11 ms·

S.F. programmers build alternative to HealthCare.gov [video]

103 points by r721 13y ago

aram 13y ago
Hats off to the guys - good job. Here's the link to the site: http://www.thehealthsherpa.com/ http://www.thehealthsherpa.com/
deleted 13y ago
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- w1ntermute 13y ago
  You can't just "reach out". There's a complex procurement process for government contracts. The companies that get contracts are usually those who are best at navigating the bureaucracy, not those who are the best at creating the product. Most of these companies have been in this business for a long time. It would take years for a startup to figure out how to get these contracts and build up the contacts in the bureaucracy necessary for it to actually happen.
  - munin 13y ago
    this is very short sighted. hire a contracts person away from one of the big contractors, or get a recently retired contracts person as a consultant. other startups do this, you can too. odds are low they'll relocate to SF though, maybe they should work remotely ;)
    - dnautics 13y ago
      >hire a contracts person away from one of the big contractors Do you understand how much of a capital investment that takes?
      - hga 13y ago
        "One does not simply walk into government contracting." Seriously, it's a really involved thing. E.g. you need competent, domain experienced lawyers, there's massive amounts of law and regulations to follow. I've seen it at various levels, including working closely with a small firm's lawyer who e.g. got many of its products on the GSA catalog.
      - munin 13y ago
        yes, I've done it
    - Iftheshoefits 13y ago
      The "contracts person" is one link in the chain. The far more important and relevant links--the ones with the connections and personal relationships with people in the government who award these contracts. One of the reasons government contracting is the wasteful, corrupt mess it is is because it's an extension of the rest of politics in Washington: a machine designed to move taxpayer money into the hands of the connected and already-wealthy. Having a "contracts person" may slightly increase one's chances of getting smaller contracts. Having the right pedigree is the almost the only thing that matters with contracts as big as the web of HealthCare.gov contracts, and no startup is going to be able to offer a level of financial or intangibles compensation to pull those with the right pedigree away.
- scotth 13y ago
  You're assuming these guys actually solved the problem, and that's a pretty big leap to make.
  - hga 13y ago
    Indeed. There's a big difference between what I call the Minimum Viable Demo (which is what was reported to have been shown to Obama before the launch, the thermocline of truth was in evidence there: http://brucefwebster.com/2008/04/15/the-wetware-crisis-the-themocline-of-truth/ http://brucefwebster.com/2008/04/15/the-wetware-crisis-the-t...) and a MVP, which is what we desperately need.
willchilcutt 13y ago
I don't understand how this site works. A few days ago when it was first posted here, I tried my zip, and it returned "Plan Results Found 0 exchange plan." Today I searched my zip again, this time even messing with the different options of insurance type, and still zero results. Is this saying there are no insurances available for people in my area?
- joyeuse6701 13y ago
  Apparently it only works for California zip codes:
  - frakkingcylons 13y ago
    Not necessarily, I tried it with Arizona and Texas zip codes and those both returned valid results.
    - toomuchtodo 13y ago
      Worked just fine for my Chicago suburb zip code (60195)
- dmethvin 13y ago
  You haven't provided enough information for anyone to give you advice about what might be the problem. Perhaps you live in a state that has its own exchange (e.g., Kentucky or Maryland). Or maybe there is no data for your area yet. Try Chicago (60609) for some sample data to use for an experiment. If that doesn't work, perhaps some error is occurring on the page; check the JavaScript console and report it to them.
_pius 13y ago
This looks great, but haven't the big, embarrassing problems been with scaling the back end? Even if this were a superior UI and flow, it wouldn't address the issues that made the news.
- hga 13y ago
  Perhaps, and no. E.g. the front end registration problem is due to a late requirements change in August that had the effect of preventing window shopping, plus we know there were changes ordered though the week before launch, and no integration testing until 1-2 weeks before launch, and that discovered it locked up if 200 simultaneous login attempts were made or if it had ~1,100 users on it. So, yeah, those are scaling problems, but not ones we can necessairly blame the techies for, given that they didn't have enough time, and couldn't do integration testing (the government's CMS was the integrator and integration tester, now replaced by QSSI, the ones who did the "data hub"? I think it's called, which is supposed to be not so bad). But also no, in that the fix-it czar's #1 declared priority is to fix the garbage 834 EDI transactions that are being sent to insurers. That includes incorrect data and incorrect transactions (e.g. multiple enrollments and cancellations for the same person). Based on that, the front end's problems have been a blessing in disguise, because the insurers are only getting a few hundred enrollees a week and that low volume allows the insurers to call each up and straighten out problems. An estimated 16 million policies in the individual market, and an unknown number in Obamacare's interim high risk pool must sign up for new policies by December 15th or so or they'll suffer a lapse in coverage, which for many of the latter will be fatal. The only way to get subsidies is through the Federal system, i.e. the state exchanges use it for that (maybe with inaccuracies, but it's evidently working for the state exchanges that are working, but don't judge that for any given state exchange until you find out which are getting Obamacare and the much larger numbers reported to be signing up for Medicaid), and that makes sense to avoid fraud, since it results in direct payments from the Federal fisc.
  - dr_ 13y ago
    Valid point with the window shopping comment. A huge mistake on the part of the administration though. The site was apparently flooded with visitors and you have to wonder how many of those visitors were people who already had decent coverage, privately or through their employer, but were just curious to check it out because they had heard so much about it. I know I was one of those people.
danso 13y ago
