Healthcare.gov is in the recovery room.
The entry point into the competitive exchanges set up for every state to provide health insurance to residents is adding server capacity and fixing software bugs to rectify problems that made it difficult if not impossible to sign up for coverage under the 2010 Affordable Care Act.
“While we are increasingly moving more users through the system, we are not satisfied with the performance – we can do better,” Brian T. Cook, a spokesman for the Centers for Medicare and Medicaid (CMS), told CruxialCIO via email. “To make further improvements to the system, we are undertaking a threefold operation.”
Test, test and test again. Run tests at multiples of expected user and stress levels. Run first tests six months in advance of launch. Identify bugs, remediate. Overstress again. Make sure all functions work and can be duplicated across servers. Keep spare servers and cloud capacity available at launch. If system fails, shut down. Fix. Relaunch.
Coding problems and a lack of server capacity plague the federal health insurance exchange hub, Healthcare.gov.
Part of the U.S. Department of Health and Human Services, CMS is responsible for making sure the national site operates effectively and routes inquiries by applicants to the correct state site. The federal effort built and maintains insurance exchanges for 36 states. Its Healthcare.gov site acts as a portal to the exchanges in those states and routes individuals seeking information on plans available elsewhere to the exchanges set up in those states, such as Colorado or Connecticut.
CMS is adding more server capacity to allow the federal HIX site to handle a bigger load, according to Cook. Almost 3 million Americans tried to visit the exchanges on the first day of operation on October 1.
The federal government also intends to move the part of the system that became “overstressed” from “virtual machine” technology, where the computing and storage capacity of racks of servers are shared with other users, to dedicated hardware with more power.
It also will implement software fixes that will “make the system more efficient and enable it to handle higher volumes,” Cook said.
The launch of the Healthcare.gov site, which acts as a portal to the states’ exchanges, has been marred by coding problems and architectural flaws, The Wall Street Journal reported on Oct. 6.
A technical problem in the system involved confirmation of enrollees. As users create their accounts, the system crashes and fails to show users what insurance subsidies they’re eligible for. In addition, the site doesn’t recognize accounts opened before Oct. 1 when consumers could explore insurance options, the Journal reported.
“To improve access to the system, work at night has significantly cut down on time people wait before accessing the Website,” Cook said.
“We continue to increase access to HealthCare.gov in light of strong demand,” Cook added. “Wait times have been significantly reduced and more people are logging on and applying.”
Systems integration company CGI Group developed the federal exchange.
Experian, an information-services firm holds a federal subcontract for Healthcare.gov, as the Journal reported, but the company declined comment to CruxialCIO.
Media Temple, a Web-hosting company, told the Journal that a stray software code existed in the system that did not serve a purpose. In addition, without saving parts of the federal hub that change infrequently, the Website’s “plumbing” became “clogged,” the Journal reported.
The technical requirements for the federal health insurance exchange hub may not have been well-formed and well-understood by workers involved in the development, suggested Scott Lundstrom, group vice president and general manager of IDC Financial and Health Insights.
Instead of the required six months to a year of testing, the federal site went live after only 60 to 90 days of testing, Lundstrom told CruxialCIO. “The fact that the onboarding process worked so poorly is really telling that little testing took place,” Lundstrom said.
“I’m sure there are thousands of minor coding problems,” he added. “We’re going to be chasing bugs here for several months.”
Brian T. Horowitz is a breaking news reporter with nearly 20 years of experience covering business, technology, health care information systems and innovation. He has written for Computer Shopper, eWEEK, Fast Company, InternetNews.com, NYSE magazine and ScientificAmerican.com. He holds a B.A. from Hofstra University. Follow him on Twitter: @bthorowitz.