Tuesday, October 22, 2013

Adventures in Health Insurance, Part 2: CoveredCA Here I Come

So let's see if I got this right. The original contractor blows a high profile rollout, everyone - and I mean everyone - is screaming mad about the lousy software, management panics, and an elite tiger team swoops in to save the day. In the world of health IT, we call that Tuesday.

As I mentioned before, I am actually shopping for insurance right now. I'm in good health and could probably buy insurance on the private market for a bit less than what I've been paying COBRA for the past several months, but I thought I'd wait to see what the exchanges had to offer. This is the story of my adventure on CoveredCA.

I signed up early, was able to compare prices somewhat and already had a login before the October 1st rollout. I finally found the time and motivation to do some for real shopping. It's 7:17pm and I'm logging in.

It's showing the strain of prime time load, the poor thing.

Waiting ten seconds and clicking didn't seem to help, but the APPLY button did take me somewhere useful. The login worked. I was in.
 My first impression is that of a nice, clean layout. I can see right away I've already filled in all the forms (there aren't that many), but then none of the things I want to click are hyperlinked. I'm a very nonlinear user and I like to click on everything. I suspect there's a NEXT button hiding in the corner somewhere, and there is.

It turns out to be a very linear navigation, and by "very" I mean "exclusively." It's next-next-next until you see at least three text regions overlapping each other, like an HTML panel editor threw up in the corner. 
It looks terrible but I just need to click Select Health / Dental Plan so I move on.

I get to my selection of 26 plans, of which I can view exactly three at a time. There's too much real estate at the top being used by navigation links I don't care about right now, leaving precious little room at the bottom for a ridiculously constrained scrolling region containing all the information I really want. In this picture you can see two rows of that.

And here's a collapsed list of all the information you can scroll through down there. If you count you'll see there's a lot. It's all useful and I wish I could view it more easily.

Here's a tip for all you twelve year old kids who want to build web applications like this one: The ideal number of scroll bars on a given page is zero. One is marginally acceptable but if you have two or more they interfere with each other and that's bad. Very bad.

Let's get to the part where I search for my doctor. He's not there. I hope he hasn't left town but when I search by name this is what I get.
And this is what I get when I search for "S"
I point this out not because it's broken, in fact it works perfectly fine. However, that NextLast bugs me. It makes me want to open a text editor and fix it, but I can't, so it's just annoying.

Let me show you a brilliant health care web site.
This is Palo Alto Medical Foundation. They've been pioneers in health web applications from the very beginning so when I say it's a brilliant site I mean it. It's been polished by years of heavy use, tweaks, and overhauls. Notice the clean layout containing lots of information. Everything you think you should click on, you can. From here you can do any number of things, whether logging in or checking urgent care wait times. And what's that at the top of Special Notices? A list of ACA plans. Just what I need!

However, on the CoveredCA site, I can't search by plan name, or much of anything really. I can browse and find the plans easily enough. It browses side to side with lots of stuff to read, here's an example of some of the mouse overs.

Oops, that's no mouse-over. I'm guessing some of the javascript events aren't being picked up by the timeout mechanism. In any case, I have most of what I need so I can call it a day. I know what plan I want and it's a bit cheaper than what I'm paying now. I would like to make double sure all my providers are in network along with a few other minor questions, as is true with any health insurance plan. However it didn't crash, annoyances were constant but didn't stop me, and I'll probably have to talk to someone in person before making a purchase anyway.

In other words, it's working just as well as your average brand new health IT system.

The automatic timeout works, and it is nothing if not secure.

Thursday, October 17, 2013

Adventures in Health Insurance Exchange Part I: Doctor, Doctor

The insurance exchanges are online and I need insurance.

A little background on me: I was a software architect at Optum (the IT arm of United Healthcare) building Health Information Exchange (HIE) systems until recently. I left to join a very small consulting company (there's 3 of us) and lot of exciting stuff is happening in health care: HIEs, ACOs, NwHIN, FHIR, Blue Button, all these amazing things coming into existence right now.

I'm not without coverage. I have a UNH plan, high deductible with HSA, which is fine. I like my doctors. I'm on COBRA which is $500 a month but I get $100 off for being in good health (rockin' all the vital signs - oatmeal and half marathons yo). Not a bad deal, in relative terms. The individual private plan is about the same but I've been waiting for the insurance exchange to come online and now I get to put it to the test.

Being a Silicon Valley kind of guy, I went to CoveredCA.com - I actually signed up months ago and the "window shopping" part of the site has been up for quite some time so I know my rates are going to be similar. Turns out that's just what they cost.

I have a few requirements for my next health insurance plan:

  1. I want to keep my doctors - all of them. PCP, eye doctor, dentist, everyone because I want to live as long as humanly possible and that involves watching the progression of my health very carefully as I age. I stand on the principle that continuity makes better care.
  2. I kind of like my health savings account (HSA), I'd like a plan with an HSA. You pour money in tax free and when it's time to pay that high deductible it doesn't feel nearly as painful as pulling that same amount of money out of a savings account. I also figure when I'm old and feeble I'll be paying the yearly max every year, so there's that.
  3. If they have high tech wellness tools, like a really killer mobile app, that's a plus.

At first, I didn't know if I could keep my doctor. A tool to search for providers was added October 7th, and with it I was able to find my care organization - Palo Alto Medical Foundation - but not my doctor. I had to go to PAMF's web site to see what plans they accept. PAMF was an early pioneer in this technology and their tools are very, very good. I not only saw what plans I could pick from the exchange, I saw this:

How about that. If I don't switch plans, there's a chance I won't be able to keep my doctor.

Partisan pundits have asked, "Will I get to keep my doctor under ObamaCare?" I think the real answer to that question is, "Were you ever able to keep your doctor?" I had to switch doctors every time I changed jobs, and sometimes just because my insurance company decided to change its "network" for no reason I ever knew. If I move to another city I'll find a new doctor, but as long as I live here, walking distance from PAMF, I'm not switching. I shouldn't have to.

With an ACA plan I can keep my doctor. In fact, I need to sign up now if I want to keep my doctor.

In a later post I'll describe my experience navigating the web site, along with a few others, and actually buying insurance. Spoiler alert: I'm a big, big fan of health IT systems and I'm inclined to like it, but I did run into one or two problems.