Health

Op-Ed: What Really Went Wrong With HealthCare.gov

AP

Much of the commentary surrounding the botched launch of the HealthCare.gov website has contained nuggets of truth, but many critics are too stuck on the particulars to take the broader view. Equally disturbing, the usual blame game is well underway, even though all of the precise causes of the problems have not yet been identified.

To the extent the root cause analyses of the website issues identify incompetence or subpar performance by any contractors involved, they will be held accountable. But just as success has many fathers, so too does failure. The development and implementation of complex technology programs is a team sport, and it’s rare that any single player is entirely responsible for the outcome.  In the case of HealthCare.gov, this may be more true than usual.

Some argue that the problems with technology and performance resulted from a broken procurement system and could have been avoided had the government followed a more progressive process. But as much as we need wide-ranging procurement reform, it is unclear whether the outcome would have been different had the Centers for Medicare and Medicaid Services pursued a different strategy, be it agile development, opening the competition to more than the 16 firms that were pre-qualified, or any other alternatives. None of these tactics could be effective without first addressing the endemic and systemic obstacles -- ranging from politics to people to policy to operational coordination and collaboration -- that affected this program from the beginning. 

After all, the term “procurement” in this case refers not just to contracting but to the complete acquisition system. That system is entirely reliant on cross-functional and cross-organizational collaboration across the user/customer and provider landscape, an effective and mature requirements generation process, and well-developed business, technical and human capital strategies. Achieving these critical goals requires multiple disciplines and, in many cases, multiple organizational elements. By all accounts, HealthCare.gov was significantly challenged in these areas, as well as in the timing and nature of policy decisions that underpinned system requirements.

The People Problem

Many government leaders and front-line professionals openly acknowledge the experience and capability gaps in the federal workforce. In fact, in surveys, many have expressed concern that those gaps are getting worse, not better. The government faces obvious hurdles in attracting and retaining top technical talent. It also lacks an integrated workforce -- instead staffs are functionally divided -- and professional development initiatives that promote new and creative acquisition and technology strategies. To say the problem is one of procurement is too narrow.  It actually requires a much broader strategic perspective.

Likewise, CMS’ decision to be its own systems integrator should have come as no surprise. In recent years, various components of the Health and Human Services Department, including CMS, have shown a bias toward insourcing, often without substantive analyses to support their decisions. Requests for explanations from companies or Congress members often are met with vagaries such as “it’s a strategic decision,” “because we can,” or “because that’s what leadership wants.”

Such myopia, be it in favor of outsourcing or insourcing, is problematic, particularly absent supportive analytics. In the case of HealthCare.gov, it may have played a critical role. Healthcare.gov is not simply one website or one system. It is a complex series of systems that must be seamlessly interconnected. The engineering and program management expertise needed to effectively design and manage such a project involves significant skills for which the government simply cannot compete well. Thus, it is fair and important to ask whether this insourcing bias impacted CMS’ aperture from the start, from establishing the system architecture and requirements to designing and implementing the acquisition strategy.

Looking for Lessons

Ironically, two years ago CMS awarded a massive contract to a federally funded research and development center with the intent of providing special, sole-source support for the implementation of the Affordable Care Act. Many in the private sector objected to the award because the scope of work covered an array of engineering support services that are widely available in the competitive marketplace, and therefore violated the rules governing federally funded R&D centers. That aside, there is no evidence the center was tapped to provide critical systems engineering and integration. Whether or not it was used for those purposes, there is a lesson there as well.

Make no mistake about it; every technology company has experienced significant failures. Remember Google Buzz, Windows Vista, or Apple maps? But the long-term success of those companies has largely hinged on their tolerance for failure and their willingness to aggressively identify and apply the full breadth of lessons learned from their failures. That might be the most compelling lesson we can take from HealthCare.gov. Some have called the experience a teaching moment. But it might better be seen as a clarion call for holistic change. Taking the narrow, incremental view is unlikely to result in the necessary advances we all seek.

Stan Soloway is president and chief executive officer of the Professional Services Council.

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