HealthCare.gov Lesson? Ignoring Integration Will Bite You Every Time

Drivers and Challenges of Enterprise Integration Revealed

Are integration problems at the heart of the HealthCare.gov fiasco?

“Data Integration Challenges Underpin Balky Health Exchanges,” read a Wall Street Journal blog column headline on Friday.

John Engates, CTO of Rackspace Hosting, told the Wall Street Journal that data integration is at the most likely root of the exchange problems. Engates pointed out that even one database can act as a bottleneck for the entire system.

There’s no doubt that the site required a lot of back-end integration, although the government is hush-hush about what’s causing the problem. The Centers for Medicare and Medicaid Services, which is the central coordinator for the entire health marketplace program, had to connect the health care portal to servers at the Treasury Department, the IRS, Homeland Security and state agencies, according to the article.

The WSJ talked with Charlene Frizzera, who worked for CMS as the acting administrator until she left in 2010. Frizzera compared Healthcare.gov with CMS’s 2006 Medicare Part D rollout. The article reports:

“Then, as of now, CMS didn’t know how to design a system to integrate enrollee financial and health data from several government agencies. And then, as of now, unforeseen glitches popped up. But building the health exchange system, which combines data from different federal agencies—stored in customized software systems—with insurance plan information, is like ‘Part D on steroids’ because the customer pool is wider than the Part D pool, she said.”

Even one faulty, integrated database can create system-wide bottlenecks, the article notes.

If only someone had explained to the coordinators “Why You Should Make Smart Integration IT’s First Priority.” 

The problems have lead to insurers obtaining incorrect data, with no clear way to resolve the data quality problems. ZDNet notes that Blue Cross & Blue Shield of Nebraska resorted to hiring temps to contact enrollees to clarify questions.

Of course, integration may not be the only source of the problem. Other reports cited a poorly designed interface, illogical processes such as forcing users to log on even to browse the plans, and just plain old bad code.

While the problems may be rooted in technology, it seems this could have a very real impact on individuals, according to TechCrunch. Kenneth Davis, CEO of Mount Sinai, told TechCrunch the site’s calculator could create coverage problems if it recommends cheaper plans without considering deductibles, co-pays and what’s covered.

The technology problems are also turning into political ones:

• TechCrunch blames federal and state governments for refusing to prioritize tech companies, particularly startups, with the task of building HealthCare.gov and its massive database.
• President Obama took to the bully pulpit to defend the Affordable Healthcare Act and argue that the technology problems are not a sign that the overall act won’t work. “Nobody’s madder than me about the fact that the website isn’t working as well as it should, which means it’s going to get fixed,” Obama said at a press conference.
• Sen. Ted Cruz, R-Texas, called for the immediate resignation of HHS Secretary Kathleen Sebelius. Why? “Because the program she implemented, Obamacare, is a disaster,” Cruz told CNN. “It’s not working. It’s hurting people all across this country.”

Kind of makes you glad you don’t work in government, doesn’t it?

Of course, these kinds of problems are not unique to government, although I’d like to think few organizations in this day and age would roll out a program nationally without a regional pilot—an approach that the WSJ argues could have resolved some of these problems.

It’s worth noting that several private companies thought about integration.

TechCrunch notes that eHealth is integrating with the maker of TurboTax to provide young taxpayers with the opportunity to buy insurance at the moment they would otherwise have to pay the $95 no-coverage fine.