From the convoluted articles I've read, not only was the main bottleneck in the identification process, but the issue seemed to be that the authentication was necessary to just show the plans, because the gov wanted to make sure you were 25 before showing you a range of prices...was that the case? If so, whatever happened to letting people just browse the entire table of prices....remember when people had to look things up and scan tables once in awhile, instead of living in a Minority Report world where every piece of info is handcrafted to the user? I wonder how much of Healthcare.gov's problems could have been eliminated if the sign up was more modular...users were allowed to browse before signing up for anything. Then they could sign up via email and tentatively pick a plan. Then in 3 days, they go through the full authentication process...this is similar to how Amazon does things...you can sign up without a credit card, you can browse without signing up, and you don't go through the processing bottleneck till the very end.
- hga 13y ago
  The contractors were ordered in August to change the system to require up front registration and submission of "correct" information on penalty of perjury, no window shopping allowed, nor checking out "what if" scenarios (e.g. using the Kaiser Foundation's calculator, someone was unable to find any scenario where being married wasn't more expensive, and of course subsidies are based on income, and that can be very flexible for a lot of people). Since then window shopping has been allowed, but I don't know if the "under penalty of perjury" bit was dropped. As to "what happened", I'll just point you at this Washington Post article and let you come to your own conclusions: http://www.washingtonpost.com/politics/challenges-have-dogged-obamas-health-plan-since-2010/2013/11/02/453fba42-426b-11e3-a624-41d661b0bb78_print.html http://www.washingtonpost.com/politics/challenges-have-dogge... Note also the front end traffic jam has avoided sending the insurers more garbage 834 EDI enrollment and cancellation transactions than they can manually clean up by contacting enrollees. That's the #1 thing to correct according to the fix-it czar. And I do agree with you, an Amazon system, which I'm sure is based on the BASE eventual consistency back ends, e.g. you don't get your confirmation email until it decides who "won" the last copy of an item, would have been a lot better. But then again the contractors were doing a lot less of that sort of top level design that you'd think (see the Post article).
analog31 13y ago
I just tried it, and it's great. Nice job, on many fronts: Recognizing a problem, coming up with a simple, uncluttered solution, and making it work. In my view, a site like this is useful for a lot of purposes beyond actually signing up for health care. For instance, I've got employer sponsored care, but I was simply curious about what my costs would be through the exchanges. I also want to be an informed citizen, and "how much does it really cost" is an obvious question that anybody might be inclined to ask. In my view, knowing the magnitude of the numbers should help provide a reference point for political debate.
- hga 13y ago
  Have you tried this: http://kff.org/interactive/subsidy-calculator/ http://kff.org/interactive/subsidy-calculator/ ?
  - analog31 13y ago
    Thanks for that! I had assumed that I wouldn't qualify for a subsidy, and indeed I don't. As others have mentioned, these sites don't actually solve all of the problems, but it seems to me that a few free tools that just help people gather information would take some of the pressure off of the main system. And if enough of these tools were to crop up, then none of them would have to be 100% reliable. Simply making people less nervous about signing up will make the official process work better.
    - hga 13y ago
      "I had assumed that I wouldn't qualify for a subsidy, and indeed I don't." And having learned that, you could now go to individual insurer's sites, or various ... marketplaces? like http://www.ehealthinsurance.com/ http://www.ehealthinsurance.com/ which I've also tried, shopped around (that site even integrates "is your doctor in the network", at least for Humana), and gotten yourself covered. But everyone was told to go to Healthcare.gov, and right now individual states are doing a lot of marketing for their own sites, some of which aren't sufficiently functional.... However a lot of people are due and need subsidies, e.g. see this link I found using Google right after the Kaiser one: http://obamacarefacts.com/obamacare-subsidies.php http://obamacarefacts.com/obamacare-subsidies.php A smaller fraction of the individual market I'd assume, but I also assume a rather large fraction of the temporary Obamacare high risk pool, many of whom could die if they suffer a lapse in coverage (I imagine kludges will be arranged if Healthcare.gov is not too late in becoming a MVP).
meshko 13y ago
Not even going to click to find out how stupid people are. Did they implement integration with data streams from hundreds of national insurance companies? Didn't think so.
- theg2 13y ago
  It is stunning just how much a lack of education and expertise went into this. This says nothing about HIPA, security, scaling, data source integration. It's staggering how much misinformation this PR stunt is going to cause.
  - misterjangles 13y ago
    Their site doesn't ask for any data except your zip code then forwards you on. Where does HIPA come into play?
  - otterley 13y ago
    HIPAA is not implicated in the new health insurance marketplace. HIPAA protects personal medical information, and under the Affordable Care Act, you cannot be asked any personal health information on any insurance portals because insurers are required to cover any pre-existing conditions.
    - absconditus 13y ago
      HIPAA covers far more than privacy.
  - ddebernardy 13y ago
    Now now now. They're only 20 but "have plenty of experience working at places like Twitter and Microsoft." Surely they \cough\ know what they're doing.
- gruseom 13y ago
  Your point may be valid, but you put it so maliciously that I winced when I read it. Smart but malicious comments are the worst thing about HN. They are like dioxins where stupidity is mere sewage. PG has written about implementing a comment filtering mechanism. I hope he does and that it will catch stuff like this. I don't mean to pick on you; it's just a cumulative reaction, plus it happened to be the first thing I read this morning. I agree that back-end integration is likely orders of magnitude harder than UI for a system of this nature.
butner 13y ago
Seriously -- this tool is equivalent to a cardboard cut-out of computer. It is embarrassing this is getting attention. They're dumping a publicly available spreadsheet that contains example age-group pricing... i.e. unless you're 27 or 50, it's giving incorrect information.
deleted 13y ago
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ollymorgs 13y ago
