Lessons from the HealthCare.gov debacle (NY Times)

Tension and Flaws Before Health Website Crash.

  • The old “more is better” approach from bureaucrats doesn’t cut it online. This applies not just to governments but also to private contractors trying to woo their clients.
  • You need to have a single person in charge, able to say “no” to different parties, whatever their political stature.
  • Since there is a political component (states could opt out, for starters), you need to include it in the planning, being as risk averse as possible (make it work whether they opt in or not, even if that meant no customized state home pages).
  • Tender the specs first, then its implementation, to reduce risk? With a panel before the second phase to establish whether it can be done, tying its outcome to the payout of the first stage. This is a common failure even among private parties: salespeople promise the moon.
  • The audience was poorly defined, and needed a champion with enough clout to keep it the central focus: it became politicians and bureaucrats, not the actual consumer.
  • The agency blatantly did not have the abilities required to manage the project.
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Can we lower medical costs by giving the neediest patients better care? (NewYoker)

The Hot Spotters

The will, the experience, data.

Jeffrey Brenner… Camden, New Jersey… “If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs.”

Verisk Health… supplies “medical intelligence”… Nathan Gunn… “The higher co-payments had backfired… The sickest patients became much more expensive because they put off care and
prevention until it was too late.”

Rushika Fernandopulle… Special Care Center… “program experienced a twenty-five-per-cent drop in costs”