The Centers for Medicare and Medicaid Services (CMS) plans to transition Healthcare.gov almost entirely to the cloud by April 2019, according to a senior official that oversees the website's technical infrastructure.
Retired Colonel Bobby Saxon, who serves as chief technology officer for the Center for Consumer Information & Insurance Oversight, the CMS agency that oversees Healthcare.gov, issued a mandate when he came aboard in January 2017 that the ACA exchange website would run entirely on the cloud by the end of the first quarter of 2019.
Saxon has led several cloud planning and analysis sessions over the last six months and issued a draft plan with “high-level milestones” for Healthcare.gov’s technical infrastructure. A couple of legacy data systems will likely operate on a hybrid cloud-warehouse platform, but the plan is to push the entire platform to an Amazon-hosted cloud infrastructure over the course of the next year, Saxon told a group of reporters at HIMSS last week.
Moving to the cloud will provide the system with elasticity and flexibility, improve the agency’s disaster recovery posture and reduce costs, he says.
It’s one of several initiatives from a CTO that just weathered his first open enrollment period at the agency. Saxon says the CMS is also planning to roll out several new API-based initiatives in the fall aimed at helping industry partners connect to the system and improving the user experience.
CMS uses 36% of scheduled downtime
Healthcare.gov saw 11.8 million people sign up for ACA exchange plans during open enrollment in 2018, a small decline from the previous year. But the open enrollment period was cut in half, meaning the site had to manage a higher number of visitors over a shorter time frame, including 1.4 million unique visitors on the final day of open enrollment.
In the weeks leading up to open enrollment, the agency was criticized for increasing its scheduled downtime. In September, Kaiser Health News reported the Trump administration planned to shut down the federal exchange website for 12 hours during all but one Sunday.
Healthcare.gov downtime is typically scheduled to coordinate with other databases at the IRS, the Department of Homeland Security and the Social Security Administration, but some saw the longer time frames as another attempt by the administration to undermine the ACA. Former Department of Health and Human Services (HHS) CIO Frank Baitman told FierceHealthcare at the time that there “are no technical limitations” that require the site to be shut down for 12 hours every seven days.
In the end, Saxon says the agency used just 21.5 of the 60 hours of planned downtime—or 36%—during four of the five scheduled days. He notes there was also an hour and a half of unplanned downtime due to human error.
But the backlash and a subsequent investigation took Saxon by surprise.
“It got to the point where I was being questioned by the OIG and the GAO,” he says.
Saxon says the decision to increase the planned downtime was based on statistics from the previous year when actual downtime exceeded the planned time frame. According to statistics CMS provided FierceHealthcare last year, the agency overshot its planned downtime on two occasions during the 2017 open enrollment period.