The troubled launch of HealthCare.gov has been costly for President Obama and Democratic supporters of the entire Affordable Care Act program, also known as “Obamacare.” The difficulties surrounding the launch have spurred broader criticism about the federal government’s management of major IT deployments.
Estimates of the government’s financial investment in the information technology associated with the launch of the health insurance program — especially the Web portal — vary from US$70 million to well over $300 million, depending on which components are counted.
So far, $118 million has been spent on the website launch, with an additional $56 million expended for various IT support activities, Department of Health and Human Services Secretary Kathleen Sibelius told a Congressional panel last week.
In light of the near total failure of the result, the eye-popping cost of the portal launch has generated a major political backlash — especially from Republican members of Congress who were opposed to the program from the start.
“The smoking crater of Healthcare.gov once again reaffirms that politics and engineering mix like oil and water. I believe we are seeing a project that many think is too big to fail suffering from a groupthink mentality that allowed all involved to suspend many software development best practices,” said Scott Lundstrom, group vice president at IDC Health Insights.
What Was the Government Buying?
“I am not sure the government even knew what it was buying in terms of all of the various elements of the program with the massive health regulations as well as procurement hurdles. I suspect there are some huge IT architecture issues here,” Lundstrom told the E-Commerce Times.
“Turning thousands of pages of legislation into millions of lines of source code is a challenging and error-prone process. Expectations of a quick, inexpensive, politically expedient solution were optimistic at best, and show the naivete of politicians playing at being doctors and software engineers,” he remarked.
Security concerns and scale requirements added to the complexity of the project. The Center for Medicare and Medicaid Services, a unit of HHS, fell short in its management resources, suggested Lundstrom.
“You have some intelligent and diligent people there, but I am not fully confident CMS had the capability to fully integrate all the components of the program,” he said.
“This project in its realm was similar to a major NASA space shot, which takes more than three years to manage properly — both in preparing expectations that it will take a long time and then managing it accordingly,” Lundstrom observed.
The healthcare insurance plan launched in Massachusetts by former governor Mitt Romney was handled properly with a soft launch and enough time for fully testing all elements of the project before it was introduced to the public, he said.
Up to 50-percent of enterprise-scale IT projects in both the private and public sector fail outright, or fail to deliver value in the proposed time frame, Lundstrom noted, citing IDC research. “Many of these failed projects do recover through reinvestment, reengineering and redeployment, but there is a significant learning process in getting this right.”
A Reflection of Broader Problems
The problems with the healthcare.gov launch not only revealed major errors in the management of the health insurance project, but also exposed the significant flaws in the way federal agencies acquire and deploy major information technology projects, according to TechAmerica.
“Let’s be frank — the procurement system is broken, and the government’s relationship with technology is dysfunctional,” said Global Public Sector SVP Trey Hodgkins.
“The way the government buys technology uses horse-and-buggy era budgeting and Cold War era processes, while trying to keep pace with the innovation era. The process is cumbersome, redundant, confusing and — this is the most important part — utterly discouraging for companies and government personnel alike,” he said.
“Innovation doesn’t wait for Congress or the U.S. government. They are no longer drivers of technology in the U.S. economy,” Hodgkins told reporters last week.
What’s needed is an end-to-end review of federal IT procurement, he said, noting that a similar review led to a series of improvements in the 1990s.
“We don’t need to scrap the prior reforms, but since then we have moved away from a flexible approach to acquisition to a more rigid one,” Hodgkins told the E-Commerce Times.
More recent attempts at reforms have been a reaction to particular highly publicized mismanaged projects leading to patch-work fixes rather than to a comprehensive approach, he noted. A current example of a band-aid approach is the interest of government agencies in “lowest price technically acceptable” contracts that do not fully embrace non-financial considerations such as the experience and resources of various IT vendors. The method also steers government procurement personnel to focus only on price and not the outcome of the project.
The LPTA movement is a fad, in Hodgkins’ view.
Rep. Darrell Issa, R-Calif., has introduced a proposal to reform IT acquisition, but Hodgkins regards that measure as useful but not comprehensive enough.
For HealthCare.gov, a broader and more open contracting vehicle might have been better than using an existing 2007 task order contract process as the basis for selecting IT providers, Hodgkins suggested, though he noted he was not fully knowledgeable about the details of the rollout.
Aggressive Pace of Reform Required
Despite all the criticism of the health exchange project, there were some positives among the many disappointments, suggested Federal Chief Information Officer Steven Van Roekel.
Credit was due to those contributing to the bold project, he said.
“We should all be proud of the fact that something this complex, this integrated to legacy systems — and there are mainframes out there that this thing hooks to — was done at Internet scale and taken online in this way,” said Van Roekel.
That said, the flawed rollout provided an opportunity to emphasize the need to change the way major federal IT projects are managed, Van Roekel conceded.
“It’s often notable risk taking or notable failures that teach us how to do things differently in the future,” he said.
“The overarching themes of federal IT that I’ve been talking about for the last few years have been a lot about how do you build systems that are more modular, that lower the risk surface, that engage new technologies and things like that,” Van Roekel said at a recent forum sponsored by the American Council for Technology — Industry Advisory Council.
Certain aspects of government make it hard to move swiftly in the procurement and implementation of a new technology, he said. “We need to get very aggressive in reforming many aspects [of IT management] as well as pushing the needle on smart risk taking.”
Federal agencies would do well to seek advice from the private sector in launching big IT projects, suggested Jim Williams, chair of the Industry Advisory Council.
HealthCare.gov was a significantly complex project involving the challenging task of integrating technology from the 1960s and 1970s, he noted.
“The way ahead is lit by the extensive experience of both government and industry in successfully designing, deploying and managing similar systems. We believe that government’s mission is better served if there is early, frank and consistent communication and collaboration between government and industry partners,” he told the E-Commerce Times.
Government IT managers can take advantage of organizations such as ACT-IAC for links to the private sector in managing IT projects, Williams noted. Resources from such public-private partnerships can be used up front for strategy on designing the best system.
“In many instances, you can look at the plans and see that something won’t succeed if certain sound principles are not applied, say for software integration or testing,” he said.
The Department of Veterans Affairs used a team of industry and government experts convened by ACT-IAC to provide guidance in exploring open source technologies for the department’s VISTA program for managing health records, Williams noted . “The government can benefit from gaining a balanced perspective about the tried-and-true ways of effectively applying technology to advance their mission versus reliving the mistakes of others before them.”