The government contractors should of just built healthcare.gov as a data service and asked people like these guys to build an intuitive front-end for it. Then if people don't like the interface, they can do something about it :) This may also help to dissipate the traffic load and present the same data in more relevant ways to different types people. The idea of building apps as single, monolithic system is out-dated. Even though I'm a Brit, some governments are making moves to modernise and open up their data for others to play with, over here we've got a great government-funded team working on exactly that (called the GDS). (http://digital.cabinetoffice.gov.uk/ http://digital.cabinetoffice.gov.uk/) Frankly I think this is a massively expensive and missed opportunity for the US Government's digital service team.
- drivingmissm 13y ago
  Britain is far worse than the USA -- your health care system just flushed $18 billion down the loo on a massively failed IT system. http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-pulls-the-plug-on-its-11bn-it-system-2330906.html http://www.independent.co.uk/life-style/health-and-families/...
  - hga 13y ago
    A closer reading reveals that 11 billion (I assume that's thousand million) pounds was the projected cost at the time for completion of the system. "Only" 2.7 billion, or 4.3 billion USD, has been spent, although I don't know if there are contract terminations of serious size to be paid. Still, it's an epic failure, said to be the greatest single one in government IT contracting. (E.g. I'll bet the FAA's eternal quest to upgrade from their 1940's (sic) technique and '60s or so architecture has cost more over time, but not any single failed effort.)
  - ollymorgs 13y ago
    Yea we get stuff wrong too. That was a massive balls up, but well before the time of the GDS team. Also note that the NHS system was about building a database for every NHS health record across the country; prescription notices, medial history, etc. etc. I'm not sure it'll even be legal now. HealthCare.gov isn't going nearly as far as that.
semerda 13y ago
For an MVP this is a great start. Front-end code is clean, concise and the flow far better than the gov version. If the gov is looking for solutions to their problems these guys just showed what local talent can do vs outsourcing an important piece offshore and messing up.
robomartin 13y ago
I must admit I have not devoted any time to understanding the real technical issues behind healthcare.gov. What little I know is from interpolating and extrapolating what I read here and elsewhere. One impression I got is that this $600+ million dolar website's authors tried to do it all. I don't get that at all. So, here's what I would have done. This is completely sit-of-the-pants. I'm sure it has holes. Nothing that couldn't be sorted out by applying real thought to the problem beyond this quick and admittedly faulty definition: My approach would have been to first develop a specification for an API all insurers would have to implement. They would be required to have a full implementation of this API in order to participate in the service. Now you have hundreds of teams working for you. This would cost almost not taxpayer money. The next step would be to develop an automated test suite to test for API compliance. Open source it and release it. Setup a method through which this API could be used to certify compliance. Perhaps this would be an insurer's portal in healtcare.gov. Upon certification they would receive an expiring token identifying the plans submitted as being fully compliant with the API. More on this later. Now everyone knows what they have to do to communicate their plans and how to make sure their API is fully compliant. No tokens. No participation. Each plan has a token. The token is also the GUID for each plan. Unit and regression testing are your friends. Insurers would do their own testing and they would be forced to continue to guarantee compliance by means of the tokens expiring at preset intervals (a year?). Next the API would be released for anyone interested to implement health insurance browsing sites. Yup, let entrepreneurs battle it out for best-in-class discovery services. You would have hundreds of sites pop up with all kinds of really good solutions. You would then publish another API anyone could use to actually communicate with government servers and "book" insurance. Now you have a potential of tens of thousands of people working for you. And still virtually zero cost to taxpayers. If that's too open, perhaps the plan browsing sites simply redirect you to a government site for the actual booking. They pass the token for the plan that was selected and a secure government site takes it from there. Not done yet. I would also hold a pre-release contest with cash prizes in the range of $1,000 to $100,000 for faults found during penetration testing of the government booking site. Release the code to the .gov site and let hackers mount massive attacks from every angle. Do this until top hackers agree the site is pretty damn hard. Give the top ten contributors cash as well as some kind of a presidential recognition at the White House. In other words, make it very public and very prestigious. Money and time well spent. Once there, load test for something in the order of a million simultaneous users. The site must be built with elastic capacity as it will have to be able to manage insane traffic for a few months and then scale down to a more reasonable baseline. Then open the doors. However. This does not happen all in one shot. Segment the population around data centers. Perhaps a couple of states on the east coast and a couple on the west. Announce it across all media. Schedule additional population segments across a period of a few months in order to average out a reasonable load on the system. All independent browsing sites would have API access to the schedule. They could then save your selection and email/sms you when your turn comes up. In other words, decouple the act of browsing and researching plans from actually booking it. And, at the same time, utilize a mechanism through which the rate of booking per unit time might be controlled. The browsing sites would simply not be able to forward to healthcare.gov unless it is your time slot. Now you have a situation where you simply can't have a hundred million people hitting healthcare.gov. One could further segment booking by implementing time slots based on other criteria. For example, the last digit or two digits of your SSN. Yet another approach would be to offer a limited number of booking time slots per hour. Browsing sites, through the API, would have access to this information. This means they could provide a virtual appointment system where you pick the time and date that is most convenient for you to actually book your plan. If a slot is available you are in. Otherwise you are offered alternatives. With this you could easily throttle the number of people who hit healtcare.gov per unit time. Again, healthcare.gov would NOT be a browsing site. You'd have to go through private sites for plan discovery. Once booked, healthcare.gov would --via a pre-published API-- forward a completed and validated application to the insurance company. I am sure further checks and balances would be required. And, as I said above, this game-plan surely has holes. It is seat-of-the-pants, I am coming up with it as I type. No way it is perfect. However, there is one thing I know: The general idea here is to leverage the free market and private enterprise in order to delivery a massively better product. I realize this goes counter to the ideas the current administration must have about how a country ought to be run. However, if this healthcare disaster has done anything at all for all of us is to potentially prove, once and for all, that central planning and management by government is a horrible idea. This is exactly how everything is done in government. We simply don't get to see it and experience it in daily life. With the ACA there was no way to hide it. This has been and continues to be a very unique opportunity for the American public to really see how bad government is about specifying, planning, managing and executing anything at all. If this makes people understand the fallacies in that school of thought this could very well have been the best $600 million we ever spent.
