5.10.2013

Implement Direct Enrollment or Lead Generation at the Health Exchange?


Henry Chao, the deputy CIO at CMS was probably not kidding when he said "Let's just make sure the Federal Health Exchange don't turn into a third world experience". We saw a slight glimpse of Chao's fears during the QHP submission period when the issuers kept experiencing the timeout issues.

During the planning phase the Govt. underestimated the website traffic by a major margin which is why when they went live, they suffered from a phenomenon similar to that of a traditional hacking attack known as DOS attack (Denial of Service). DOS attack happens when too many people visit one's website at the same time clogging its resources and rendering it unusable for everybody.

HHS recently announced that they will be adding some more servers to their HIOS fleet to facilitate seamless experience. Eventually their changes will allow issuers to get their QHP applications in, but this mess begs attention to a bigger event being the open enrollment!

The Federal Facilitated Marketplace

Starting October 1st the population interested in tax subsidies and Qualified Health Plans will visit Federal Facilitated Marketplace. This number of visitors will be way bigger than what HHS saw during its QHP submission time. I can only hope that the Feds have kept this larger traffic in mind when designing their hardware needs.

Direct Enrollment or Lead Generation

Direct Enrollment and the Lead Generation are one of the options through which the issuers can sell their products on the exchange. They are very important because they allow issuers to let consumers shop their plans without competing with anyone else.

The only single and the most important difference between these two options is that under Direct Enrollment, it is the issuer who carries most of the Burdon while under the Lead Generation, the exchange does all the processing. This brings us to the crux of this post which is the question that if one of these two algorithms is better than the other?

While I understand that due to IT staff size or budget shortages, having HHS do all the work would be the way to go for many plans; I lean towards the Direct Enrollment method. It is the safer bet of the two because it does not fully rely on the Federal servers.

Delivering on time is not enough

There was an article published this AM in USAToday that mentioned Whitehouse touting the success of ACA on the fact that it was hitting milestones on time. The problem is not delivering the milestones on time but delivering the products that will work. The USAToday failed to mention anything about the mess that happened at the Government severs which resulted in deadline extension. Only time will tell how the whole thing turns out but let's just hope it is not a nightmarish whack job scenario.

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