech experts like Engates say the site's front-end — the part that consumers can see — is dramatically improved, that's actually the easy part.

"The easy part is to put your data into the system," he says. "The hard part is to go and process that to make sure you have health care coverage. The government really has to deliver on that or else the whole thing is for naught. I mean, we really have to have a system that works from end to end or it really isn't a system."

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Transcript

ARUN RATH, HOST:

HealthCare.gov is, quote, "night and day" from where it was when it was launched on October 1st. That's according to the Obama administration, which says it has met its goal of getting the troubled site working for a vast majority of users by this weekend.

NPR's Elise Hu takes a closer look at the challenges that still lie ahead.

ELISE HU, BYLINE: The eight-page HealthCare.gov progress report released today confirms with numbers just how broken the system was in October. Metrics released by the administration show that in October, only 30 percent of consumers could get all the way through the online application process for the federal insurance exchange. Now, after nine weeks of furious fixes...

JULIE BATAILLE: Today, we're now more in the zone of about 80 percent of users being able to do that same process successfully.

HU: That's Center for Medicare and Medicaid Services Julie Bataille. She says the system is far more stable. Response times have fallen to less than a second, and the system capacity now allows for 50,000 people to use the site at the same time. That's the original goal for October 1st.

Jeffrey Zients is the HealthCare.gov chief fixer.

JEFFREY ZIENTS: It's really the series of significant hardware enhancements that have been made across the last several weeks that have increased the redundancy, the reliability and the scale.

KENDALYN THUMA: They said it was fixed, so I'm going to give it another shot.

HU: Michigan-based Kendalyn Thuma has been trying to get through the enrollment process since mid-October. She tried again this morning.

THUMA: Says my application was received and processed, and that I can view my results. And before, it always got stuck right here.

HU: Thuma and other consumers we checked in with report a smoother overall experience, but not a perfect one. An enrollment button shows up near the end of Thuma's registration process, but she still can't see which subsidies she might be eligible for.

THUMA: So if I click on view eligibility results, I just don't get anything. And I'm going to stop trying probably. I have tried on different browsers.

HU: To put things in perspective, we called John Engates.

JOHN ENGATES: Everything is relative. I mean, this is a site that has been plagued with problems from the outset.

HU: Engates is chief technology officer at the server and software company Rackspace. He's also one of the few outside engineers who's seen the HealthCare.gov command center from the inside.

ENGATES: I think what they focused on to a large extent is the consumer's view from the outside looking into this website. I don't necessarily think they've gotten all of the behind-the-scenes connections to the health insurance providers and all of the work that needs to go on behind the scenes to really take this to the finish line. I don't know if that's all done yet.

HU: We don't know either. The data on how well the back end is getting clean enrollment forms to insurers is something that wasn't part of this weekend's progress report. Again, Julie Bataille.

BATAILLE: We are working with issuers on a regular basis, getting daily feedback from them, and will continue that conversation.

HU: The conversations will need to happen quickly, as a December deadline draws near for those who want coverage to start in January. December is also when the chief fixer, Zients, is expected to leave his role. So big questions remain. While outside tech experts like Engates say the site's front end that consumers can see is dramatically improved, that's actually the easy part.

ENGATES: The easy part is to put your data into the system. The hard part is to now go and process all of that and make sure you have health care coverage. The government has to really deliver on that or else the whole thing is for naught. I mean, we really have to have a system that works from end to end or it really isn't a system.

HU: Whether the full system works as intended will be the crucial test going forward. Elise Hu, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

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