xbeta 13y ago
As a Canadian living in the U.S. (SF bay area), I still don't understand why American make healthcare so complicated. At beginning, HMO vs PPO vs whatever makes me very confused. Why not just move to a public national health care that works for all?
- wildgift 13y ago
  money * low information voters * paranoid messages = tea party Also, around 80% of people are in private insurance plans through a plan at work. Some fraction of these people are happy with their HMO or PPO. These are the middle class and upper middle class or rich. They are also politically resistant. The support for national health care or even single payer would come from the uninsured and people who have lower-end insurance (high deductible plans) and are forced into a kind of expensive PPO (insurance that makes you pay most of the costs of doctor visits). Hilary Clinton's single payer plan was demolished by the insurance industry. So this time around, they kept insurance companies in the reforms. That negated some of the resistance from the well-insured.
meerita 13y ago
They bootstrapped a lot, that's nice :)
x0054 13y ago
This makes me so infuriated! This site is great, it's exactly what needed to be done, it works, and of course, it was NOT designed by our government, because it works, and that just makes way too much sense! I used the CA site before to look at available covarage. It's much more dificult to use, and it hides from me the more affordable "Catastrophic Plan" for which I do qualify, because I am under 30 years old. They do not want people to sign up for that plan, so they just hide it! This is outrageous beyond belief. All this site now needs is the ability for the insurance companies to upload information about their plans directly to thehealthsherpa.com and we can forget about healthcare.gov all together. People signed up for years for insurance coverage by phone, directly with the companies, and they can continue to do so. The exchange should be just be an informational tool. This site does the trick. I think thehealthsherpa.com should provide links, or better yet, add pages to the site directly, to explain the different plans and regulations for different states, so it can be more of an information hub. Great Job!
- greg5green 13y ago
  Why would you want to sign up for the "Catastrophic Plan"? From my calculations here in Ohio, you could have actual coverage for not much more?
  - x0054 13y ago
    For me it comes out to $250/month for Bronze Plan, and only $170/month for Catastrophic Plan. I don't go to doctors unless I need to, and when I need to, I can afford paying cash. I can take a $6,350 bet on my health, but I still want to be covered above and beyond that. And the question isn't about whether or not I should get catastrophic plan. I have the right to get it under the new law, and CA's Exchange site should have the duty to show me it as an option. Instead, they hide it, which is very underhanded.
- wildgift 13y ago
  For other readers, here's a comparison of these plans. http://health.usnews.com/health-news/health-insurance/articles/2013/08/28/aca-obamacare-bronze-tier-vs-catastrophic-health-insurance http://health.usnews.com/health-news/health-insurance/articl...
chucknelson 13y ago
A little skeptical of this, as others are. How was this tested? Just because it seems to "work" with responsiveness and items on the screen does not mean the info is correct. Not saying healthcare.gov is any better, but there is just no mention of the information given and/or calculations done being correct.
hsitz 13y ago
I'm assuming the task these guys have done is tiny portion of the actual work needed for the website. I've been wondering for a while, though, why the federal government can't just buy/beg a copy of software running one of the exchanges for one of the states doing things themselves. Then they could modify it to work for other states. Maybe they'd then have to replace existing federal exchange with 26 different instances (one for each state that's a member of the federal exchange), but I can't imagine that the technical difficulties of modifying one state exchange's software to run with another state's data would be as bad as fixing what seem to the problems with the existing federal exchange website.
- hga 13y ago
  Probably too late for the very hard mid-December deadline for those losing their insurance, maybe too late for getting enough young healthy people enrolled before adverse selection forces insane 2015 premium filings from insurance companies, which are due by the end of March. They also have only 4 well functioning states' systems to chose from as I understand it. The centralized subsidy calculation/verification/etc. process, which the Federal system does for all the exchanges is another issue, although I've only heard that some time ago is was known to produce incorrect results under testing. Also would require the Federal government to admit a much bigger screwup than they've been willing to so far, in a process entirely driven by politics (http://www.washingtonpost.com/politics/challenges-have-dogged-obamas-health-plan-since-2010/2013/11/02/453fba42-426b-11e3-a624-41d661b0bb78_print.html http://www.washingtonpost.com/politics/challenges-have-dogge...) until the last week of last month when CMS was fired and the fix-it czar was appointed. If you've been in this game long enough you've seen projects and companies destroyed by a failure to take decisive action when it could have made a difference (or read, for example, Churchill's The Gathering Storm, or any shorter version of how WWII could have been so easily averted by preventing German rearmament). The odds are pretty high this is going to be another example of that.
- wildgift 13y ago
  Or allow one state to operate another state's exchange. The states were given federal money to build their state ACA programs... so the government already owns it. Now, imagine if they had been forced to open source this stuff, at least between the contractors.
l34ch 13y ago
"Well plenty of programmers do write code" Don't ALL programmers write code??? LOL

