The Centers for Medicare & Medicaid Services (CMS) and other public and private organizations should use key lessons for the successful design and deployment of website and other operating systems revealed in a report of the findings of the Department of Human Services (HHS) Office of Inspector General (OIG) investigation into what lead to the notoriously poor launch and other problems in the Healthcare.gov health insurance marketplace website and operating system that the Patient Protection & Affordable Care Act (ACA) directed HHS to establish and administer to facilitate the purchase of private insurance by citizens living in states that declined to establish a state health insurance marketplace in response to ACA.
According to just released OIG Report OEI-06-14-00350, “many missteps” committed by the Department of Health & Human Services (HHS) and its Centers for Medicare & Medicaid Services (CMS) lead to the widespread crashes of the Healthcare.gov website and other widespread problems with the Healthcare.gov enrollment tools necessary for millions of Americans to enroll in new health insurance coverage options created as part of the ACA. The report not only helps to explain what went wrong, but also provides key insights for HHS as well as other public and private organizations of common management issues that often derail the design and deployment of website or other technologies required to execute key organizational goals.
Problems in the completion and operation of the Healthcare.gov website at its launch on October 1, 2013 and for some time created significant challenges for U.S. families residing in states that elected not to sponsor a state-sponsored health insurance marketplace in response to the ACA. Among other things, HealthCare.gov users attempts to use the Healthcare.gov website were disrupted by a host of website outages and technical malfunctions. After corrective action by CMS and contractors, HealthCare.gov performance improved and facilitated health plan enrollment for millions of consumers. The problems at launch raised concerns about the effectiveness of CMS management of the Federal Marketplace. The findings set forth in the report resulted from an OIG study conducted to gain insight into CMS implementation of the Federal Marketplace, focusing primarily on HealthCare.gov.
The report details the results of OIG’s review and analysis of the chronology of events and identifying factors that contributed to the Healthcare.gov website’s breakdown at launch, its recovery following corrective action, and implementation of the Federal Marketplace through the second open enrollment period based on interviews of 86 current and former HHS and CMS officials, staff, and contractors involved with the website and OIG’s review of “thousands of HHS and CMS documents,” including management reports, internal correspondence, and website development contracts.
Based on this review and analysis, OIG found that “HHS and CMS made many missteps throughout development and implementation that led to the poor launch of HealthCare.gov.” According to the report, the “most critical” misstep was “the absence of clear leadership, which caused delays in decisionmaking and a lack of clarity in project tasks.” The report also criticized HHS and CMS for:
- Devoting too much time to developing policy, which left too little time for developing the website;
- Failing to properly manage its key website development contract;
- Allowing CMS’s organizational structure and culture to create poor coordination between policy and technical work and otherwise to hamper progress; and
- CMS continuing to follow a “failing path despite signs of trouble” and “making rushed corrections that proved insufficient.
While highly critical of the initial mismanagement, OIG also complimented HHS and CMS for quickly learning and using certain key lessons for more effectively managing major technology projects to respond to and start correcting deficiencies in the Healthcare.gov site. These core practices include:
- Leadership. Assign clear project leadership to provide cohesion across tasks and a comprehensive view of progress.
- Communication. Promote acceptance of bad news and encourage staff to identify and communicate problems.
- Alignment. Align project and organizational strategies with the resources and expertise available.
- Execution. Design clear strategies for disciplined execution, and continually measure progress.
- Culture. Identify and address factors of organizational culture that may affect project success.
- Oversight. Ensure effectiveness of IT contracts by promoting innovation, integration, and rigorous oversight.
- Simplification. Seek to simplify processes, particularly for projects with a high risk of failure.
- Planning. Develop contingency plans that are quickly actionable, such as redundant and scalable systems.
- Integration. Integrate policy and technological work to promote operational awareness.
- Learning. Promote continuous learning to allow for flexibility and changing course quickly when needed.
