With millions of Americans still unable to access the troubled Obamacare sign-up site, HealthCare.gov, it was no surprise when the man who oversaw the rollout, Tony Trenkle, announced on Nov. 6 that he would be stepping down. The site was overwhelmed with traffic when it went live on Oct. 1, and only six people were able to sign up for health insurance there on that day, according to documents released by the U.S. House of Representatives. The White House won’t say how many sign-ups have happened since then, but the site is still so buggy the President himself has advised people to enroll by phone instead.
Experts in the information technology industry say the flawed HealthCare.gov debut can be summed up with two words: quality assurance (QA). Or rather, lack thereof. QA, once a staple of software development, if often given short-shrift when projects have limited funding, short deadlines, or both, as was the case with HealthCare.gov. But many observers say the industry can learn valuable lessons from the site’s debut about the importance of prioritizing QA.
In its simplest terms, QA is a systematic process of monitoring a technology project while it’s being completed, to ensure at every step along the way that all the stakeholders—most importantly the final users—will get the product they’re expecting. It’s often more involved than it sounds, however. “First you have to be able to communicate the customers’ needs to the members of the development team, then the project manager needs to monitor the team on an ongoing basis to ensure it’s delivering what the customer wants,” says Dan Katz, vice president of technology for McClean, Va.-based INADEV, a provider of mobile technology.
One key to making QA work, Katz says, is effective communication—a challenge on projects like HealthCare.gov, which involved stitching together information from multiple stakeholders, including state health agencies, insurance companies, and the federal government. “With such a massive project, the overall architecture of the application needs to be really well planned out up front,” says Katz, who spent the early part of his career as a web developer for CareFirst BlueCross BlueShield. Then there needs to be a continuous hand-off of information among all of the parties that are contributing to the site. “You need a lot of opportunity for peer review and for catching problems before something is packaged up and delivered,” Katz says.
Successful QA teams should include not only software experts, but people with a deep understanding of the industry the site will be serving, says Bill Curtis, chief scientist at CAST, a New York-based software quality analysis firm, and the director of the Consortium for IT Software Quality, which is working to develop QA standards. “If you know healthcare, you know all the different weird things that can happen when people sign up for accounts, and you can be prepared for those,” Curtis says. “Part of functionality is understanding all the possible different conditions that the site has to be ready to handle.”
QA often goes by the wayside when there’s a tight deadline for delivering the final site—most definitely an issue with HealthCare.gov. But experts watching the botched rollout from the sidelines believe the problems could have been averted if the White House had staged the project rather than putting up the full site all at once. For example, they could have put up a bare bones site on Oct. 1, perhaps allowing visitors to set up accounts but not to sign up for particular plans yet. Then more sophisticated capabilities could have been layered on to the site over time, giving the QA team more time to test them before unleashing millions of consumers onto the site.
“This was such a huge project that I do think they should have had checkpoints along the way that said ‘Phase 1 will include this, Phase 2 will add this, and Phase 3 will be complete,’” says Brenda Hall, CEO of Bridge360, an Austin, Texas-based software developer. “One good risk mitigator is to start with lesser functionality.”
Hall was so disturbed by the HealthCare.gov rollout she blogged about it on Oct. 30, urging software developers to learn from the fiasco and never crimp on QA. “The way of the world today is quick, quick, quick because we’re so connected,” Hall says. “I don’t think pushing quality aside is the answer. Plan for it on Day One. There’s really no excuse to not integrate quality into the overall process.”
Take a good look around your office. If the figures are right, one in four of your employees are stealing from you. And that’s just who will admit to it.
A new survey of 2,000 American adults released today from personal-finance comparison website MoneyRates.com finds that one quarter of adults have stolen company property for personal use at home.
And that's just employees. If you think that your customers are playing fair, think again. Almost four in 10 survey respondents admit to keeping extra change that a cashier may have accidentally given them. A quarter of them say they would do it again -- even if they were immediately aware that they had been given more money back than they were owed.
As a business owner, don’t take American dishonesty personally. Twenty-three percent of survey respondents say they have fibbed to Uncle Sam by under-reporting their income, and three in 10 say that if they were sure they wouldn’t get caught, they would be willing to do the same.