103 points by r721 13y ago

aram 13y ago

Hats off to the guys - good job. Here's the link to the site: http://www.thehealthsherpa.com/ http://www.thehealthsherpa.com/

deleted 13y ago

[deleted]

w1ntermute 13y ago
You can't just "reach out". There's a complex procurement process for government contracts. The companies that get contracts are usually those who are best at navigating the bureaucracy, not those who are the best at creating the product. Most of these companies have been in this business for a long time. It would take years for a startup to figure out how to get these contracts and build up the contacts in the bureaucracy necessary for it to actually happen.
- munin 13y ago
  this is very short sighted. hire a contracts person away from one of the big contractors, or get a recently retired contracts person as a consultant. other startups do this, you can too. odds are low they'll relocate to SF though, maybe they should work remotely ;)
  - dnautics 13y ago
    >hire a contracts person away from one of the big contractors Do you understand how much of a capital investment that takes?
    - hga 13y ago
      "One does not simply walk into government contracting." Seriously, it's a really involved thing. E.g. you need competent, domain experienced lawyers, there's massive amounts of law and regulations to follow. I've seen it at various levels, including working closely with a small firm's lawyer who e.g. got many of its products on the GSA catalog.
    - munin 13y ago
      yes, I've done it
  - Iftheshoefits 13y ago
    The "contracts person" is one link in the chain. The far more important and relevant links--the ones with the connections and personal relationships with people in the government who award these contracts. One of the reasons government contracting is the wasteful, corrupt mess it is is because it's an extension of the rest of politics in Washington: a machine designed to move taxpayer money into the hands of the connected and already-wealthy. Having a "contracts person" may slightly increase one's chances of getting smaller contracts. Having the right pedigree is the almost the only thing that matters with contracts as big as the web of HealthCare.gov contracts, and no startup is going to be able to offer a level of financial or intangibles compensation to pull those with the right pedigree away.
scotth 13y ago
You're assuming these guys actually solved the problem, and that's a pretty big leap to make.
- hga 13y ago
  Indeed. There's a big difference between what I call the Minimum Viable Demo (which is what was reported to have been shown to Obama before the launch, the thermocline of truth was in evidence there: http://brucefwebster.com/2008/04/15/the-wetware-crisis-the-themocline-of-truth/ http://brucefwebster.com/2008/04/15/the-wetware-crisis-the-t...) and a MVP, which is what we desperately need.

willchilcutt 13y ago

I don't understand how this site works. A few days ago when it was first posted here, I tried my zip, and it returned "Plan Results Found 0 exchange plan." Today I searched my zip again, this time even messing with the different options of insurance type, and still zero results. Is this saying there are no insurances available for people in my area?

joyeuse6701 13y ago
Apparently it only works for California zip codes:
- frakkingcylons 13y ago
  Not necessarily, I tried it with Arizona and Texas zip codes and those both returned valid results.
  - toomuchtodo 13y ago
    Worked just fine for my Chicago suburb zip code (60195)
dmethvin 13y ago
You haven't provided enough information for anyone to give you advice about what might be the problem. Perhaps you live in a state that has its own exchange (e.g., Kentucky or Maryland). Or maybe there is no data for your area yet. Try Chicago (60609) for some sample data to use for an experiment. If that doesn't work, perhaps some error is occurring on the page; check the JavaScript console and report it to them.

_pius 13y ago

This looks great, but haven't the big, embarrassing problems been with scaling the back end? Even if this were a superior UI and flow, it wouldn't address the issues that made the news.

hga 13y ago
Perhaps, and no. E.g. the front end registration problem is due to a late requirements change in August that had the effect of preventing window shopping, plus we know there were changes ordered though the week before launch, and no integration testing until 1-2 weeks before launch, and that discovered it locked up if 200 simultaneous login attempts were made or if it had ~1,100 users on it. So, yeah, those are scaling problems, but not ones we can necessairly blame the techies for, given that they didn't have enough time, and couldn't do integration testing (the government's CMS was the integrator and integration tester, now replaced by QSSI, the ones who did the "data hub"? I think it's called, which is supposed to be not so bad). But also no, in that the fix-it czar's #1 declared priority is to fix the garbage 834 EDI transactions that are being sent to insurers. That includes incorrect data and incorrect transactions (e.g. multiple enrollments and cancellations for the same person). Based on that, the front end's problems have been a blessing in disguise, because the insurers are only getting a few hundred enrollees a week and that low volume allows the insurers to call each up and straighten out problems. An estimated 16 million policies in the individual market, and an unknown number in Obamacare's interim high risk pool must sign up for new policies by December 15th or so or they'll suffer a lapse in coverage, which for many of the latter will be fatal. The only way to get subsidies is through the Federal system, i.e. the state exchanges use it for that (maybe with inaccuracies, but it's evidently working for the state exchanges that are working, but don't judge that for any given state exchange until you find out which are getting Obamacare and the much larger numbers reported to be signing up for Medicaid), and that makes sense to avoid fraud, since it results in direct payments from the Federal fisc.
- dr_ 13y ago
  Valid point with the window shopping comment. A huge mistake on the part of the administration though. The site was apparently flooded with visitors and you have to wonder how many of those visitors were people who already had decent coverage, privately or through their employer, but were just curious to check it out because they had heard so much about it. I know I was one of those people.

