USA64: Why a Health Insurance Exchange Mistook Enrollment UX for Enterprise Architecture Maturity

Sunil Dutt Jha
Aug 19
2 min read

Overview:

This case is part of a 100-diagnostic series revealing how US healthcare marketplaces have mislabeled front-end improvements as “Enterprise Architecture progress.”

In state and federal health exchanges, a recurring pattern is treating a polished enrollment experience as proof of architectural maturity.

Citizens could browse plans, check subsidies, and enroll through a sleek interface — yet the enterprise structure linking eligibility rules, provider networks, payment reconciliation, compliance reporting, and appeals was never modeled.

P1–P6 Insight Preview:

P1 (Strategy): The UX redesign was justified as part of an “access and equity” initiative, but there was no architecture-driven plan to improve cost efficiency, policy agility, or long-term sustainability.

P2 (Process): Enrollment workflows were streamlined, but downstream processes like billing, coverage changes, and appeals handling remained disjointed.

P3 (System): Front-end enrollment was not behaviorally integrated with eligibility engines, provider directories, or payment systems.

P4 (Component): UI modules, rules engines, and provider data sources were managed as separate silos.

P5 (Implementation): Development sprints optimized for visible interface features, while structural integration backlog items were repeatedly deferred.

P6 (Operations): Business ops could enroll citizens quickly, but tech ops were constantly patching mismatches between front-end data and backend systems, leading to delays in coverage activation.

Stakeholder Impact Mapping:

CEO/Exchange Director: Feels P1 — political and media wins on launch, but no improvement in long-term operational metrics.
CIO: Feels P3 & P4 — core systems are still disconnected, creating manual reconciliation overhead.
Sales Head (Outreach & Partnerships): Feels P2 & P5 — enrollment looks smooth, but churn rises when coverage changes or claims fail.
Chief EA: Feels P1–P6 — the architecture is front-loaded for optics, not designed for sustainable operations.
Head of Enrollment Operations: Feels P2, P3, & P6 — spends more time fixing mismatches than supporting new applicants.