Related: How to Motivate Employees in Less Than 5 Minutes
In addition, about 13 percent of survey respondents say they have under-reported the amount that their child uses their car to the insurance company to keep their premiums down.
And do they feel guilty? Get a picture of a puppy queued up to make you feel better about life because the answer is likely to bum you out. About half of respondents say they felt guilty enough about cheating that it would dissuade them from repeating the dishonest behavior. But one in five cheaters report having no guilt whatsoever and say they would be more than willing to repeat the behavior.
This September, an internal memo from grocer Trader Joe's chief executive officer Dan Bane to his employees leaked--and caused more than a bit of a stir. The memo reportedly said that as of next year, Trader Joe's employees working fewer than 30 hours per week will no longer be able to obtain health coverage through the company, but instead would be steered towards the new health exchanges being set up under the Affordable Care Act, often referred to as Obamacare. This from a company that had become famous for offering exceptionally rich benefits to all of its employees, whom it refers to as Crew Members.
A spokeswoman for Trader Joe's, based in Monrovia, Calif., declined to confirm the existence of the memo, which was reported by Huffington Post. In an e-mail, she said: "We have made some changes to our health-care coverage that we believe will be a benefit to all Crew Members working in our stores. We are committed to providing all our Crew Members with benefits that are among the best in our industry."
As the October open enrollment period for health benefits draws near, several large companies are reacting to Obamacare by overhauling their health plans. Although they're loathe to admit it, cost is likely the biggest driver behind the changes. "We're continuing to see health-care costs rise at a pretty unrealistic rate. At the same time you have the health of the population declining," says Craig Rosenberg, health and welfare benefits administration practice leader for Lincolnshire, Ill.-based human resources consultant Aon Hewitt. "That feeds into a big challenge for employers, because there's only so much cost they can shift to employees and a lot has already been done through higher deductibles and [premiums]."
In addition to dropping coverage for part-time workers, many companies are re-thinking their approach to covering adult dependents, such as spouses and domestic partners. Many companies now tack on extra charges for employees who insure their spouses and Aon Hewitt estimates that nearly 20 percent of companies are now increasing those surcharges.
Some companies are taking even more drastic actions. United Parcel Service acknowledged recently that it would no longer offer coverage to spouses who can obtain health care through their own employers. A spokesman for the Atlanta-based company said in an e-mail that "there were a number of factors that went into the decision," and that it wasn't contingent just on cost pressures under health reform.
Other companies, among them IBM and Time Warner, have said they will shift their retirees from their companies' health plans to private exchanges that allow retired workers to pick from several different coverage options. The companies will still subsidize the coverage, they just won't administer it. This can save money for the companies while at the same time increasing the health choices for retirees. In a survey released Aug. 21 by New York-based Towers Watson, 58 percent of companies reported that they view private exchanges as a viable alternative to employer-sponsored coverage in 2015. (Both Towers Watson and Aon Hewitt run private health exchanges.)
In lieu of cutting back their health coverage--and possibly alienating valuable employees as a result--some companies are trying to lower health-care costs by promoting good diet and exercise habits in the workplace. Zane Tankel, chairman of Apple-Metro--owner of 35 Applebee's restaurants in the New York City area--says his company has started running health fairs, and it recently passed out pedometers to employees and held a contest to reward those who walked the most in the course of their day. Tankel expects healthier workers will incur fewer insurance claims, resulting in lower costs for the company. "Even when you have a young labor force, the rewards come back to you," he says.
James Smith, senior vice president in the New York office of the Camden Group, expects more employers to embrace such wellness programs. "Many employers are using incentives to help employees become healthier over the medium and long-term," Smith says. Some studies have shown that wellness programs reduce absenteeism in the workforce, Smith says, though "the jury is still out" on whether companies will see a financial return on their investment in wellness programs.
In the midst of all the changes, some companies are boasting that they're not cutting back on their health coverage, but rather adding to it. Seattle-based coffee chain Starbucks says it will continue to offer coverage to all employees working at least 20 hours a week and it's not dropping spousal coverage, either. As of next year, the company will begin funding women's preventative health services at 100 percent, a spokesman says in an e-mail, adding, "there are no plans to cut benefits as a result of the health care law."
