OIG Says CMS Mismanaged HealthCare.gov ACA Federal Marketplace Implementation

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.

 

Insist President & Congress Get Real About Health Care Reform

Every American should watch and internalize the insights from these videos and then send them to Mr. Obama and Congress and insist they do the same when making healthcare, war and other policy with a message to get real and start coming up with real solutions for real American families:

A key problem with health care policy made in Washington, D.C. is that most of our leaders make health care policy decisions as if they are playing an Xbox game.  In most cases, the leaders deciding our health care policy are privileged people who don’t currently live in or experience life in the real world that most Americans live in, and either have never really done so or have forgotten what life in the real world is like.

While disability, illness or death eventually come to all families, Mr. Obama and other Presidents, Congress members, and  to a lesser extent, their staffs use billions of dollars of Americans’ tax dollars to get special benefits, perks and privileges that help insulate them and their families from these challenges even as they adopt and enforce an epidemic of rules that these leaders won’t apply to themselves and their families, administered by thousands of newly hired bureaucrats who also enjoy many of those same special benefits, perks and privileges denied to taxpaying Americans. See e.g., on Presidential Perks, here; on Congressional Perks, see here and on Affordable Care Act special treatment, see White House Approves Deal: Congress And Staff Exempt From Obamacare and Members, Staff Will Keep Health-Care Subsidies Under Obamacare.

The President and many members of Congress and their advisors make inappropriate health policy choices because most don’t have a real experience in dealing with these issues that matches the reality of most Americans.  don’t pay real bills or face the limits of a real budget.  The President and members of Congress don’t stand in line at the local clinic, wait hours, much less days, to get a doctor’s appointment, have to leave work to take a parent or child to the doctor or go out-of-pocket to pay for care.  They don’t have to struggle to patch their shoes, turn down their heat or replace hamburger with Mac’N Cheese to pay the health premiums that Obama Care will mandate while concerned about reduced hours or unemployment.  Their knowledge is based instead on political ideology buttressed by filtered and carefully selected anecdotal stories, selected because their re-enforce the already existing world view of the political decision-maker.

We need to insist that the President and Congress make and administer health care policy based on a real world understanding and stop treating health care reform like an Xbox simulation where the budget reloads and the suffering and death are washed away by starting a new game.
Americans should not allow or trust any President or member of Congress to make important decisions about health care, jobs or war when the leader passes laws or supports the adoption of laws and rules that :

  • Force Americans to pay billions and new taxes to submit to a government dictated health care system that wastes trillions for bureaucrats to dictate the care, coverage and premiums that American families will get while the President and Congress have decided that system is not good enough for the President, Congress, their staff and their families;
  • Waste thousands of taxpayer dollars of special perks like allowing the President to spend more than $100K to fly his puppy to meet the First Family on vacation, throw lavish birthday parties, and take a series of expensive vacations;
  • Break promises made to the millions of Medicare-eligible Americans and veterans and their families who constantly find their benefits cut, new costs imposed and wait times lengthened; and
  • Force Americans to “cut back” to pay for a deluge of other expensive new government regulators to create and enforce new and expanded government regulations that only further tax American taxpayer’s pocketbooks, job opportunities, competitiveness and choices.

While Mr. Obama talks a lot about his experiences as an “organizer,” it is clear that he and others either never actually learned, long ago forgot, or don’t care about the real struggles of Americans struggling to care for aging or disabled family members, rising taxes and mandates amid job losses and reduced buying power, military service members and veterans whose families are left struggling with broken promises and the host of other real world issues that impact most average American families.

Americans need to use their e-mail, telephones, social networks and other communication channels, votes, contributions, and their time to remind regularly and hold the President and Congress accountable for understanding and regulating with an awareness and concern for the real world challenges and needs of Americans. Insist our leaders see and experience life from the shoes of real people by sharing the experiences of your and your friends families.  Insist they not only see the world through our eyes by watching these videos, but also by wearing the same shoes and walking the same paths without the special benefits, perks, and privileges that insulate them and their families from really experiencing life the way those who are taxed experience it. Speak up and be persistent until they get the message or are replaced.