danso 13y ago

From the convoluted articles I've read, not only was the main bottleneck in the identification process, but the issue seemed to be that the authentication was necessary to just show the plans, because the gov wanted to make sure you were 25 before showing you a range of prices...was that the case? If so, whatever happened to letting people just browse the entire table of prices....remember when people had to look things up and scan tables once in awhile, instead of living in a Minority Report world where every piece of info is handcrafted to the user? I wonder how much of Healthcare.gov's problems could have been eliminated if the sign up was more modular...users were allowed to browse before signing up for anything. Then they could sign up via email and tentatively pick a plan. Then in 3 days, they go through the full authentication process...this is similar to how Amazon does things...you can sign up without a credit card, you can browse without signing up, and you don't go through the processing bottleneck till the very end.

hga 13y ago
The contractors were ordered in August to change the system to require up front registration and submission of "correct" information on penalty of perjury, no window shopping allowed, nor checking out "what if" scenarios (e.g. using the Kaiser Foundation's calculator, someone was unable to find any scenario where being married wasn't more expensive, and of course subsidies are based on income, and that can be very flexible for a lot of people). Since then window shopping has been allowed, but I don't know if the "under penalty of perjury" bit was dropped. As to "what happened", I'll just point you at this Washington Post article and let you come to your own conclusions: http://www.washingtonpost.com/politics/challenges-have-dogged-obamas-health-plan-since-2010/2013/11/02/453fba42-426b-11e3-a624-41d661b0bb78_print.html http://www.washingtonpost.com/politics/challenges-have-dogge... Note also the front end traffic jam has avoided sending the insurers more garbage 834 EDI enrollment and cancellation transactions than they can manually clean up by contacting enrollees. That's the #1 thing to correct according to the fix-it czar. And I do agree with you, an Amazon system, which I'm sure is based on the BASE eventual consistency back ends, e.g. you don't get your confirmation email until it decides who "won" the last copy of an item, would have been a lot better. But then again the contractors were doing a lot less of that sort of top level design that you'd think (see the Post article).

analog31 13y ago

I just tried it, and it's great. Nice job, on many fronts: Recognizing a problem, coming up with a simple, uncluttered solution, and making it work. In my view, a site like this is useful for a lot of purposes beyond actually signing up for health care. For instance, I've got employer sponsored care, but I was simply curious about what my costs would be through the exchanges. I also want to be an informed citizen, and "how much does it really cost" is an obvious question that anybody might be inclined to ask. In my view, knowing the magnitude of the numbers should help provide a reference point for political debate.

hga 13y ago
Have you tried this: http://kff.org/interactive/subsidy-calculator/ http://kff.org/interactive/subsidy-calculator/ ?
- analog31 13y ago
  Thanks for that! I had assumed that I wouldn't qualify for a subsidy, and indeed I don't. As others have mentioned, these sites don't actually solve all of the problems, but it seems to me that a few free tools that just help people gather information would take some of the pressure off of the main system. And if enough of these tools were to crop up, then none of them would have to be 100% reliable. Simply making people less nervous about signing up will make the official process work better.
  - hga 13y ago
    "I had assumed that I wouldn't qualify for a subsidy, and indeed I don't." And having learned that, you could now go to individual insurer's sites, or various ... marketplaces? like http://www.ehealthinsurance.com/ http://www.ehealthinsurance.com/ which I've also tried, shopped around (that site even integrates "is your doctor in the network", at least for Humana), and gotten yourself covered. But everyone was told to go to Healthcare.gov, and right now individual states are doing a lot of marketing for their own sites, some of which aren't sufficiently functional.... However a lot of people are due and need subsidies, e.g. see this link I found using Google right after the Kaiser one: http://obamacarefacts.com/obamacare-subsidies.php http://obamacarefacts.com/obamacare-subsidies.php A smaller fraction of the individual market I'd assume, but I also assume a rather large fraction of the temporary Obamacare high risk pool, many of whom could die if they suffer a lapse in coverage (I imagine kludges will be arranged if Healthcare.gov is not too late in becoming a MVP).

meshko 13y ago

Not even going to click to find out how stupid people are. Did they implement integration with data streams from hundreds of national insurance companies? Didn't think so.

theg2 13y ago
It is stunning just how much a lack of education and expertise went into this. This says nothing about HIPA, security, scaling, data source integration. It's staggering how much misinformation this PR stunt is going to cause.
- misterjangles 13y ago
  Their site doesn't ask for any data except your zip code then forwards you on. Where does HIPA come into play?
- otterley 13y ago
  HIPAA is not implicated in the new health insurance marketplace. HIPAA protects personal medical information, and under the Affordable Care Act, you cannot be asked any personal health information on any insurance portals because insurers are required to cover any pre-existing conditions.
  - absconditus 13y ago
    HIPAA covers far more than privacy.
- ddebernardy 13y ago
  Now now now. They're only 20 but "have plenty of experience working at places like Twitter and Microsoft." Surely they \cough\ know what they're doing.
gruseom 13y ago
Your point may be valid, but you put it so maliciously that I winced when I read it. Smart but malicious comments are the worst thing about HN. They are like dioxins where stupidity is mere sewage. PG has written about implementing a comment filtering mechanism. I hope he does and that it will catch stuff like this. I don't mean to pick on you; it's just a cumulative reaction, plus it happened to be the first thing I read this morning. I agree that back-end integration is likely orders of magnitude harder than UI for a system of this nature.

butner 13y ago

Seriously -- this tool is equivalent to a cardboard cut-out of computer. It is embarrassing this is getting attention. They're dumping a publicly available spreadsheet that contains example age-group pricing... i.e. unless you're 27 or 50, it's giving incorrect information.