Sole proprietorships are among the millions of individuals expected to buy health insurance through the state-based marketplaces which will start enrolling consumers on Oct. 1. Under the new Affordable Care Act, self-employed people with no employees are considered individuals even if they hire independent contractors, and will be required to purchase insurance for themselves or face a fee.
Sole proprietors might find more entrepreneurs joining their ranks once the ACA marketplaces go into effect. Health reform advocates believe the law will free workers of "job lock" caused by the need to hold on to employer-sponsored group health coverage. A report this year co-authored by the Urban Institute and the Georgetown University Health Policy Institute's Center on Health Insurance Reforms estimated that 1.5 million more Americans will be self-employed in 2014 because of reforms under the ACA.
Since many self-employed individuals currently lack health insurance, they might be researching their insurance options for the first time. Open enrollment runs until March 31, and if you want to know what's available to you, we've outlined your main options below.
Option #1: Do nothing and forgo health insurance.The landmark law requires that most Americans have coverage starting next year or face a fine. Fees for those who opt not to buy individual coverage for 2014 is the higher of 1 percent of annual income or $95 per person, increasing yearly to the higher of 2.5 percent of income or $695 per person. There are exceptions that would allow some people an exemption from the fee. This could include those who would qualify for Medicaid under new, higher U.S. income limits, but who live in states that aren't expanding Medicaid eligibility and who may not qualify for marketplace subsidies. Talk with a broker, accountant or other professional familiar with the ACA, or chat online with a representative at the government's HealthCare.gov website, to see if you might qualify for an exemption.
Option #2: Keep the health coverage you have. Under the ACA, if you have a plan that was in place prior to March 23, 2010, it might be grandfathered in. However, these plans might not have the same protections created by the health reforms. For instance, a grandfathered individual plan doesn't have to cover you if you have a pre-existing condition. Since many self-employed individuals tended to purchase catastrophic coverage, those plans won't likely meet the new law's requirements and you'll need to get shopping regardless. (The state marketplaces will have catastrophic plans, including free preventive benefits and three annual, no-cost primary care visits, for people younger than 30 and certain others with limited incomes.) Consult with your broker to see if your current plan meets requirements.
Individuals who would like to delay researching the impact of health reforms on their coverage may be able to renew their existing plans by December 31, 2013. Such renewed policies, however, won't offer the premium subsidies available through the exchanges and aren't likely to provide the broad coverage guarantees required under Obamacare. Be sure to read carefully and understand your options thoroughly before making any commitments.
Reform advocates at Georgetown University's Center on Health Insurance Reforms warn that while some younger, healthier applicants could benefit in the short term, consumers renewing or starting plans this year that extend into 2014 may be forgoing new benefits they'd have with coverage that goes into effect on or after Jan. 1, 2014.
Option #3: Find a plan through an exchange. Depending on family size and income, solo entrepreneurs and other individuals may qualify for federal subsidies if they purchase plans through their state-based marketplaces.
Through your state marketplace, you'll be able to compare plans side-by-side, including premiums, deductibles and out-of-pocket costs. All marketplace plans will offer an array of "essential health benefits," including emergency services, hospitalization, maternity and newborn care, lab services, chronic disease management, pediatric care, rehabilitative care, mental health and substance abuse services, and prescription drug coverage.
Additionally, marketplace plans will fit into one of four possible coverage levels, based on the percentages of costs, such as deductibles, copayments and coinsurance, shared by consumers. As the National Association of Insurance Commissioners notes, bronze plans must cover 60 percent of an average person's expected costs, silver plans 70 percent, gold plans 80 percent and platinum plans 90 percent.
The Kaiser Family Foundation has a tool to help people estimate their costs and potential savings, although exact prices won't be available until open enrollment gets underway.
Option #4: Find a plan outside the exchanges. People also will be able to buy insurance outside the marketplaces, through insurance agents or private-sector online brokerages. Independent agents know the market well and can usually offer you options that will fit your needs. Be aware though that federal subsidies are available only through the government-overseen exchanges so you might not benefit from price breaks on premiums and out-of-pocket costs such as copayments and deductibles.
Option #5: Hire someone. Once you have an employee, you are no longer a sole proprietor. As a micro-business, you are not obligated to purchase health insurance for your employees. The status makes you eligible to purchase insurance from your state's small business exchange, also called a Small Business Health Options Program (SHOP) Marketplace. Outside the exchange, some agents will also sell group premiums for 2 or more employees. If you decide being a sole proprietor no longer works for your business, make sure that you hire a full-time employee, the type whose income you report at the end of the year with a W-2. Hiring independent contractors will not make you eligible for the SHOP exchanges.