Start by joining the discussion and sharing your thoughts about health care reform  by joining Project COPE: Coalition for Patient Empowerment here.

About Project COPE: The Coalition On Patient Empowerment & Its  Coalition on Responsible Health Policy

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 on Patient Empowerment & It’s Affiliate, the Coalition on Responsible Health Policy.

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 for Patient Empowerment here 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.

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also 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, or our HR & Benefits Update electronic publication available here .  You also can get access to information about how you can arrange for 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. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail by creating or updating your profile here. You can reach other recent updates and other informative publications and resources.

Recent examples of these publications include:

 

For important information about this communication click here.

©2013 Cynthia Marcotte Stamer.  Nonexclusive right to republish granted to Solutions Law Press, Inc. All other rights reserved.

Logon & Password Creation For Personal Accounts Lend Significance To Consumer Security Concerns About Using HHS Health Insurance Exchange Portal

Report Raises Questions About Security Of Sensitive Personal Information Americans Will Share With HHS Exchange Portal

The reported finding that the Department of Health & Human Services (HHS) has yet to complete the necessary security arrangements and testing for the web-portal Incomplete security arrangements and testing necessary to ensure the security of personal health and other information shared by consumers on the health insurance exchange Hub that Obamacare charged the HHS Centers for Medicare & Medicaid Services (CMS)  with creating under Obama Care raises concerns about whether these security issues might undermine the security of the sensitive personal information that a consumer might share now or in the future when exploring or enrolling in health coverage options offered through the health insurance exchange.

On Monday, August 5, 2013, HHS sought to beef up interest and anticipation among Americans for the new health insurance exchange option by inviting consumers to prepare for the upcoming enrollment period scheduled to begin October 1, 2013 by creating their personal accounts on HHS’ Healthcare.gov website now.

HHS began encouraging Americans to the HHS website “healthcare.gov” to open a personal account, the first step to buying coverage through one of the health insurance exchanges that HHS is creating under the Patient Protection & Affordable Care Act reforms.  See Consumers Can Take First Step To Enrolling In New Insurance Options Today.  HHS is encouraging Americans to prepare for enrollment today by setting up their personal account on the HHS Website, Healthcare.gov.  A HHS Twitter Tweet yesterday announced , “Today you can be 1 step closer to getting health ins. by creating your Marketplace account:.” The Healthcare.gov website main page now invites Americans to “[a]nswer a few questions to get some personalized info here.”

Unfortunately, HHS kicked off this campaign on the same day that the HHS’s Office of Inspector General (OIG) released a report titled Observations Noted During The OIG Review Of CMS’s Implementation Of The Health Insurance Exchange—Data Services Hub (Report) that raises questions about the adequacy of the current security of the data portal and whether HHS will complete the arrangements and testing to verify it appropriately safeguards the security of the sensitive personal information that consumers will share there when the enrollment period begins and thereafter.

Data shared by Americans as part of the process of exploring and enrolling in coverage through the health insurance exchanges will be collected and shared through a data security Hub that will host and transmit that data.  The OIG Report raises clear concerns about the existing security arrangements that CMS has implemented to protect that data, as well as questions about whether CMS will complete the necessary arrangements to secure and protect that sensitive data before enrollment begins October 1.

The findings reported by OIG in the Report raise significant questions about whether Americans should accept the HHS invitation to establish their personal accounts now in anticipation of the October 1, 2013 beginning of the  enrollment period for applying for coverage through the health insurance exchanges that would take effect on January 1, 2014.

The Report makes clear that OIG found reason for concern about the Hub security currently and whether these issues will be adequately addressed by the time the enrollment period begins on October 1, 2013.

OIG reports many critical tasks required to implement and test necessary security controls are unfinished.  It states “[S]everal critical tasks remain to be completed in a short period of time, such as the final independent testing of the Hub’s security controls, remediating security vulnerabilities identified during testing, and obtaining the security authorization decision for the Hub before opening the exchanges. CMS’s current schedule is to complete all of its tasks by October 1, 2013, in time for the expected initial open enrollment period.”

