Case Study

Marketplace Systems Integration for Healthcare.Gov

From 24 discrete systems to a cohesive digital experience

During the 2024 Open Enrollment Period, 21.3 million Americans signed up for health insurance via Healthcare.gov and associated channels. As the sign-ups rolled in, eclipsing the previous year’s enrollment total by close to 30%, site visitors were met with a smoothly functioning online process, experiencing no major outages or other technical hiccups. Healthcare.gov and the Affordable Care Act (ACA) Health Insurance Marketplaces have come a long way since their launch more than a decade ago, growing the number of people they serve by millions and notably improving the quality of service that those people receive. As the systems integrator for the program since 2015, Booz Allen has played a pivotal role in the Marketplace’s much-heralded growth, modernization, and improvement.

The Challenge: Ensuring that 24 Separately Developed Systems Work as One, 24/7/365

While the public experiences Healthcare.gov as a single entity, it is, in fact, digitally comprised of 24 interconnected software applications with more than 38 application programming interfaces (APIs). Each application is built and run by a separate application development contractor, and each contractor is focused on flawlessly delivering their own piece of the larger puzzle. As the Marketplace Systems Integrator (MSI), one of Booz Allen’s roles is to align all those respective efforts, ensuring a cohesive, stable experience for millions of health insurance seekers as well as for the Centers for Medicare and Medicaid Services (CMS) employees who administer the ACA Marketplace.

Those 24 applications and APIs work together to connect the many different organizations that serve essential Marketplace functions, including state governments, federal agencies like the IRS and Social Security Administration, and the private insurance companies that offer qualified health plans via secure API services. As MSI, Booz Allen also drives the integration of eligibility and enrollment services for commercial agents and brokers as well as state-based exchanges. If one service or application goes down or performs poorly, it could adversely impact the whole system, delaying or preventing the enrollment process for millions.

When relevant new laws or policies take effect, the system of systems must be brought into compliance before the next open enrollment period begins. For example, during the COVID-19 emergency, policies changed to allow additional special enrollment periods for uninsured consumers to apply for health insurance, helping millions acquire health coverage when they needed it more than ever. Enacting such changes is a complex technical undertaking because it impacts not only the Healthcare.gov system of systems, but also the API services insurance agents and brokers use to sell qualified health plans from their own approved, secure websites. Booz Allen, as the MSI, is tasked with ensuring that such complexity does not negatively impact the user experience for Marketplace customers, a group that includes consumers, states, agents, and brokers.

The Approach: Seamlessly Coordinating a Complex System of Systems

Our MSI team is comprised of a diversity of technical and subject matter experts who bring a shared understanding of the Marketplace’s mission and the capabilities necessary to achieve it. Among those team members are people whom we align to each of the Marketplace’s capabilities and products in order to understand each capability and product and the details of how they work. Deep Marketplace knowledge is essential to our integration efforts, enabling us to strengthen and maintain a high degree of trust between contractors, as well as the Marketplace’s many other stakeholders, including CMS, the Department of Health and Human Services, and other federal agencies, state governments, and private insurance providers.

It's through efforts such as these that we maintain a view across the entire program and an intricate understanding of each of its constituent parts. We see the forest and the trees to make sure all of the Marketplace’s systems are working together to deliver a highly available and fully functioning experience to the public.

While our role does not include writing code, we build the standards, shape the requirements, vet and verify what capabilities are best prioritized at a given time, coordinate with leadership and operations to ensure alignment, and shepherd each proposed improvement to the system from beginning to end to make sure all the pieces come together seamlessly and to prevent any mistakes or miscues that might degrade stability, availability, or performance.

The Solution: A Scaled Agile Framework for Highly Available Systems Integration

To provide a solid and enduring foundation for the task of managing the continuous integration, development, maintenance, and improvement of the ACA Healthcare Marketplaces, Booz Allen restructured the entirety of the program’s planning, implementation, and operational processes beneath an adaptation of the Scaled Agile Framework (SAFe). We now use key components of SAFe to coordinate between the Marketplace’s many business stakeholders and application development contractors, and to deliver work through teams of Agile teams—a SAFe organizational structure known as Agile Release Trains.

Our framework dictates that before anything new gets built, or any new requirements are implemented, they must be vetted through our purpose-built Marketplace Project Startup (MaPS) process. MaPS identifies all stakeholders impacted by upcoming work and brings them together in an integrated planning forum. The process also serves to identify any risks inherent to the work at hand to ensure that they are all shared and mitigated. Once work is approved via MaPS, we employ our “run of show” framework, which documents the key activities required to deliver, validate, and operate a particular product or enhancement across teams. We use a “manage by exception” process to minimize administrative work and only focus on handoffs, milestones, risks, assumptions, decisions, and issues. Every key item is ticketed and tagged with an effective date so it can be found and reported. The “run of show” facilitates stakeholder alignment on what’s changing and why, the process for making those changes, and what steps must be taken, when, and by whom.

By expertly combining and coordinating these many processes, we facilitate constant communication between dozens of stakeholders of varying levels and work to ensure that everyone is always working in harmony. That’s how the complex system of systems, that comprises the ACA Healthcare Marketplace, is delivered to the user as a single, intuitive process so they can shop for and buy health insurance.