deleted 13y ago

[deleted]

ollymorgs 13y ago

The government contractors should of just built healthcare.gov as a data service and asked people like these guys to build an intuitive front-end for it. Then if people don't like the interface, they can do something about it :) This may also help to dissipate the traffic load and present the same data in more relevant ways to different types people. The idea of building apps as single, monolithic system is out-dated. Even though I'm a Brit, some governments are making moves to modernise and open up their data for others to play with, over here we've got a great government-funded team working on exactly that (called the GDS). (http://digital.cabinetoffice.gov.uk/ http://digital.cabinetoffice.gov.uk/) Frankly I think this is a massively expensive and missed opportunity for the US Government's digital service team.

drivingmissm 13y ago
Britain is far worse than the USA -- your health care system just flushed $18 billion down the loo on a massively failed IT system. http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-pulls-the-plug-on-its-11bn-it-system-2330906.html http://www.independent.co.uk/life-style/health-and-families/...
- hga 13y ago
  A closer reading reveals that 11 billion (I assume that's thousand million) pounds was the projected cost at the time for completion of the system. "Only" 2.7 billion, or 4.3 billion USD, has been spent, although I don't know if there are contract terminations of serious size to be paid. Still, it's an epic failure, said to be the greatest single one in government IT contracting. (E.g. I'll bet the FAA's eternal quest to upgrade from their 1940's (sic) technique and '60s or so architecture has cost more over time, but not any single failed effort.)
- ollymorgs 13y ago
  Yea we get stuff wrong too. That was a massive balls up, but well before the time of the GDS team. Also note that the NHS system was about building a database for every NHS health record across the country; prescription notices, medial history, etc. etc. I'm not sure it'll even be legal now. HealthCare.gov isn't going nearly as far as that.

semerda 13y ago

For an MVP this is a great start. Front-end code is clean, concise and the flow far better than the gov version. If the gov is looking for solutions to their problems these guys just showed what local talent can do vs outsourcing an important piece offshore and messing up.

robomartin 13y ago

I must admit I have not devoted any time to understanding the real technical issues behind healthcare.gov. What little I know is from interpolating and extrapolating what I read here and elsewhere. One impression I got is that this $600+ million dolar website's authors tried to do it all. I don't get that at all. So, here's what I would have done. This is completely sit-of-the-pants. I'm sure it has holes. Nothing that couldn't be sorted out by applying real thought to the problem beyond this quick and admittedly faulty definition: My approach would have been to first develop a specification for an API all insurers would have to implement. They would be required to have a full implementation of this API in order to participate in the service. Now you have hundreds of teams working for you. This would cost almost not taxpayer money. The next step would be to develop an automated test suite to test for API compliance. Open source it and release it. Setup a method through which this API could be used to certify compliance. Perhaps this would be an insurer's portal in healtcare.gov. Upon certification they would receive an expiring token identifying the plans submitted as being fully compliant with the API. More on this later. Now everyone knows what they have to do to communicate their plans and how to make sure their API is fully compliant. No tokens. No participation. Each plan has a token. The token is also the GUID for each plan. Unit and regression testing are your friends. Insurers would do their own testing and they would be forced to continue to guarantee compliance by means of the tokens expiring at preset intervals (a year?). Next the API would be released for anyone interested to implement health insurance browsing sites. Yup, let entrepreneurs battle it out for best-in-class discovery services. You would have hundreds of sites pop up with all kinds of really good solutions. You would then publish another API anyone could use to actually communicate with government servers and "book" insurance. Now you have a potential of tens of thousands of people working for you. And still virtually zero cost to taxpayers. If that's too open, perhaps the plan browsing sites simply redirect you to a government site for the actual booking. They pass the token for the plan that was selected and a secure government site takes it from there. Not done yet. I would also hold a pre-release contest with cash prizes in the range of $1,000 to $100,000 for faults found during penetration testing of the government booking site. Release the code to the .gov site and let hackers mount massive attacks from every angle. Do this until top hackers agree the site is pretty damn hard. Give the top ten contributors cash as well as some kind of a presidential recognition at the White House. In other words, make it very public and very prestigious. Money and time well spent. Once there, load test for something in the order of a million simultaneous users. The site must be built with elastic capacity as it will have to be able to manage insane traffic for a few months and then scale down to a more reasonable baseline. Then open the doors. However. This does not happen all in one shot. Segment the population around data centers. Perhaps a couple of states on the east coast and a couple on the west. Announce it across all media. Schedule additional population segments across a period of a few months in order to average out a reasonable load on the system. All independent browsing sites would have API access to the schedule. They could then save your selection and email/sms you when your turn comes up. In other words, decouple the act of browsing and researching plans from actually booking it. And, at the same time, utilize a mechanism through which the rate of booking per unit time might be controlled. The browsing sites would simply not be able to forward to healthcare.gov unless it is your time slot. Now you have a situation where you simply can't have a hundred million people hitting healthcare.gov. One could further segment booking by implementing time slots based on other criteria. For example, the last digit or two digits of your SSN. Yet another approach would be to offer a limited number of booking time slots per hour. Browsing sites, through the API, would have access to this information. This means they could provide a virtual appointment system where you pick the time and date that is most convenient for you to actually book your plan. If a slot is available you are in. Otherwise you are offered alternatives. With this you could easily throttle the number of people who hit healtcare.gov per unit time. Again, healthcare.gov would NOT be a browsing site. You'd have to go through private sites for plan discovery. Once booked, healthcare.gov would --via a pre-published API-- forward a completed and validated application to the insurance company. I am sure further checks and balances would be required. And, as I said above, this game-plan surely has holes. It is seat-of-the-pants, I am coming up with it as I type. No way it is perfect. However, there is one thing I know: The general idea here is to leverage the free market and private enterprise in order to delivery a massively better product. I realize this goes counter to the ideas the current administration must have about how a country ought to be run. However, if this healthcare disaster has done anything at all for all of us is to potentially prove, once and for all, that central planning and management by government is a horrible idea. This is exactly how everything is done in government. We simply don't get to see it and experience it in daily life. With the ACA there was no way to hide it. This has been and continues to be a very unique opportunity for the American public to really see how bad government is about specifying, planning, managing and executing anything at all. If this makes people understand the fallacies in that school of thought this could very well have been the best $600 million we ever spent.

