Health Insurance Exchanges Struggle To Charm Customers

1 7 Portals Powering Patient Engagement

The nation's state and federal healthcare insurance exchanges are gradually overcoming a variety of technical growing pains but continue to face an uphill battle on one essential measure of success: closing the sale.

In the weeks since repairs began on the federal government's online health insurance marketplace, HealthCare.gov has made big strides in improving the purchasing experience for visitors. The tech problems that dogged the site when it launched Oct. 1 -- long page-loading delays, mysterious error messages, and site crashes from too much volume -- have mostly been vanquished.

Because of these problems, and the political battle over healthcare reform in Washington, media attention has focused heavily on the performance problems of the federal website and largely overlooked the exchanges established by 17 states and the District of Columbia. 

Many of the state sites, including those rolled out by California and Kentucky, have been praised as a success in signing up thousands of residents and avoiding the types of technical glitches that plagued the federal exchange. Other state exchanges, most notably Maryland's Health Connection, have faced technical glitches that have marred their rollout.

Mostly overlooked have been subtler aspects of each health exchange's design, and an issue familiar to most online retailers: How well do the information and navigational aids on each of the sites translate customer visits into customer purchases?

[ Read our complete coverage of the HealthCare.gov launch. ]

Qubit, a company specializing in website optimization for retailers, has found that between 60% and 80% of visitors abandon their transactions at checkout, even on optimized commercial sites.

What might federal and state-run exchanges learn from commercial sites? Qubit examined all the healthcare exchanges, and discovered the exchanges could learn quite a bit from private-sector lessons.

"We thought this was interesting to undertake because we're a technology company that builds [products] to understand consumer behavior on the Web," said Ian McCraig, co-founder and CMO of Qubit. "There are best practices that we tend to look for on the retail sites; we wanted to see how they translate to these healthcare sites."

The company applied 11 yes-or-no questions to all 19 online health insurance sites. These questions offer a partial checklist of what project managers should be asking of their design and build-out teams:

"We found that the federal site didn't signpost the direction consumers should be going in order to purchase. There was no simple, easy way to contact anyone for help," said Robin Jack, Qubit's chief researcher. "You need to keep informing users where they are in the purchase process at any moment in time."

Figure 1: Source: Qubit survey of consumers on their experience with state and federal (HealthCare.gov) health insurance exchange websites.

HealthCare.gov didn't fare too badly overall on the benchmarks evaluation. Qubit found that the site met seven of the benchmarks, as did California and Utah. Based on Qubit's research, using U.S. Census data, 88% of American citizens have access to websites that hit seven or more of the benchmarks.

But hitting the benchmarks doesn't necessarily translate into higher purchasing rates. Maryland's site hit all 11 benchmarks, for instance, but its underlying technical problems hamstrung visitors from being able to purchase health insurance. Kentucky's site, Kynect, in contrast, met only three of the prescribed benchmarks, but the state's enrollments generally surged.

McCaig says that if people are intent on buying something they "will just wrestle with it. If it takes three hours to do it, they'll just keep at it." Demand is high because there are so many uninsured people in the United States, he said, "but the experience doesn't leave a nice taste in people's mouths … Some very simple best practices (and knowing how consumers) use the sites, will optimize the experience."

Another company that evaluates user behavior on websites, UserTesting.com, using different benchmarks, found HealthCare.gov has made significant improvements in its design. The company engaged ConversionMax to evaluate HealthCare.gov in early November.

As ConversionMax chief marketing officer Theresa Baiocco saw the site, it appeared that HealthCare.gov's designers didn't fully consider all the different types of users coming to the site, and what they were trying to accomplish.

"It's an attractive site, laid out nicely; they did a lot of things right," she said. But developing models for the user experience involves understanding the different types of people who will use the site and "defining ... what they're trying to accomplish. You might have five user types; [it] seems like that's missing."

E-commerce sites commit the common mistake, she says, of designing a website with a mindset of "we want people to apply immediately, and that's what we're aiming for." HealthCare.gov was "not intuitive at all; visitors [had] to stop and think way too much."

UserTesting.com was so struck by ConversionMax's findings, it re-evaluated HealthCare.gov two more times -- at the end of November and on Dec. 9 -- and noted these improvements:

Patience Wait is a Washington-based reporter who covers government IT for InformationWeek. 

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