HealthCare.gov doesn’t need a tech surge, it needs better primary care

HealthCare.gov doesnt need a tech surge, it needs better primary care

The Affordable Care Act is off to a rocky start, to say the least.

Attention has been focused on HealthCare.gov, where those without employer-provided insurance can shop for health plans.  Finger pointing abounds, with the Centers for Medicare & Medicaid Services and contractors blaming each other.

A story in the Wall Street Journal chronicles the debacle:

The contractors said each of their pieces worked more or less as intended, but the HealthCare.gov website was nearly paralyzed when they were bolted together. The federal agency overseeing the site also took on the job of integrating the many parts of the system—an unusual arrangement for such a complex project.

Testing of the complete package took place in the final two weeks before the launch and revealed problems, contractors said. But they couldn’t name who in the government was responsible for addressing the problems or making key decisions.

It appears that the dozens of contractors were working on the site without a single entity “quarterbacking” the project.

Indeed, White House spokesperson Jay Carney was asked who was supervising the many moving parts.  His response: “This is on us. And that goes from the president on down.”

You mean the president, who didn’t even appear to be aware of the problems of the site before going live?

Let’s think of HealthCare.gov like the American patient.

First, according to a New England Journal of Medicine study, Medicare patients today see 7 different doctors in a given year: two primary care physicians and five specialists working in four different practices.  HealthCare.gov had dozens of contractors working on it, rather than a single entity building the site.

Second, electronic medical record systems from various care venues often don’t talk to one another.  Consider a typical patient who was recently admitted for congestive heart failure.  He may have separate records on three different systems: one from his primary care doctor, another from the hospital, and yet another from his cardiologist. This is similar to HealthCare.gov, which has trouble accessing information from separate non-compatible systems like the IRS to determine subsidies and private insurers for health plan data.

And finally, the primary care shortage contributes to many patients being without a “quarterback” to coordinate their care.  HealthCare.gov also lacked a clear, accountable authority figure.

It doesn’t matter when you’re a patient or a website.  If you have too many mismanaged parts — even if they work well in isolation — it breaks down when put together.

HealthCare.gov needs a stronger leader to coordinate its care.  In other words, akin to a primary care doctor.  The much publicized “tech surge” sounds like the government is sending it to see more specialists at leading academic medical centers.

Which is exactly the last thing this patient needs.

HealthCare.gov doesnt need a tech surge, it needs better primary careKevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • ninguem

    I thought we needed more Cheesecake Factory.

    • May Wright

      I think we need a British-Canadian journalist-entertainer whose highest academic qualification is a BA in History to lead the way. Malcolm Gladwell seems to suddenly be flavor of the month as the latest One True Savior of the American healthcare system. For some unfathomable reason.

      • ninguem

        You don’t worship Gladwell?

        You muse be a racist.

        • May Wright

          Unrepentant.

          • ninguem

            I like you already.

  • May Wright

    “HealthCare.gov needs a stronger leader to coordinate it’s [sic] care.”

    Healthcare-dot-gov is is a prime example of how Central Planning by the State fails on almost every level.

    Who appoints this “strong leader” you want? The same Central Planners who failed at creating a simple website? What, we just give them even more power and chuck another $638 million at them and hope that THIS time will be different?

    Maybe we need *less* Central Planning, and *less* government involvement. It was the free market which created Apple, which created Kayak, which created Amazon. Obama threw more than three times as much money at his failed website as Apple spent developing the iPhone (a product which sold 9 million units _the first weekend its latest version was released_, without citizens even being forced by law to buy it).

    By the way, e-surance managed to create a true health insurance marketplace without costing American taxpayers a dime. There was market demand for a product, private citizens filled the niche, and voila. I’m pretty sure there’s a teachable moment in there somewhere.

  • buzzkillerjsmith

    Fixing a website will be a lot faster and easier than fixing family medicine and general internal medicine.

  • Bob

    Most people think that Social Security Numbers were applied at birth along with birth certificates, like mine that have my footprints on them, but they’d be wrong.

