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

AP

Systemic IT procurement obstacles hobbled the program from the start.

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.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.