While acknowledging that CMS has affirmed its commitment to complete and implement the necessary security arrangements before enrollment begins on October 1, 2013, the OIG Report also notes that CMS already has missed several critical target dates in its efforts to implement the required security measures.

The Report additionally states: “CMS is working with very tight deadlines to ensure that security measures for the Hub are assessed, tested, and implemented by the expected initial open enrollment date of October 1, 2013. If there are additional delays in completing the security assessment and testing, the CMS CIO may have limited information on the security risks and controls when granting the security authorization of the Hub.” (emphasis added).

The security concerns highlighted in the Report should raise questions about the adequacy of the security of information that an individual might enter on the Healthcare.gov portal in response to the invitation of HHS extended beginning yesterday. 

The importance of the security concerns raised in the reports becomes evident when one considers that consumers establishing their personal accounts must “Choose  your user name and password; Create security questions to add an extra layer of protecting your information.”   While many may be temped to discount the significance of the security concerns because the information that HHS currently asks individuals to share when they create their personal accounts appears relatively harmless, it merits noting that the creation of the login and security password that will be used to control access to the personal account of registrants are among those initial elements. To the extent security deficiencies compromise the security of this information, these security deficiencies could undermine the security of the personal accounts and all of the information they contain.

In light of the findings contained in the Report, Americans concerned about the security of their personal information may want to hold off entering data in response to the HHS’s invitation.  Additionally, Americans concerned about these and other security issues also may want to share their feedback with HHS and members of Congress.

Are you concerned about whether health care reform preparations are on track or have other health care policy concerns. Tell us what you think by responding to our poll. 

Join the discussion about health care reform and share your input by joining Project COPE: Coalition for Patient Empowerment here.

About Project COPE: The Coalition On Patient Empowerment & Its  Coalition on Responsible Health Policy

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 on Patient Empowerment & It’s Affiliate, the Coalition on Responsible Health Policy.

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 for Patient Empowerment here 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.

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also 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, or our HR & Benefits Update electronic publication available here .  You also can get access to information about how you can arrange for 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. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail by creating or updating your profile here. You can reach other recent updates and other informative publications and resources.

Recent examples of these publications include:

For important information about this communication click here.

©2013 Cynthia Marcotte Stamer.  Nonexclusive right to republish granted to Solutions Law Press, Inc. All other rights reserved.

OIG Questions Security For American’s Personal Information On HHS Health Insurance Exchange-Data Services Hub

Report Raises Questions About Security Of Data Americans Will Share With HHS Exchange Portal

A report released today by the Department of Health & Human Services (HHS) Office of Inspector General (OIG) raises serious questions about whether Americans should accept the opportunity made available by HHS for the first time today to establish a personal account and begin entering their data into HHS data banks in preparation to apply for health care coverage through health insurance exchanges to be created under the Patient Protection & Affordable Care Act when enrollment begins on October 1, 2013.  In light of the OIG findings, Americans concerned about protecting their personal information may want to hold off entering information on the Healthcare.gov website and to share their concerns with HHS and Congress.

HHS Invites Americans To Enter Their Personal Information At Healthcare.Gov Beginning Today

Health insurance exchanges are State-based competitive marketplaces where individuals and small businesses will be able to purchase private health insurance.

Today, HHS began encouraging Americans to the HHS website “healthcare.gov” to open a personal account, the first step to buying coverage through one of the health insurance exchanges that HHS is creating under the Patient Protection & Affordable Care Act reforms.  See Consumers Can Take First Step To Enrolling In New Insurance Options Today.  HHS began encouraging Americans to prepare for enrollment today by setting up their personal account on the HHS Website.  A HHS Twitter Tweet earlier today proclaimed, “Today you can be 1 step closer to getting health ins. by creating your Marketplace account:.” The website today invites Americans to “[a]nswer a few questions to get some personalized info here.”