    In 1980 after the GAO published Fraud in Government Programs: –How Extensive Is
    It? –How Can It Be Controlled? The government stopped accepting Social Security numbers as a form of identification. This was as the government was computerizing and each agency had their own systems and forms of identifying items, and no computers were designed to “talk to each other” and some in government didn’t want them to, i.e. the “Gorlick Wall” of 9/11.
    But the IRS and social security, knowing from the 1980 GAO study that 60% of Social Security frauds were caused by false statements on social security applications, which didn’t study Medicare or Medicaid applications as they were too new in 1975 to study and Medicare ones were in the old Health, Education and Welfare department, and Medicaid was considered a “state responsibility then” weren’t included.
    So today with $1 trillion in fraud, waste and abuse we place the identification process in ACA based on Social Security numbers and think massive fraud won’t ensue?
    “Humpty Dummy sat on a wall,
    Humpty Dumpty had a great fall; and
    all the Kings programmers and all the Kings men
    won’t be able to put Humpty Dumpty together, ever.”

  • wahyman

    This post is a good example of not needing any relevant factual information in order to blog about something.

    Does the writer actually know what the actual problems with the software are? If not how does he know what it will take to fix it?

    Is the analogy actually illuminating, or is it just for fun?

    He also overlooks (or chooses to ignore) that the federal web site is not the only way to sign up. He also ignores that MDs themselves have created the primary care shortage, if there is one.

    Anti government rants also don’t fix anything.

    • EE Smith

      “the federal web site is not the only way to sign up”

      It is, actually, if you want to sign people up to ACA-compliant insurance and not just dump them onto the Medicaid rolls.

      All of these paper and phone applications that the “navigators” are taking, because the software doesn’t work, can only be processed by having whoever receives the low-tech applications manually enter the data into the software.

      • wahyman

        But that entry is not done through the front end portal which is the piece that has received all of the attention, and which is being fixed. Those that enjoy failure will have to find something else to gnash their teeth about.

        • EE Smith

          That entry is into the exact same system which is currently not working.

          It’s not like there are two separate systems, one for ordinary citizens which doesn’t work, and one secret one for navigators, which works beautifully. The navigators are using the same system everyone else is.

          And it’s not just “the front end portal” which is munted. It’s the whole thing.

          CBS News reported, “Insurers say the federal health-care marketplace is generating flawed data that is straining their ability to handle even
          the trickle of enrollees who have gotten through so far, in a sign that technological problems extend further than the website traffic and software issues already identified.

          “Emerging errors include duplicate enrollments, spouses reported as children, missing data fields and suspect eligibility determinations,
          say executives at more than a dozen health plans.”

          • wahyman

            The congressional testimony of the back end data entry contractor was that their entry process is working smoothly. It is not the same system because it is behind the portal. In any case, it is all going to worked out, ACA haters not withstanding.

  • May Wright

    The Canadian company he hired to do the healthcare.gov site which doesn’t work are the same people who did a Canadian diabetes database that didn’t work and the Canadian long gun registry which similarly didn’t work. No one sabotaged this to make Obama look bad, he did it to himself.

    “Its performance on Ontario, Canada’s health care medical registry for diabetes sufferers was so poor that officials ditched the $46.2 million contract after three years of missed deadlines, the Washington Examiner has reported.

    “CGI is also the company behind the $2.7 billion failed,
    Liberal-launched Canadian Gun Registry that was so plagued with corruption and mismanagement it brought on an investigation by Canadian Auditor General Sheila Fraser.

    “The company is deeply embedded in Canada’s single-payer system, which is the direction President Obama’s health care policies are driving us. CGI has provided IT services to the Canadian Ministries of Health in Alberta, British Columbia, New Brunswick, Quebec and Saskatchewan, as well as to the national health provider, Health Canada, according to CGI’s website.

    “George Schindler, CGI Group president for U.S. and Canada, became an Obama 2012 campaign donor after his company won the ObamaCare contract, a pattern we’ve seen in green-energy stimulus money going to companies like Solyndra.

    “As it happens, the Daily Caller reports that Michelle Obama’s college roomie Toni Townes-Whitley, Princeton class of ’85, is a senior vice president at CGI Federal, which earned the no-bid contract to build the $678 million ObamaCare enrollment website at Healthcare.gov.”

    Read more: http://news.investors.com/ibd-editorials-obama-care/102813-676947-jarrett-balkissoon-wedding-influenced-cgi-selection.htm?p=full

    • Solid State Max

      Most of what you wrote and quoted makes sense except that part claiming that Obama’s health care policies are towards single payer which is false. Single payer and Obamacare are entirely different with the former using tax dollars for providing basic coverage for all US citizens while the latter is all about mandating US citizens to choose among a group of corporate thugs – big difference. Canada does allow for private plans but that’s on supplementary stuff.

      • May Wright

        One of the goals of Obamacare was to add 17 million new clients to the Medicaid rolls. That’s more new clients than any private insurers will be seeing, I’m pretty sure.