Experts in the information technology industry say the flawed HealthCare.gov debut can be summed up with two words: quality assurance (QA). Or rather, lack thereof. QA, once a staple of software development, if often given short-shrift when projects have limited funding, short deadlines, or both, as was the case with HealthCare.gov. But many observers say the industry can learn valuable lessons from the site’s debut about the importance of prioritizing QA.
In its simplest terms, QA is a systematic process of monitoring a technology project while it’s being completed, to ensure at every step along the way that all the stakeholders—most importantly the final users—will get the product they’re expecting. It’s often more involved than it sounds, however. “First you have to be able to communicate the customers’ needs to the members of the development team, then the project manager needs to monitor the team on an ongoing basis to ensure it’s delivering what the customer wants,” says Dan Katz, vice president of technology for McClean, Va.-based INADEV, a provider of mobile technology.
One key to making QA work, Katz says, is effective communication—a challenge on projects like HealthCare.gov, which involved stitching together information from multiple stakeholders, including state health agencies, insurance companies, and the federal government. “With such a massive project, the overall architecture of the application needs to be really well planned out up front,” says Katz, who spent the early part of his career as a web developer for CareFirst BlueCross BlueShield. Then there needs to be a continuous hand-off of information among all of the parties that are contributing to the site. “You need a lot of opportunity for peer review and for catching problems before something is packaged up and delivered,” Katz says.
Successful QA teams should include not only software experts, but people with a deep understanding of the industry the site will be serving, says Bill Curtis, chief scientist at CAST, a New York-based software quality analysis firm, and the director of the Consortium for IT Software Quality, which is working to develop QA standards. “If you know healthcare, you know all the different weird things that can happen when people sign up for accounts, and you can be prepared for those,” Curtis says. “Part of functionality is understanding all the possible different conditions that the site has to be ready to handle.”
QA often goes by the wayside when there’s a tight deadline for delivering the final site—most definitely an issue with HealthCare.gov. But experts watching the botched rollout from the sidelines believe the problems could have been averted if the White House had staged the project rather than putting up the full site all at once. For example, they could have put up a bare bones site on Oct. 1, perhaps allowing visitors to set up accounts but not to sign up for particular plans yet. Then more sophisticated capabilities could have been layered on to the site over time, giving the QA team more time to test them before unleashing millions of consumers onto the site.
“This was such a huge project that I do think they should have had checkpoints along the way that said ‘Phase 1 will include this, Phase 2 will add this, and Phase 3 will be complete,’” says Brenda Hall, CEO of Bridge360, an Austin, Texas-based software developer. “One good risk mitigator is to start with lesser functionality.”
Hall was so disturbed by the HealthCare.gov rollout she blogged about it on Oct. 30, urging software developers to learn from the fiasco and never crimp on QA. “The way of the world today is quick, quick, quick because we’re so connected,” Hall says. “I don’t think pushing quality aside is the answer. Plan for it on Day One. There’s really no excuse to not integrate quality into the overall process.”
Take a good look around your office. If the figures are right, one in four of your employees are stealing from you. And that’s just who will admit to it.
A new survey of 2,000 American adults released today from personal-finance comparison website MoneyRates.com finds that one quarter of adults have stolen company property for personal use at home.
And that's just employees. If you think that your customers are playing fair, think again. Almost four in 10 survey respondents admit to keeping extra change that a cashier may have accidentally given them. A quarter of them say they would do it again -- even if they were immediately aware that they had been given more money back than they were owed.
As a business owner, don’t take American dishonesty personally. Twenty-three percent of survey respondents say they have fibbed to Uncle Sam by under-reporting their income, and three in 10 say that if they were sure they wouldn’t get caught, they would be willing to do the same.
Related: How to Motivate Employees in Less Than 5 Minutes
In addition, about 13 percent of survey respondents say they have under-reported the amount that their child uses their car to the insurance company to keep their premiums down.