While many are likely to view the information that HHS asks individuals to share when they create their personal accounts as relatively harmless, it merits noting that the creation of the login and password that will be used to control access to the personal account of registrants is one of those key elements. The text of an e-mail broadcast by HHS restated this invite by stating:  “Starting today you can be one step closer to getting health insurance by creating your Marketplace account. Setting up your account is the first step in the process to get you ready for October 1.  Follow these quick, easy steps and you’ll be on your way:  Provide  basic information like your name, address, and email address;  Choose  your user name and password; Create security questions to add an extra layer of protecting your information.  When open enrollment begins October 1, you’ll be set up to apply for health coverage, compare plans side-by-side, and enroll in a plan.  Create your account today! And after you’ve set up your account, make sure to tell your family and friends to set up theirs too.  Coverage starts as soon as January 1, 2014.”

 

OIG Report Questions Security Of Data Shared With HHS

On the same day as HHS invited Americans to begin entering their personal data on the Healthcare.gov website, the HHS OIG released a report titled Observations Noted During The OIG Review Of CMS’s Implementation Of The Health Insurance Exchange—Data Services Hub (Report) that raises serious questions about the security of the sensitive personal data that Americans accepting the HHS invitation to explore health care coverage offered through health insurance exchanges will share with HHS as part of the process.

Data shared by Americans as part of the process of exploring and enrolling in coverage through the health insurance exchanges will be collected and shared through a data security Hub that will host and transmit that data.  The OIG Report raises clear concerns about the existing security arrangements that CMS has implemented to protect that data, as well as questions about whether CMS will complete the necessary arrangements to secure and protect that sensitive data before enrollment begins October 1.

The findings reported by OIG in the Report raise significant questions about whether Americans should accept the HHS invitation to begin sharing their data with HHS now, as well as provide another basis for Congressional and public concern about whether CMS’ system for enrolling Americans in and administering the exchanges will be ready for prime time in October..

The findings contained in the Report are disquieting. The Report details the results OIG’s review of the efforts of CMS to implement and test the security of the Hub.  While acknowledging that CMS stated that it is confident that the Hub will be operationally secure before October 1, 2013, the Report makes clear that OIG found reason for concern about the Hub security.

The Report reflects that critical tasks required to implement and test necessary security controls remain unfinished, stating: “[S]everal critical tasks remain to be completed in a short period of time, such as the final independent testing of the Hub’s security controls, remediating security vulnerabilities identified during testing, and obtaining the security authorization decision for the Hub before opening the exchanges. CMS’s current schedule is to complete all of its tasks by October 1, 2013, in time for the expected initial open enrollment period.”

While acknowledging that CMS has indicated that it is committed to complete and implement the necessary security arrangements before enrollment begins on October 1, 2013, the OIG Report also notes that CMS already has missed several critical target dates in its efforts to implement the required security measures.  The Report additionally states: “CMS is working with very tight deadlines to ensure that security measures for the Hub are assessed, tested, and implemented by the expected initial open enrollment date of October 1, 2013. If there are additional delays in completing the security assessment and testing, the CMS CIO may have limited information on the security risks and controls when granting the security authorization of the Hub.” (emphasis added).

The security concerns highlighted in the Report should raise questions about the adequacy of the security of information that an individual might enter on the Healthcare.gov portal in response to the invitation that HHS began extending today.  Furthermore, the reported findings are likely to prompt additional questions about whether ACA and its health insurance exchanges are ready for prime time.  For policymakers, the security questions and delays in implementation also suggest additional security issues may arise when insurers and other parties required to exchange and access information through the CMS Hub interact with the Hub.   This is because CMS must complete its arrangements before other agencies and parties can implement and test their system’s interaction with the Hub and the adequacy of the security of these processes.  The continuing delay by CMS to finalize the Hub and its security will leave little time to identify and resolve issues that might stem from these interactiosn.

