Thursday, October 10, 2013

HeathCare.Gov: Software Making it Hard to Get Health Insurance

Many of the 8.6 million unique visitors to HealthCare.Gov experienced difficulty accessing the website and enrolling in healthcare plans. These difficulties were caused by a limited system capacity and issues with the website’s software.

Reported glitches included not being able to access the registration portion of the website and long wait times for access to agents, brokers and the registration pages. The Department of Health and Human Services said that they were able to expand system capacity this week and will continue to do so in the future to accommodate the high volume of traffic on the website.

The issues with scalability occur when there are more users attempting to access the site than the system has capacity for. This is a hardware issue and may be resolved with adding more hardware that will increase system capacity.

One way the government is addressing this problem is by metering access. The idea is only a certain number of users are allowed to access the site at any given time. Any users that attempt to access the site once the maximum user threshold is reached will be put in a virtual line. These users will be allowed access as other users leave the site.

There are also bugs in the website’s code. These bugs are responsible for the error messages that appear when a user is trying to click various parts of the website but unable to do so. These types of issues will take more time to solve because they are more complex than just adding more physical equipment.

Articles Outlining Healthcare.Gov Software and Traffic Glitches:

Huffington Post: Obamacare Website Glitches Reveal Larger Government Problem
http://www.huffingtonpost.com/2013/10/10/obamacare-website-glitches_n_4077092.html

USA Today:Review: Healthcare.gov a winner despite glitches
http://www.usatoday.com/story/money/business/2013/10/03/healthcaregov-website-review/2912987/

Washington Post:A techie walks us through healthcare.gov's two big problems
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/05/a-techie-walks-us-through-healthcare-govs-two-big-problems/


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Friday, October 4, 2013

HealthCare.Gov: Website Glitches & Alternatives

The open enrollment period for individuals, families and small businesses to select health insurance plans was highly anticipated.  As expected with any new website or websites with high-traffic volume, there were technical difficulties for users trying to access the marketplaces.  These problems are similar to issues encountered eight years ago with the launch of Medicare Part D.  The department of Health and Human Services reported that HealthCare.Gov had over 2.8 million visitors on the first day the exchange opened.  The live chat assistance option received over 60,000 requests as users navigated the health plans and website.  People interested in healthcare coverage also had the option of calling the consumer hotline; over 81,000 calls were placed the first day. 

Reported glitches included not being able to access the registration portion of the website and long wait times for access to agents, brokers and the registration pages. The Department of Health and Human Services said that it was able to expand system capacity this week and will continue to do so in the future to accommodate the high volume of traffic on the website.

As of October 4, the website (www.healthcare.gov) displays a message that explains, “We have a lot of visitors on the site right now” if the site is experiencing heavy traffic that exceeds system capacity. It then directs you to stay on the page to save your place in line. The site will direct each user to the login page in order that they attempted to access the page. The page also offers the phone number for users wishing to speak with a trained representative and apply over the phone.

Non-technical issues with the marketplaces also exist. In some states small businesses weren’t able to use the SHOP Marketplace on opening day. Additionally, the Spanish-language version of the healthcare marketplaces was unable to accept applications for healthcare coverage. There are also expected delays in Medicaid enrollment with federal insurance exchanges and a few states delayed online enrollment for individual and small-business marketplaces.

Below you will find phone numbers to call as an alternative to using the website for enrollment.  Even under high-volume conditions the website’s pages that outline the insurance plans and answer frequently asked questions generally operate smoothly and are a useful resource for determining plans you may be interested in and your eligibility.

Health Insurance Marketplace Information:



 SHOP Marketplace Information:

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Healthcare Marketplace: The Nuts & Bolts

On October 1st HealthCare.gov, the portal for the more than 30 health insurance exchanges being run by the federal government and the marketplaces operated by 16 states and the District of Columbia, opened to the public for enrolling in healthcare plans  under the requirements of the Affordable Care Act. Enrollment for individuals and families is open from October 1, 2013 – March 31, 2014. Enrollment for small businesses lasts year round. 

