Sunday, October 20, 2013

Healthcare.gov's current problems: Hiccup or deadly disruption?


An insightful (anonymous) commenter to my previous post said:
Disruption is fine, but only when oriented toward a useful and healthy goal. Disruption for disruption's sake is not helpful at all (Wanamaker missed that really).
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You’re right  - “disruption” for disruption's sake is the mode of current government, and has no place when we’re building ways to get people enrolled in health plans. 

But I’m not ready to say the enrollment system and Healthcare.gov set out to not work well.  We may differ about this.  But that’s where I stand.  You did get me interrogating just how I approach solutions, tools, technologies that, along their way, create disruption. ( I do realize I'm talking about "disruption" on a pedestrian level here - not as intended by theorists talking about disruption as social change agent/imperative). 

The reality of “disruptive technologies” resonates with me in the following way:
In public health there is a long, long history of identifying problems or “barriers”. Most often we’ve done so by identifying problems/deficits in the population or target community, and in rarer moments, identified problems in the providers or delivery systems.

The over 20 years of research in (personal) health literacy was relentlessly focused on how to “cure” the low health literacy of patients.

I’ve found, in my own work, that when you re-frame health literacy in the public area, using a societal lens, it forces you to see health literacy and public understanding and engagement as a social construct, much like risk (Douglas; Wildavsky; Tversky).  So you wind up broadening the lens to look at social and organizational factors that actual can shape our interest in and understanding of, say, health.
  • More and more I find myself doing the following:
  • Identifying a problem that consumers/patients are having with X
  • Asking “how is this problem similar to other problems they are having in their day to day lives?
  • Learning how they deal with this other “daily life” problem
  • Then recalibrating, re-understanding the current problem and try to tackle the X problem I started out with


So, back to your take on the “disruption” currently caused by the somewhat torturous enrollment process.  I’m informally speaking to “aspirants” to enrollment these days, and I am looking forward to two panelists very close to the enrollment process who will speak at the New York Roundtable on Public Health Literacy soon.
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   The NYC residents I work with are all to familiar with systems not working properly – from getting your cable fixed, to getting power turned back on after a storm, to figuring out how to get downtown when the subways aren’t running.

·       Many residents come from countries where disruption (and corruption) at every level was the norm.  It can take them a long time to come to expect that when a clinic doctor sends a prescription to the pharmacy, it will be there waiting for them – and with no pills mysteriously missing.  They accept that some things are “rigged” and they can count on others not to be and they adapt.
·      Many (PEW estimates close to 65%) have smart phones; use social media, download new apps, and suffer the same glitches and disruptions with technology that keeps us all wondering just why we are so tethered to these little glass boxes. 

I believe there is some value in adding this analytical perspective – room for looking at what the information commons has already primed us for.  Do you agree? 

For now it seems that people will have to rely more on the Navigators, the Call in Centers.  They will have to persist.  And we worry that some won’t. But people need and want affordable health insurance.  I can hear it in line at the Dunkin’ Donuts here in East Harlem. People are talking about it. 
It’s in play.  It’s not going away.
I don't want to join or be deflected by those who are spending precious time on hand-wring and dart throwing about the glitches, and just fix them?  

The other night I tried to use the healthcare.gov and things were going great until, on the 3rd page of personal info, the pull-down menu for what city and state I lived in DIDN’T WORK.  To myself I said, “they gotta’ lot of work to due by January.”

I’m still waiting for them to fix the glitches in the new iPhone iOS7 – some things draining the battery. 

8 comments:

  1. Perhaps I'm a natural born cynic, but I'm not surprised that the website roll out was less than stellar. Recall the chaos that ensued during the initial roll out of Medicare Part D? And, as you point out, even tech behemoths like Apple are not immune to major snafus (remember the first iMaps app?). I think the real test will come when the number crunching happens - and we find out whether the ACA is delivering on its promise to bring health insurance at better costs to more people. If people see that the ACA has real benefits, then these initial hiccups will be forgiven and forgotten.

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  2. Agreed. To say nothing of the Facebook IPO debackle. It's not just behemoth health and social service roll outs that go a bit pear shaped.

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  4. It is definitely expected that some technical errors will occur, especially when attempting to sign up an entire state for health care. I have to agree with Wendy that the real test will come next year when the health care is actually implemented. My biggest concern is how many people are going to keep persisting if the process continues to be annoying and unreliable.
    I have seen multiple Facebook statuses asking for advice on how to sign up, and the comments that follow are generally peers engaging in frustrating and predictable solidarity. It has been relevant over the past decades that the people are losing faith in the government and I'm starting to witness this from a few different angles. A friend of mine the other day asked me what was up with the ACA and I told her how to sign up online and how to get an estimate, to which she replied "Well I tried, couldn't get through the application" and was not interested in following up, as if she didn't expect it to be that easy to begin with. I have noticed that I'm waiting around myself to see what happens next, instead of persisting. I was told to call a certain number to try to reset my username and password, but when I called I was disconnected after being on hold for 2 minutes and did not attempt to call back. I literally thought to myself "UGH this is so pointless right now, I'll try this again later" - yet, I haven't.
    Maybe this reliance on Smartphones and apps is creating a dependence on instant gratification and a less patient society. People don't want to spend the "time" being aggressive about technical glitches and leaving that type of thing to the "experts", wherever they are

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  5. It's a shame that a website glitch is the barrier keeping people from accessing health insurance. We have become too reliant on instant gratification when it comes to the internet and I can easily see myself getting incredibly frustrated over some website error keeping me from enrolling - especially when so many people have been desperately waiting for open enrollment. I won't need to enroll for another year, but I hope they the website is functional by then.

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  6. Once enrollment was open on October 1, I decided to view the website and sign up for the Affordable Care Act. I had encounter many glitches after the first page. It was frustrating and I gave up on the website. I think these glitches can be minimize but they do exist. In order to by pass them I had to wait a few days in order to sign up. This is unfortunate the government should of been prepared for these glitches. In the future I hope these glitches would be addressed before the launch of a website.

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  7. I agree with my fellow classmates that it is such a shame that the healthcare .gov is having some many glitches. The government expects the average consumer when they file their income taxes that they have to have all their i 's dotted and all their t's crossed. In the case of making open enrollment process barrier free it has become impossible. I think the government needed to have taken more time so that they could have tired out the system way before it took off. You will expect some errors in beginning when you have million of Americans trying to apply for health insurance. However, the whole system has been a complete nightmare. I hope that the government can work together to fix these glitches so that millions of Americans can apply for health insurance. I will wait a little longer to see how all this plays out.

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  8. I agree with Daniel in saying that being the techy-genereation we are makes us less patient and we want instant gratification. This is true because most of us are really dependent on smartphones as they seem to be on the go and operate rally fast. As with the website, the glitches that we have been seeing are temporary and are mere hiccups, it will soon be up and running full force, um... hopefully before the open enrollment process ends. Large websites are not immune to glitches, and healthcare.gov was no exception.

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