And do they feel guilty? Get a picture of a puppy queued up to make you feel better about life because the answer is likely to bum you out. About half of respondents say they felt guilty enough about cheating that it would dissuade them from repeating the dishonest behavior. But one in five cheaters report having no guilt whatsoever and say they would be more than willing to repeat the behavior.
This September, an internal memo from grocer Trader Joe's chief executive officer Dan Bane to his employees leaked--and caused more than a bit of a stir. The memo reportedly said that as of next year, Trader Joe's employees working fewer than 30 hours per week will no longer be able to obtain health coverage through the company, but instead would be steered towards the new health exchanges being set up under the Affordable Care Act, often referred to as Obamacare. This from a company that had become famous for offering exceptionally rich benefits to all of its employees, whom it refers to as Crew Members.
A spokeswoman for Trader Joe's, based in Monrovia, Calif., declined to confirm the existence of the memo, which was reported by Huffington Post. In an e-mail, she said: "We have made some changes to our health-care coverage that we believe will be a benefit to all Crew Members working in our stores. We are committed to providing all our Crew Members with benefits that are among the best in our industry."
As the October open enrollment period for health benefits draws near, several large companies are reacting to Obamacare by overhauling their health plans. Although they're loathe to admit it, cost is likely the biggest driver behind the changes. "We're continuing to see health-care costs rise at a pretty unrealistic rate. At the same time you have the health of the population declining," says Craig Rosenberg, health and welfare benefits administration practice leader for Lincolnshire, Ill.-based human resources consultant Aon Hewitt. "That feeds into a big challenge for employers, because there's only so much cost they can shift to employees and a lot has already been done through higher deductibles and [premiums]."
In addition to dropping coverage for part-time workers, many companies are re-thinking their approach to covering adult dependents, such as spouses and domestic partners. Many companies now tack on extra charges for employees who insure their spouses and Aon Hewitt estimates that nearly 20 percent of companies are now increasing those surcharges.
Some companies are taking even more drastic actions. United Parcel Service acknowledged recently that it would no longer offer coverage to spouses who can obtain health care through their own employers. A spokesman for the Atlanta-based company said in an e-mail that "there were a number of factors that went into the decision," and that it wasn't contingent just on cost pressures under health reform.
Other companies, among them IBM and Time Warner, have said they will shift their retirees from their companies' health plans to private exchanges that allow retired workers to pick from several different coverage options. The companies will still subsidize the coverage, they just won't administer it. This can save money for the companies while at the same time increasing the health choices for retirees. In a survey released Aug. 21 by New York-based Towers Watson, 58 percent of companies reported that they view private exchanges as a viable alternative to employer-sponsored coverage in 2015. (Both Towers Watson and Aon Hewitt run private health exchanges.)
In lieu of cutting back their health coverage--and possibly alienating valuable employees as a result--some companies are trying to lower health-care costs by promoting good diet and exercise habits in the workplace. Zane Tankel, chairman of Apple-Metro--owner of 35 Applebee's restaurants in the New York City area--says his company has started running health fairs, and it recently passed out pedometers to employees and held a contest to reward those who walked the most in the course of their day. Tankel expects healthier workers will incur fewer insurance claims, resulting in lower costs for the company. "Even when you have a young labor force, the rewards come back to you," he says.
James Smith, senior vice president in the New York office of the Camden Group, expects more employers to embrace such wellness programs. "Many employers are using incentives to help employees become healthier over the medium and long-term," Smith says. Some studies have shown that wellness programs reduce absenteeism in the workforce, Smith says, though "the jury is still out" on whether companies will see a financial return on their investment in wellness programs.
In the midst of all the changes, some companies are boasting that they're not cutting back on their health coverage, but rather adding to it. Seattle-based coffee chain Starbucks says it will continue to offer coverage to all employees working at least 20 hours a week and it's not dropping spousal coverage, either. As of next year, the company will begin funding women's preventative health services at 100 percent, a spokesman says in an e-mail, adding, "there are no plans to cut benefits as a result of the health care law."
Sole proprietorships are among the millions of individuals expected to buy health insurance through the state-based marketplaces which will start enrolling consumers on Oct. 1. Under the new Affordable Care Act, self-employed people with no employees are considered individuals even if they hire independent contractors, and will be required to purchase insurance for themselves or face a fee.
