Friday, October 18, 2013

How to critique Open Enrollment without being a critic: that's the bind

We know the motivation of those who are using every dirty trick in the book in a futile attempt to undo the ACA.  This week they're busy highlighting the glitches in the federal portal (many of which arise when an older, underfunded IT platform is asked to do extreme heavy lifting to accommodate thousands of people each day who are enthusiastically trying to get affordable health insurance).  

But I'm not going there. 

There's another group of "critics" that shouldn't get lumped in with the bad guys. 

People like me and my colleagues.  We're trying to figure out how to critique elements of enrollment based on our research with health consumers. 

We believe in the ACA and the powerful change that can come when more people in the US have access to affordable health care. We see things that can  be done to improve consumer engagement and decision-making.  BUT we run the risk of being caste as "friendly fire" - good motivations, but deadly just the same. 

Based on years of research with patients/consumers, studying how they take in and understand information - countless patient participants in the lab telling us, showing us, what they do and don’t understand, and even being gracious enough to tell us how to do our job better - we’re bringing that empirical knowledge to our assessment of current open enrollment practices.

And so we’re commenting on the literacy, health literacy and financial literacy demands (load) of what we see.  Karen Palladino's story today in US News and World Report, “When Buying Insurance on the Exchanges, It Helps to Have Help” reports on some of the areas where we know consumers have historically had difficulties in understanding and making good choices.
       understanding health insurance terms – network, co-pay, generic…
       understanding insurance concepts – deductibles, out of pocket limits…
   health literacy skills – specifically numeracy – working with numbers
  health literacy concept – recognizing the connection between you/your family's health needs and the plan you choose…

We are spot on.
It’s smug and I hate when I find myself saying this to my bright student, but we have years of experience dissecting information and watching people trying to work with this information.  Some of us predicted and now are seeing some problems here in River City. But they're fixable problems. 

We want to point out the needed repairs because we live in a world we're “review and repair” happens every day, and all to the good. 
No successful software or app today is designed without this imperative.  And the tools that win are the product of user centered design.  That’s how your bank’s ATM and your favorite Apps, Facebook, Google Maps and Yelp all made it to the big time.

It takes careful analysis, time and money and input from experts.

So now, anyone have ideas on how to get our best information on users, health choices and health insurance to the toolmakers? 


  1. It is nothing short of a miracle that a HealthCare overhaul in the United States has passed and is in its growing pains. To even fathom that such an undertaking would be smooth and without glitches right out of the gate is preposterous. Its out there, its the law of the land, it survived an ill-conceived shut-down attempt by the extreme right, and its mistakes are but learning tools for its future.

    This link highlights the negative rhetoric being used by critics of the plan...

    I have been fortunate in that the health insurance that I have had in life has always been top-notch and provided by my various employers. Little in the way of hard choices needed to be made, as the companies that I've worked for had it all laid out nice and neat. Never have I had to make decisions based on my comprehensive understanding of terms such as deductible, co-insurance, copayment, fixed indemnity, exclusion or preexisting condition.

    The mere thought of having to traverse documentation related to Medicare, Medicaid, Medigap, HMO"s, PPO's and all the variables inherent in these structures makes me woozy.

    Its no doubt that the decision-making tools on the exchanges will improve over time. They must, if those on the low end of the SES and health literacy ladders are to have any chance of obtaining the health care they both need and deserve.

    I say in time it may be necessary to rally up some troops and get some experts out there in the communities that need them...pharmacies, grocery stores, parks, schools, hair salons, churches etc. Visibility with a friendly, knowledgable face and nice user-friendly materials to get the ball rolling.

  2. Martin - so true - the importance of promoters on the ground in communities. I've read of a few efforts in different states, promoting the ACA and open enrollment in local pharmacies, barber shops, etc.

  3. I just came across this insightful piece by Ben Wanamaker, "Disruptive Innovation and the Affordable Care Act"
    Wanamaker states:
    "Despite the vitriol about the ACA, one objective nearly everyone can agree on is that health care in the United States needs to become more affordable and accessible without compromising quality. For that to happen it is crucial for innovators and policymakers to understand and seize the disruption opportunities presented by the ACA and navigate around the barriers imposed by it. In this way we are convinced brilliant individuals and companies can innovate within the framework of the ACA to make care more affordable and accessible for all."

  4. When a website, like, is so poorly constructed on the back-end .. as we are learning .. the health literacy of users is of little, or perhaps perversely negative, effect (As health literate users are more likely to quit using a poorly designed website first). When websites crash, it isn't often the health literacy of users that are to blame, no?

    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).

    So at this level, given that most of the problems reported regarding are structural (not unlike the recent overall government shutdown which can largely be blamed on gerrymandering Congressional districts), what do you propose people should actually do to obtain health insurance?

  5. what is neurofeedback training
    - is an Industry Leader in Healthy Brain Workout, Fitness Program, Neurofeedback for ADHD, Brain Exercises, Neurocare, PTSD Disorder and Biofeedback Systems."/>

  6. aging parent is a free social network that care & Support for the Caregivers, eldercare, senior caregiving, senior helpers, aging parent and family caregivers.