What Can We Learn from Healthcare.gov?

Back in October after the initial launch of Healthcare.gov and online consumer registration, I wrote about the massive and overpriced failure. Healthcare.gov would have been too expensive even with amazing success, but that’s a product of government contracting and should not be a surprise.

To the credit of HHS, it did get Healthcare.gov working shortly after the launch. The news today and is that over seven million people registered for insurance through the site. That’s pretty amazing to me, especially given the delays in the fall with the launch. And supposedly 80-90 percent of registered users have paid.

The administration and HHS are touting Healthcare.gov this week as a massive success and rightfully so. Seven million registrations was the target set back in the fall, lowered to six million after the debacle of its launch. Most people felt that was a stretch.

This isn’t to say that the outcome of these seven million registrations is going to improve healthcare, reduce costs, or make people happier with their experience of the health system, But it does mean that the administration and HHS were able get seven million Americans to go online and register for insurance. Many more than that were just online looking at Healthcare.gov and presumably, engaged in activities and thinking related to healthcare. Getting that many people online and completing a process related to their health is impressive.

With that in mind, what can we learn from the success of Healthcare.gov?

Market the hell out of it

If you haven’t noticed, a ton of resources were poured into marketing Healthcare.gov. President Obama has been on TV doing comedy sketches in support of it. Almost everywhere I turn — and likely I’m more attuned to it than others — I’ve seen marketing for Healthcare.gov. If you’re going to push a digital health product on consumers or if you’re creating anything to engage consumers in their health, don’t stop at the product. Focus on distribution. It doesn’t hurt to have a nearly limitless budget and some celebrity appeal.

Fear is a strong motivator

Several of the people I work with have asked me, even though I have no good answer, if they should be worried about the penalty for not having healthcare coverage. Several of the people who help us with benefits have helped fuel the fear aspect of not having insurance. I was wondering how HHS actually talked about the penalty for not carrying insurance, so I Googled it. Healthcare.gov was the second link after only Wikipedia, so they are doing something right with SEO. I don’t think the messaging on the site is overly scary, but that is certainly the impression. Fear is a good motivator — just look at medical education.

The new status quo

One of the things the marketing campaigns and messaging from HHS did well was to paint Healthcare.gov and the insurance exchanges as the new order of doing healthcare business. In that sense, the expectation from consumers was that this is how things are going to be done now. It’s like taking away choice. Healthcare.gov provided good forms of support beyond just online, and that’s also crucial. I think it’s the same thing with digital health services. It’s important to set a bar to say that "phone is how we do follow-up" or "online is how we do registrations and appointments." It’s easier for the government to set a new standard as there really isn’t any competition.

Make it about money

People care about money. For almost everybody, it’s tangible and has meaning. Healthcare.gov has the benefit of being specifically about payment for healthcare and about the fear of fines for lack of coverage. Similarly to fear above, money is a strong motivator for people. Offering incentives for healthy behavior, or even for activities that show engagement in health, is potentially powerful part of any digital engagement strategy.

I’d love to hear from anybody that used Healthcare.gov to sign up for coverage. What was the experience like? What was the main motivator that made you decide to use it?


Travis Good is an MD/MBA and co-founder of Catalyze. More about me.

  • marcyhorn

    I logged in early on when I thought I’d be without insurance. Took forever and many tries, but finally got in long enough for the government to get my name, address and ss# (biting fingernails on that one). After that I bailed on the whole process. Still wondering if I’m counted as one of those seven million.

    Then another young friend signed up, but ultimately chose an outside carrier from healthcare.gov because his doctor was not part of any of those available plans, so he chose an outside plan and paid for that. Wondering if he is one of the seven million, too? Will we ever know?

  • Kool Aid MD

    It’s like an EMR company inflating their number of actual “users” – the 7M is just the number of logins/accounts that were registered.

  • Mobile Man

    While we initially had some difficulties back at the end of 2013, my mother went from Zero to Silver in 30 minutes on Healthcare.gov weekend before last (no exaggeration – literally). She got her insurance cards (Dental too) last week. First time in her life she’s had health insurance. Hard for me to be a critic of that…

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