In light of the findings contained in the Report, Americans concerned about the security of their personal information may want to hold off entering data in response to the HHS’s invitation.  Additionally, Americans concerned about these and other security issues also may want to share their feedback with HHS and members of Congress.

 Other Questions About Exchange Readiness Remain

Today’s OIG Report of security concerns is just one of many growing concerns about the readiness of CMS and its health insurance exchanges and other health care reforms slated to take effect over the next few months are ready to go effective as scheduled.

Beyond the security issues in the OIG Report, for instance, the General Accounting Office (GAO) and others have expressed concern about arrangements and the need for added funding to prepare for the massive conversion in the U.S. health care system slated to take effect January 1, 2014.  Despite these concerns, Obama Administration officials are continuing to claim readiness to begin enrollment of Americans In federal health care marketplace on schedule on October 1, 2013 and to meet other crucial deadlines necessary to effectively implement the next wave of ACA’s health care reforms in the Department of Health & Human Service’s rollout of new consumer health care education and decision-making tools on its newly designed healthcare.gov website.

While HHS says its tools and other preparations ready to meet the October 1, 2013 enrollment commencement and the January 1, 2014 rollout of the new health insurance exchange system, others are less confident.  For instance, GAO officials recently found that major work that federal and state officials  must complete to timely begin enrollment by October 1 remains unfinished, making it unclear if they will meet the impending October 1, 2013 enrollment kickoff deadline.  See GAO Report and  GAO Report such as::

  • 17 states committed to run their own exchanges have missed March 2013 deadlines on 44% of key activities;
  • Officials creating the small business exchanges still must review plans and train and certify the “navigators” that are supposed to help companies and individuals enroll in plans and complete other key arrangements;
  • A federal  the “data hub” designed to help individuals determine their eligibility and enroll in plans offered through the exchanges has only  undergone initial testing; and
  • The current planned process for coordination of data between employer and insurer plans and the health care exchanges to evaluate eligibility of the millions of Americans expected to apply for subsidies for enrolling in coverage through the exchange presently is for HHS to contact employers by telephone employers to ask if that employer asked that employee enrollee minimum essential coverage providing minimum essential value at an affordable cost that would disqualify the applicant for the subsidy.

Meanwhile, the GAO Reports also provide a glimpse at what the federal government has spent so far on preparing the federal exchanges and the data hub. They indicate that hat the Obama Administration had approximately $394 million on exchange efforts as of March 2013 including:

  • $84 million to CGI Federal, which is building the federal exchange computer infrastructure;
  • $55 million to Quality Software Services, which is building the data hub; and
  • $38 million to Booz Allen Hamilton to provide technical assistance for enrollment and eligibility.

Contractor Booz Allen Hamilton recently has drawn attention as the National Security Association contractor through which the notorious fugitive Edward Snowden allegedly accessed information he disclosed to the public about NSA surveillance of “big data” on Americans and others through the internet.

The GAO also estimated the Obama administration needs Congress to approve an extra $1.5 billion from the budget to provide the Administration with the additional $2 billion that the GAO projects the Administration will need over the next fiscal year to create and run the federal exchanges.  Existing budget  and the political impass between the House and Senate over these and other concerns make it unlikely that Congress will approve these extra funds.

Are you concerned about whether health care reform preparations are on track or have other health care policy concerns. Tell us what you think by responding to our poll. 

Join the discussion about health care reform and share your input by joining Project COPE: Coalition for Patient Empowerment here.

About Project COPE: The Coalition On Patient Empowerment & Its  Coalition on Responsible Health Policy

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 on Patient Empowerment & It’s Affiliate, the Coalition on Responsible Health Policy.

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 for Patient Empowerment here 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.

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also 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, or our HR & Benefits Update electronic publication available here .  You also can get access to information about how you can arrange for 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. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail by creating or updating your profile here. You can reach other recent updates and other informative publications and resources.

Recent examples of these publications include:

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©2013 Cynthia Marcotte Stamer.  Nonexclusive right to republish granted to Solutions Law Press, Inc. All other rights reserved.