xbeta 13y ago

As a Canadian living in the U.S. (SF bay area), I still don't understand why American make healthcare so complicated. At beginning, HMO vs PPO vs whatever makes me very confused. Why not just move to a public national health care that works for all?

wildgift 13y ago
money * low information voters * paranoid messages = tea party Also, around 80% of people are in private insurance plans through a plan at work. Some fraction of these people are happy with their HMO or PPO. These are the middle class and upper middle class or rich. They are also politically resistant. The support for national health care or even single payer would come from the uninsured and people who have lower-end insurance (high deductible plans) and are forced into a kind of expensive PPO (insurance that makes you pay most of the costs of doctor visits). Hilary Clinton's single payer plan was demolished by the insurance industry. So this time around, they kept insurance companies in the reforms. That negated some of the resistance from the well-insured.

meerita 13y ago

They bootstrapped a lot, that's nice :)

x0054 13y ago

This makes me so infuriated! This site is great, it's exactly what needed to be done, it works, and of course, it was NOT designed by our government, because it works, and that just makes way too much sense! I used the CA site before to look at available covarage. It's much more dificult to use, and it hides from me the more affordable "Catastrophic Plan" for which I do qualify, because I am under 30 years old. They do not want people to sign up for that plan, so they just hide it! This is outrageous beyond belief. All this site now needs is the ability for the insurance companies to upload information about their plans directly to thehealthsherpa.com and we can forget about healthcare.gov all together. People signed up for years for insurance coverage by phone, directly with the companies, and they can continue to do so. The exchange should be just be an informational tool. This site does the trick. I think thehealthsherpa.com should provide links, or better yet, add pages to the site directly, to explain the different plans and regulations for different states, so it can be more of an information hub. Great Job!

greg5green 13y ago
Why would you want to sign up for the "Catastrophic Plan"? From my calculations here in Ohio, you could have actual coverage for not much more?
- x0054 13y ago
  For me it comes out to $250/month for Bronze Plan, and only $170/month for Catastrophic Plan. I don't go to doctors unless I need to, and when I need to, I can afford paying cash. I can take a $6,350 bet on my health, but I still want to be covered above and beyond that. And the question isn't about whether or not I should get catastrophic plan. I have the right to get it under the new law, and CA's Exchange site should have the duty to show me it as an option. Instead, they hide it, which is very underhanded.
wildgift 13y ago
For other readers, here's a comparison of these plans. http://health.usnews.com/health-news/health-insurance/articles/2013/08/28/aca-obamacare-bronze-tier-vs-catastrophic-health-insurance http://health.usnews.com/health-news/health-insurance/articl...

chucknelson 13y ago

A little skeptical of this, as others are. How was this tested? Just because it seems to "work" with responsiveness and items on the screen does not mean the info is correct. Not saying healthcare.gov is any better, but there is just no mention of the information given and/or calculations done being correct.

hsitz 13y ago

I'm assuming the task these guys have done is tiny portion of the actual work needed for the website. I've been wondering for a while, though, why the federal government can't just buy/beg a copy of software running one of the exchanges for one of the states doing things themselves. Then they could modify it to work for other states. Maybe they'd then have to replace existing federal exchange with 26 different instances (one for each state that's a member of the federal exchange), but I can't imagine that the technical difficulties of modifying one state exchange's software to run with another state's data would be as bad as fixing what seem to the problems with the existing federal exchange website.

hga 13y ago
Probably too late for the very hard mid-December deadline for those losing their insurance, maybe too late for getting enough young healthy people enrolled before adverse selection forces insane 2015 premium filings from insurance companies, which are due by the end of March. They also have only 4 well functioning states' systems to chose from as I understand it. The centralized subsidy calculation/verification/etc. process, which the Federal system does for all the exchanges is another issue, although I've only heard that some time ago is was known to produce incorrect results under testing. Also would require the Federal government to admit a much bigger screwup than they've been willing to so far, in a process entirely driven by politics (http://www.washingtonpost.com/politics/challenges-have-dogged-obamas-health-plan-since-2010/2013/11/02/453fba42-426b-11e3-a624-41d661b0bb78_print.html http://www.washingtonpost.com/politics/challenges-have-dogge...) until the last week of last month when CMS was fired and the fix-it czar was appointed. If you've been in this game long enough you've seen projects and companies destroyed by a failure to take decisive action when it could have made a difference (or read, for example, Churchill's The Gathering Storm, or any shorter version of how WWII could have been so easily averted by preventing German rearmament). The odds are pretty high this is going to be another example of that.
wildgift 13y ago
Or allow one state to operate another state's exchange. The states were given federal money to build their state ACA programs... so the government already owns it. Now, imagine if they had been forced to open source this stuff, at least between the contractors.

l34ch 13y ago

"Well plenty of programmers do write code" Don't ALL programmers write code??? LOL