 The website features two separate marketplaces to purchase insurance plans. The first, widely-publicized, marketplace is the “Health Insurance Marketplace” for individuals and families. The second marketplace is the Small Business Health Options Program, or SHOP Marketplace, available for small business employers with 50 or fewer employees.


Available Plans
The marketplaces offer several choices for employers and individuals to choose from. As with all health insurance plans, individuals and employees will have to pay a monthly premium. Employers may choose to contribute to these premiums to lower the monthly costs for employees. Employers that do contribute to premiums may qualify for a tax credit. You will be able to choose from: Platinum, Gold, Silver, Bronze and Catastrophic health insurance plans. Coverage will begin as early as January 1, 2014. 
The differences in the plans are the price of monthly premiums, deductibles, and copayments and the breadth of available doctors to choose from on each plan.  All the available healthcare plans must cover a specified list of preventative services at no cost.
The catastrophic health insurance plan is only available to individuals under 30 and to some low-income people. Marketplace catastrophic plans cover 3 annual primary care visits and preventive services at no cost. After the deductible is met, they cover the same set of essential health benefits that other Marketplace plans offer.

Health Insurance Marketplace
The Health Insurance Marketplace is the marketplace for individuals and families to purchase health insurance plans. Individuals and families may be eligible for lower costs on monthly premiums and out-of-pocket costs, or get free or low-cost coverage.
Medicare & Medicaid: Individuals covered by Medicare and Medicaid do not need to enroll in the Health Insurance Marketplace and the choices and benefits afforded to these individuals will not change.  Individuals that do not qualify for Medicaid now may qualify for the program in 2014. In many states the eligibility for coverage is expanding to cover more individuals.

 Questions about Medicare are addressed here: https://www.healthcare.gov/if-i-have-medicare-do-i-need-to-do-anything/ 

 Questions about Medicaid are addressed here: https://www.healthcare.gov/do-i-qualify-for-medicaid/#state=alabama

  • At the bottom of the screen you may select your state of residence to learn more about Medicaid expansion in your state.

Health Insurance Marketplace Information:


 SHOP Marketplace (Small Business Health Options Program)

 The Small Business Health Options Program (SHOP Marketplace) is designed to help employers with 50 or fewer full-time equivalent employees select a healthcare plan. The website allows employers to fill out a single application to compare price, coverage, and quality of plans in a simple straight forward manner that any layperson can understand.  Self-employed individuals will not use the SHOP Marketplace and should instead use the Individual Marketplace.

The SHOP Marketplace also provides information on the small business healthcare tax credit. To qualify for the tax credit the small business must get coverage through the SHOP Marketplace.  The maximum tax credit available is a credit for half of the amount of the premium contribution made by the employer.

 SHOP Marketplace Information:

  • Phone number: 1-800-706-7893 (TTY users: 1-800-706-7915).Hours: Monday through Friday, 9 a.m. to 5 p.m. EST


Helpful Links



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Tuesday, August 6, 2013

Data Hub for Health Insurance Exchanges nears deadline for security confirmation


HHS Inspector General reports that the data hub intended to support health insurance exchanges will not be “secure” until the day before the exchanges are due to open.
 
While the report does not state that data security will not be in place, it notes that time is running out.  HHS has said that the data hub will be secure and the exchanges will be up and running as most recently scheduled.  Federally-run health insurance exchanges are due to open October 1, the opening day of open enrollment. 
 
Find the OIG report here: https://oig.hhs.gov/oas/reports/region1/181330070.asp
 
An earlier timeline had called for the data hub to be designated as “secure” by September 4.  In the meantime, as of Monday, August 5, prospective enrollees may go ahead and create new accounts and begin collecting the required information for enrollment and coverage.  Open enrollment is scheduled for October 1, 2013 through March 2014, with coverage beginning January 1, 2014.
 
Health insurance exchanges are State-based competitive marketplaces where individuals and small businesses will be able to purchase private health insurance. The hub will help facilitate the access of data by exchanges; enable verification of coverage eligibility; provide a central point for the Internal Revenue Service when it asks for coverage information; provide data for oversight of the exchanges; provide data for paying insurers; and provide data for use in Web portals for consumers.
 