By learning from these lessons, OIG reports that CMS took corrective action and is using these lessons to address problems with Healthcare.gov and to improve its operations and services. OIG notes that after the launch, CMS and contractors pivoted quickly to corrective action, reorganizing the work to improve execution. Key factors that contributed to recovery of the website included adopting a “badgeless” culture for the project, wherein all CMS staff and contractors worked together as a team, and a practice of “ruthless prioritization” that aligned work efforts with the most important and achievable goals. CMS recovered the website for high consumer use within 2 months, and adopted more effective organizational practices.
OIG calls on CMS to continue progress in applying lessons learned from HealthCare.gov to avoid future problems and to maintain improvement across the agency. In response to the report and these recommendations, CMS concurred with OIG’s call for continued progress, stating that it will continue to employ the lessons learned and that since OIG’s review, it has implemented several initiatives to further improve its management. As CMS works to improve Healthcare.gov, other public and private organizations should leverage the lessons learned from CMS’ experience to improve their own technology and IT design and implementation.
About Project COPE: The Coalition On Patient Empowerment & Coalition on Responsible Health Policy
What do you think about the status and direction of the U.S. health care system and its reforms? Do you share Dr. Koriwchak’s concerns? Have other concerns? Do you have ideas about how to improve the understandability of medication warnings or research findings for patients or other ideas about how to improve healthcare or health care policy? Share your ideas in the PROJECT COPE: Coalition On Patient Empowerment LinkedIn Group. If you have knowledge, experience or other resources that could help patients, families, communities, or the government better understand or cope with Asperger’s or other health care conditions, costs of care, or other challenges affecting Americans and the American health care system, we encourage you to get involved and share your insights.
As American leaders continue to struggle to deal with these and other mounting problems impacting the U.S. health care system, the input of individual Americans and businesses and community leaders is more critical than ever. Get involved in helping to shape improvements and solutions to the U.S. health care system and the Americans it cares for by sharing your ideas and input through the Coalition For Responsible Health Care Policy and exchanging information and ideas for helping American families deal with their family member’s illnesses, disabilities and other healthcare challenges through PROJECT COPE: Coalition On Patient Empowerment.
Sharing and promoting the use of practical practices, tools, information and ideas that patients and their families, health care providers, employers, health plans, communities and policymakers can share and offer to help patients, their families and others in their care communities to understand and work together to better help the patients, their family and their professional and private care community plan for and manage these needs is the purpose of PROJECT COPE.
The Coalition and its PROJECT COPE arise and run on the belief that health care reform and policy must be patient centric and patient empowering. The best opportunity to improve access to quality, affordable health care for all Americans is for every American, and every employer, insurer, and community organization to seize the opportunity to be good Samaritans. The government, health care providers, insurers and community organizations can help by providing education and resources to make understanding and dealing with the realities of illness, disability or aging easier for a patient and their family, the affected employers and others. At the end of the day, however, caring for people requires the human touch. Americans can best improve health care by not waiting for someone else to step up: Step up and help bridge the gap when you or your organization can. Speak up to help communicate and facilitate when you can. Building health care neighborhoods filled with good neighbors throughout the community is the key.
The outcome of this latest health care reform push is only a small part of a continuing process. Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist. The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye. Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families. While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.
We also encourage you and others to help develop real meaningful improvements by joining PROJECT COPE: Coalition On Patient Empowerment and by sharing ideas, tools and other solutions and other resources. The Coalition For Responsible Health Care Policy provides a resource that concerned Americans can use to share, monitor and discuss the Health Care Reform law and other health care, insurance and related laws, regulations, policies and practices and options for promoting access to quality, affordable healthcare through the design, administration and enforcement of these regulations.
You also may be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, and/or our HR & Benefits Update electronic publication available here.
You also can get details about how to arrange for your employees or other communities to participate in training on “Building Your Family’s Health Care Toolkit,” using the “PlayForLife” resources to organize low-cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here.
NOTE: This article is provided for educational purposes. It is does not provide legal advice, establish any attorney-client relationship or provide or serve as a substitute for legal advice to any individual or organization. Readers must engage properly qualified legal counsel to secure legal advice about the rules discussed in light of specific circumstances.ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, or (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN. ©2016 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press. All other rights reserved.