The crash-on-takeoff of the Affordable Care Act website is already one of the most notorious flameouts in the history of digital enterprise.
Putting any merits or demerits of the ACA aside, we must grapple with the fact that as I’m writing this (one month after its launch), the digital platform upon which the ACA is perhaps too heavily reliant has been a near-total failure.
Many will be tempted to suggest this is because it’s a government effort and that government never gets anything right; it’s a sink of waste and foolishness and this proves how it ought to have been left to “the private sector” to construct and manage. But this is not necessarily the case, not least because the act was largely “privatized” in the first place, to placate a conservative congress.
Would the ACA be a much simpler proposition in a single-payer environment? No doubt. One of the the key challenges seems to be the coordination of numerous private databases in the service of what is essentially an e-commerce site. It really is not much different than a site that sells shoes, with special discounts for those who qualify. On the ACA site, you “shop for insurance.” Perhaps they ought to have given the whole project over to Amazon and had Amazon put a “healthcare” tab on the home page.
The difficulty with the the ACA web sites, apparently, is that many who seek to enroll cannot get past the authentication page, and cannot therefore apply for insurance.
To address the challenge, the White House has promised a “tech surge,” which seems to be taking shape in the form of a cry for help to Silicon Valley. It’s the first thing we’ve heard so far that seems hopeful and we wish them all the best.
Analytics or Continued Failure
The “fixers,” whomever they turn out to be, will need to pay close attention to analytics. At first, it will be all about error messages and fixing infrastructure. But once they get it to perform minimally, it will be, because of its early failure, just that much more important that the site delivers on conversion. Those in charge will need to rapidly identify friction in the system and make it more than a default way of solving a problem.
We come quickly to the question of whether digital is the right way to have tried to solve the health care morass.
The prevailing wisdom is that digital is the savior; that it cuts friction, that it is swift and simple and creates a permanent solution. However, it is entirely possible that a system of 1-800 numbers and paper applications might have served as well or better than an online solution (of course, they will have needed the same massive database on the back-end, but that is another matter). The ACA may quite unexpectedly prove a watershed in our belief that digital can solve societal problems and instead prove that it really cannot–at least not without much, much more care and devotion that would have been required by another (non-digital) system.
Analytics is What Makes Digital Different
But digital compensates in many ways that non-digital cannot hope to compete.
The way that digital triumphs comes down to its built-in accountability. Let’s not try in this brief space to describe the KPIs and reporting dashboards that the ACA site operators must put in place immediately to understand user behavior and make the site as efficient as, say, Amazon.
Let’s say instead that without the ability to:
- understand user behavior and spot trouble and fix it quickly,
- continually test and improve using feedback and algorithms,
- define desired outcomes and build in measurement and optimization;
…then digital really becomes just another choice among choices, and who can say if it was the best?
We suspect that this method was not followed in the development of the current infrastructure, and the results are a very poor showing indeed.
The only way to prove that the website for the ACA not only works, but works well–and works better than another system might have worked–is to apply robust site analytics, take careful note of what the data is saying, adjust accordingly and thereby demonstrate that digital is not just an obvious choice, but an essential component of the program’s success.
Title image courtesy of Shutterstock
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