As explained by CQ HealthBeat: “The hub is the mechanism by which the new health law marketplaces will receive data establishing whether an insurance applicant is a U.S. citizen, what his or her income is, whether the applicant is eligible for subsidies to buy coverage, and the size of those subsidies. It will include links to the Internal Revenue Service, the Department of Homeland Security, HHS, the Social Security Administration and state agencies.”
 
As such, the role of the Hub is only as a pass-through of information that resides elsewhere, in other data bases.  It is not intended to actually store information.
 
“It is important to note that the Hub does not store data,” the OIG reports. “Rather it acts as a conduit for exchanges to access the data from where they are originally stored. We evaluated the adequacy of the development and testing of the Hub from a security perspective. We did not review the functionality of the Hub.”
 
The reports summary notes that the OIG assessed the information technology security controls that CMS is implementing for the Hub, adequacy of the testing activities being performed during its development, and the coordination between CMS and Federal and State agencies during the development of the Hub.  As a conclusion, it notes that “CMS is working with very tight deadlines to ensure that security measures for the Hub are assessed, tested, and implemented by the expected initial open enrollment date for health insurance exchanges of October 1, 2013. If there are additional delays in completing the security assessment and testing, CMS may have limited information on the security risks and controls before the exchanges open.”
 
As reported by CQ: The OIG document said “several critical tasks remain to be completed in a short period of time, such as the final independent testing of the Hub’s security controls, remediating security vulnerabilities identified during testing, and obtaining the security authorization decision for the Hub before opening the exchanges.”
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Go to www.healthcare.gov


USA Today reported this week on the outreach efforts on the part of the U.S. Department of Health and Human Services, including a new government webpage (relaunched as a new website in June), training videos and infographics to help Americans better understand the health insurance exchanges that will open October 1.  
 
See “A new website will help explain the insurance marketplaces, called exchanges, where Americans will start buying health insurance October 1 under the Affordable Care Act” at http://www.usatoday.com/story/news/politics/2013/08/05/survey-americans-dont-understand-insurance/2619007/. The newly revised webpage is https://www.healthcare.gov/.  
 
The announcement came as HHS Secretary Kathleen Sebelius held a phone press conference on Monday, and insisted that the exchanges will be ready for business by that deadline.  Keiser Health News reports: “Health and Human Services Secretary Kathleen Sebelius said in a call with reporters yesterday that the agency is "on target" to open new online marketplaces October 1. She also spoke about personal "Obamacare" accounts which consumers can begin creating now in advance of being able to shop for plans.”
 
The website is intended to fill the void if what many acknowledge is a lack of easy-to-understand information for would be enrollees. When they launch on October 1, exchanges are expected to provide information on plan choices, plan benefits and premium charges. 
 
The outreach efforts by HHS also include the opening of a new call center for small business and the opportunity for potential enrollees to create their personal accounts in anticipation of the October 1 launch. CQ Healthbeat News reported that: “Officials said that more than a million people have visited healthcare.gov since the website was relaunched in June to begin efforts to educate people about enrolling in coverage. The public can now create a personal account and set up user names and passwords on the site so they are ready when the actual open enrollment begins.” 
 
The idea is that the potential enrollee who sets up an account now can learn what information will be collected by the October 1 sign up.  The site includes a form that can be used to collect information from employers to complete the coverage applications they will submit to the exchange.
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Friday, August 2, 2013

Consider These Facts About The Joint Commission's National Patient Safety Goals


Patient Access is well aware of the National Patient Safety Goals, particularly those identified in NAHAM’s Joint Commission Survey Tool Kit.

So it is worth the reminder how these goals are developed and put into place.  Below are excerpts from a Joint Commission Fact Sheet: “Facts about the National Patient Safety Goals”:

In 2002, The Joint Commission established its National Patient Safety Goals (NPSGs) program; the first set of NPSGs was effective January 1, 2003. The NPSGs were established to help accredited organizations address specific areas of concern in regard to patient safety.

