October 23, 2013
1 7 Portals Powering Patient Engagement
7 Portals Powering Patient Engagement (click image for larger view and for slideshow)
The disastrous rollout of Healthcare.gov, the new website for uninsured or privately insured citizens to sign up for health insurance, appears to combine just about all of the shortcomings of federal acquisition practices that have contributed to IT project failures for years.
None of the problems are unique to this project; the pattern of ambitious projects set to unrealistic development schedules, with constantly changing design requests, and the reliance on a complex web of contractors has been the bane of government contracting for decades. The difference is Healthcare.govis a "citizen-facing" website -- tied to a complicated suite of backend data services -- intended to serve millions of individuals.
When usability failures have shown up on other government projects, they usually have involved projects the public rarely sees -- think of the F-35 Joint Strike Fighter, which has suffered a long string of delays, or the FBI's Virtual Case File program, with hundreds of millions of dollars spent right up to the moment the project was cancelled.
While President Obama on Monday said the administration is working around the clock to fix the problems, a number of factors doomed the chances for a successful launch. Among the problems: too many pieces of the contract doled out to too many subcontractors, too many last-minute changes requested by the customer, and a decision to go with custom-built code rather than using open source software. For instance, there have been numerous media reports of government representatives changing their minds late in the process about the design of the website, leading to revisions at the last minute that couldn't be fully tested.
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One of the other factors less frequently mentioned, say experts, is the government's underlying contracting and acquisition processes that make coordination between those building the system and those who provide or process the information exceedingly difficult when agencies are under mandatory deadlines.
"There are two sides to the interface: the government and the user base. The government and its contractors did not appear to be disciplined enough to comprehensively test the solution, like what we would expect with an [integration verification and validation] effort. And some segments of the user base may have not been patient enough or savvy enough to navigate the system," said Ray Bjorklund, president of BirchGrove Consulting and an expert on the federal acquisition process.
"It appears that the solution does have some of the characteristics we attribute to flawed IT projects, but I wouldn't call it a perfect storm," he added. There have been many, many other projects just as fouled up as (maybe even more than) Healthcare.gov, but they tended to be outside the awareness of the general public. He cited the flawed launch of SAM.gov, through which the General Services Administration attempted to consolidate federal procurement systems. "Only those in government contracting knew there was anything wrong," Bjorklund said.
Healthcare.gov "is a different animal," because it is trying to create a federal marketplace that will be used by 36 states and deal with millions of Americans attempting to enroll in a new product. "Add to that the political cloud shadowing over ACA and you have people looking [for] an excuse to advocate one side or the other," he said.
The Centers for Medicare and Medicaid Services (CMS), the agency within the Department of Health and Human Services responsible for running the federal health exchange, has been reluctant to provide answers to a number of basic questions. For instance, how many contractors, subcontractors and sub-subcontractors are involved in the creation and rollout of Healthcare.gov? The agency has not released that information.
Media reports vary widely on how many contractors and subcontractors are involved in providing IT services and data in support of the exchange. A Washington Post story on Oct. 22 reported there are 55.
Alex Howard of the Harvard Ash Center for Democratic Governance and Innovation, who follows government data trends, was quoted by The Verge, saying there are between 12 and 15 companies working on the project.
One of the ambitious components of the exchange's design is software code that searches multiple government databases (such as the new IRS database for verifying applicant income) and other software instructions that distribute application information to insurers.
The bulk of the problems are on the backend, with insurers reporting they are receiving applications full of errors, such as listing dependents multiple times. The prime contractor, CGI Federal, a subsidiary of CGI Group out of Canada, subcontracted the federal data services hub to Quality Software Services, a unit of UnitedHealth Group. That hub coordinates data flow back and forth between the health insurance portal and the variety of databases used in several agencies. Other subcontractors reportedly include Serco, Equifax and Booz Allen Hamilton.
President Obama, in his speech at the White House Monday, said there is a "tech surge" underway to get the website working properly, and that tech companies across the country have volunteered to assist. He did not identify any of the private-sector rescuers, but historically, government IT projects that bring in new players to fix the problems of incumbent contractors often generate a new layer of turmoil for project management teams -- and the acquisition teams trying to keep up with the contract paperwork.
That will be one of the many entanglements Jeffrey Zients will have to contend with in overseeing administration efforts to repair the website's problems. Zients, who served as acting director of the Office of Management and Budget and served as the administration's chief performance officer, agreed to take a short-term management assignment at the Department of Health and Human Services (HHS), according to White House spokesman Jay Carney.
In the meantime, some of the answers on what must be fixed may be provided on Oct. 30. That is the day that HHS Secretary Kathleen Sebelius is scheduled to testify about the problems before the House Energy and Commerce Committee.
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