Sole proprietors might find more entrepreneurs joining their ranks once the ACA marketplaces go into effect. Health reform advocates believe the law will free workers of "job lock" caused by the need to hold on to employer-sponsored group health coverage. A report this year co-authored by the Urban Institute and the Georgetown University Health Policy Institute's Center on Health Insurance Reforms estimated that 1.5 million more Americans will be self-employed in 2014 because of reforms under the ACA.
Since many self-employed individuals currently lack health insurance, they might be researching their insurance options for the first time. Open enrollment runs until March 31, and if you want to know what's available to you, we've outlined your main options below.
Option #1: Do nothing and forgo health insurance.The landmark law requires that most Americans have coverage starting next year or face a fine. Fees for those who opt not to buy individual coverage for 2014 is the higher of 1 percent of annual income or $95 per person, increasing yearly to the higher of 2.5 percent of income or $695 per person. There are exceptions that would allow some people an exemption from the fee. This could include those who would qualify for Medicaid under new, higher U.S. income limits, but who live in states that aren't expanding Medicaid eligibility and who may not qualify for marketplace subsidies. Talk with a broker, accountant or other professional familiar with the ACA, or chat online with a representative at the government's HealthCare.gov website, to see if you might qualify for an exemption.
Option #2: Keep the health coverage you have. Under the ACA, if you have a plan that was in place prior to March 23, 2010, it might be grandfathered in. However, these plans might not have the same protections created by the health reforms. For instance, a grandfathered individual plan doesn't have to cover you if you have a pre-existing condition. Since many self-employed individuals tended to purchase catastrophic coverage, those plans won't likely meet the new law's requirements and you'll need to get shopping regardless. (The state marketplaces will have catastrophic plans, including free preventive benefits and three annual, no-cost primary care visits, for people younger than 30 and certain others with limited incomes.) Consult with your broker to see if your current plan meets requirements.
Individuals who would like to delay researching the impact of health reforms on their coverage may be able to renew their existing plans by December 31, 2013. Such renewed policies, however, won't offer the premium subsidies available through the exchanges and aren't likely to provide the broad coverage guarantees required under Obamacare. Be sure to read carefully and understand your options thoroughly before making any commitments.
Reform advocates at Georgetown University's Center on Health Insurance Reforms warn that while some younger, healthier applicants could benefit in the short term, consumers renewing or starting plans this year that extend into 2014 may be forgoing new benefits they'd have with coverage that goes into effect on or after Jan. 1, 2014.
Option #3: Find a plan through an exchange. Depending on family size and income, solo entrepreneurs and other individuals may qualify for federal subsidies if they purchase plans through their state-based marketplaces.
Through your state marketplace, you'll be able to compare plans side-by-side, including premiums, deductibles and out-of-pocket costs. All marketplace plans will offer an array of "essential health benefits," including emergency services, hospitalization, maternity and newborn care, lab services, chronic disease management, pediatric care, rehabilitative care, mental health and substance abuse services, and prescription drug coverage.
Additionally, marketplace plans will fit into one of four possible coverage levels, based on the percentages of costs, such as deductibles, copayments and coinsurance, shared by consumers. As the National Association of Insurance Commissioners notes, bronze plans must cover 60 percent of an average person's expected costs, silver plans 70 percent, gold plans 80 percent and platinum plans 90 percent.
The Kaiser Family Foundation has a tool to help people estimate their costs and potential savings, although exact prices won't be available until open enrollment gets underway.
Option #4: Find a plan outside the exchanges. People also will be able to buy insurance outside the marketplaces, through insurance agents or private-sector online brokerages. Independent agents know the market well and can usually offer you options that will fit your needs. Be aware though that federal subsidies are available only through the government-overseen exchanges so you might not benefit from price breaks on premiums and out-of-pocket costs such as copayments and deductibles.
Option #5: Hire someone. Once you have an employee, you are no longer a sole proprietor. As a micro-business, you are not obligated to purchase health insurance for your employees. The status makes you eligible to purchase insurance from your state's small business exchange, also called a Small Business Health Options Program (SHOP) Marketplace. Outside the exchange, some agents will also sell group premiums for 2 or more employees. If you decide being a sole proprietor no longer works for your business, make sure that you hire a full-time employee, the type whose income you report at the end of the year with a W-2. Hiring independent contractors will not make you eligible for the SHOP exchanges.
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