A panel of widely recognized patient safety experts advise The Joint Commission on the development and updating of NPSGs. This panel, called the Patient Safety Advisory Group, is composed of nurses, physicians, pharmacists, risk managers, clinical engineers and other professionals who have hands-on experience in addressing patient safety issues in a wide variety of health care settings. The Patient Safety Advisory Group works with Joint Commission staff to identify emerging patient safety issues, and advises The Joint Commission on how to address those issues in NPSGs, Sentinel Event Alerts, standards and survey processes, performance measures, educational materials, and Center for Transforming Healthcare projects. Following a solicitation of input from practitioners, provider organizations, purchasers, consumer groups, and other stakeholders, The Joint Commission determines the highest priority patient safety issues and how best to address them. The Joint Commission also determines whether a NPSG is applicable to a specific accreditation program and, if so, tailors the goal to be program-specific.

The National Patient Safety Goals for each program and more information are available on The Joint Commission website found here: http://www.jointcommission.org/standards_information/npsgs.aspx

 
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Consider These 5 Things to Know About Obamacare Premiums in Your State

Consider this from Keiser Health News.  Since Obamacare was passed, concerns have come from many corners that health care premiums would be too expensive for the very Americans the new health care system established by the Affordable Care Act was intended to cover.  Individuals anticipating signing up through the new health care exchanges and small businesses anticipating coverage for employees were particularly concerned. 
Keiser Health News asks “How is a consumer to make sense of this?”
KHN answers with some straight talk worth considering:  “Most policy analysts concur that average premiums will go up for younger, healthier people – and that they will get better benefits than they do now – but that rates may fall for older or sicker Americans, as new rules go into effect Jan. 1.   Increases may be offset for many of those buying coverage through tax credits available to people with low and moderate incomes.”
Finally, consider these 5 things when you evaluate anticipated cost of coverage in your state:
1.  Comparing apples to apples is virtually impossible.  The first thing to understand is that policies that will be sold to individuals and small businesses in online marketplaces are brand new and must cover a range of essential benefits that were not always covered in the past. That includes prescription drugs, hospitalization and maternity coverage. Consumers cannot be turned away or charged more because of health problems, as they can now in most states.  Women cannot be charged more than men. In addition, the amount you'll have to pay out of pocket will be capped at $6,350 for singles or $12,700 for families. Currently, almost a third of individual policies have caps that exceed those amounts, according to a report by Kaiser Health News and U.S. News & World Report.  
2. Look for which premiums state regulators are using for their comparisons.  Under the health law, coverage sold through new marketplaces to individuals and small businesses include a range of types, from the lowest-cost bronze plans that have the highest deductibles to higher-premium platinum or gold plans, where you pay fewer out-of-pocket costs.  But premiums are just one part of the cost of health insurance.  When considering a report on rates, ask which type of coverage was highlighted and how much the deductibles and co-payments are.  Was it the low-cost bronze plan price, the slightly higher priced silver plans or the highest priced platinum or gold? Or some combined average?
3. You are not average.  Many of the estimates are based on averages, which really don’t reflect what any individual consumer will pay. Premium prices will vary based on a person’s age, where they live and the insurer they select.  Generally, younger people – especially  those few who are buying high-deductible coverage now -- may see an increase in premiums, while older or less healthy people may see their rates go down.
4. Subsidies will offset costs for many people.  Most people shopping in the new marketplaces are expected to qualify for a subsidy to offset part of the cost of the premiums.  Sliding-scale subsidies will go to those earning between between about $11,590 and $46,000 a year, as individuals. Those who get subsidies will also likely pay a portion of their household income – from 2 percent to 9.5 percent – toward the premium cost.
5. Last, but certainly not least - premium changes are unlikely to affect you at all.  The rates submitted to states and the federal government are for coverage sold to individuals and small businesses with fewer than 50 workers that are not self-insured.  Currently, the vast majority of Americans with insurance coverage get it through their jobs – and they generally work for companies with more than 50 workers.  Large firms already offer coverage similar to what the health law will require insurers to offer individuals and small firms, so little change is expected.  The new rates are most likely to affect people who buy their own coverage. About 15 million do so currently and an estimated 7 million more are expected to do so next year because of the health law.
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