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Finding the Cure for Obamacare’s Website

George Grieve | February 12, 2014

The rush to implement the national healthcare website proved once again the danger of rushing a project before it has been tested thoroughly.

By George Grieve

For those of us struggling with enterprise wide, mission critical software implementations there is a new standard for all to reference and feel better.  In insurance companies across the country you can hear it being muttered, “At least it’s not as bad as Obamacare.”  Not that the sentiment is saying much.  For now, after months of watching this slow motion wreck we are finally getting to the point, at least with the vendor side, of some accounting.   

It was recently announced that CGI Group Inc., the company that built the main Obamacare website, will be replaced in February when its contract with the U.S. government expires.  The Obama administration apparently intends to sign a contract with Accenture to complete unfinished work on healthcare.gov and run the site. 

As is now common knowledge, the October 1, 2013 debut of the insurance exchange serving 36 of the 50 U.S. states was plagued by delays, error messages and hang-ups that prevented people from completing applications. A major part of the rationale for selecting Accenture, is not only it’s size, being the second-largest technology-consulting company, but also the fact that it led construction of California’s better-performing state system.

The government-run insurance exchanges offer health plans and access to subsidies created by the 2010 Patient Protection and Affordable Care Act. CGI’s role in managing healthcare.gov had been reduced following the botched rollout, with a unit of UnitedHealth Group Inc. brought in to oversee emergency repairs. As of Oct. 31, the government had spent an estimated $319 million building healthcare.gov and its supporting technology.  CGI has been paid a reported $292 million so far. 

In addition to the federal site, CGI built health exchanges for Massachusetts and Vermont, and those states have also criticized the company’s work.  According to the Boston Globe, Vermont on Nov. 21 told CGI that it would dispute $1.1 million in charges for the company’s work on its Health Connect exchange and deduct $5.1 million in damages from the state’s payments to the firm.

According to the New York Times, leaders of the Massachusetts Health Connector told their board of directors recently that most people applying for insurance at the state’s exchange haven’t been able to use its website because of CGI’s poor performance. Massachusetts Governor Deval Patrick apparently has instructed the exchange “to consider all of our legal rights related to CGI’s failure to perform and the cost of remediation.”

Back on the federal front, insurance companies and health officials are reportedly still grappling with significant online enrollment errors despite the push in November to improve the malfunctioning website. Thousand of applications from the website have apparently received inaccurate assignments to Medicaid or the private marketplace, or have received incorrect denials.  In one reported case legal immigrants, who and not eligible for Medicaid were told they would be enrolled in the program.  Even consumers who apparently successfully negotiated the website are not out of the woods; some may be required to delete accounts and start over now that certain errors have been fixed.  Errors in eligibility determination raise the possibility that consumers could remain in limbo as the program takes effect this year.  Eligibility errors date back to the launch of the federal marketplace.

The Health and Human Services Department announced the extension of a special insurance program created by the Obamacare legislation to provide coverage for those with pre-existing conditions.  The extension was intended to help consumers that want coverage but got trapped by website glitches.  This also includes some of the 4 million consumers who had their individual plans cancelled because they failed to meet the new law’s coverage standards.

In mid-January HSS Secretary Katherine Sebelius told Congress that she had asked the department’s inspector general for an independent investigation into contracting and management factors that contributed to the technology failure.

What to make of this? 

First, the most glaringly obvious fact is that the train wreck was inevitable and foreseeable.  There never was enough time to define, build, and test the complex software that was required.  This is no mere “website”, rather it is a complex and multi-tentacled system that integrates with many disparate federal, state, and private insurance company applications, sending and receiving complex and sensitive data in many different formats. The aforementioned eligibility rules are complex and rely on the retrieval and assessment of a lot of external data.  The pricing algorithm and associated coverage choices are many and varied.

Second, it was obvious months ago to both the government and CGI that there was insufficient time to do what was necessary.  Was there a pact, spoken or unspoken, between vendor and customer to keep their collective heads down, report status as yellow, and just keep going?  Many of us have been in that exquisitely awful circumstance  in which we know the piano isn’t going through the door, at least not on the current schedule, but we don’t know enough to answer the questions which will inevitably follow by confessing that yellow is actually red.  In order to declare red and survive the consequences it would be necessary to stop the project long enough to evaluate where the project is, and that would be suicidal.  With so much outside pressure it seems the project just kept going until it was obvious to anyone watching that the delivery was a failure. 

And third, it is likely the political downside of doing something rational would have been too great for logic to prevail.  Clearly it was within the power of the Administration to delay the website launch.  It delayed key aspects of the program such as the Individual Mandate, and reverse marched the insurers into reinstating coverage (where possible) for policies cancelled at the government’s behest.  So, as is always the case the (technology) debacle could have been avoided, but at great political cost.  Now we have a technology debacle and great political cost, the worst of both worlds. To paraphrase the old saying – there was not time to build it properly, but now there is time to fix it.  And apparently money!  Everyone who has been involved in an enterprise software implementation knows that the longer it takes to identify and address a bug, the more it costs; with production errors being the most expensive of all.

Fourth, what’s a vendor to do?  CGI is a big, capable company.  Why did they fail?  Ultimately because they weren’t big enough and strong enough to control an incompetent and irrational client.  CGI knew the position they were in, they knew there was insufficient time, they knew the testing was inadequate, they knew the software was unfinished and bug-ridden, and they knew that the website was going to blow up in October.  Maybe they tried to do the right thing but if they did they failed.  Maybe they just kept their heads down.  After all they had two hundred and ninety two million reasons to keep quiet.  But what of that small but insistent voice that nags at the back of the mind “We’ll get fired.  We might get sued.”  Maybe the saddest aspect of this whole sorry tale is that it isn’t the first and it won’t be the last.  Government IT projects have a tendency to fail and the same small group of vendors seem to remain in contention despite prior performance.  This time may be different, even by government standards Obamacare is huge both in scope and visibility. 

Fifth, what happens next?  Hopefully Accenture is big enough, strong enough and DHHS is chastised enough that the fix project can be rationally estimated, funded, programmed, tested and implemented.  Hopefully Accenture is big enough and strong enough to control an incompetent client, and hopefully the client is frightened enough to actually listen and act accordingly. 

Sixth, what of the beauracrats that foisted this on the unsuspecting public and burned hundreds of millions of dollars doing so?  The inspector general will order his investigation and we the taxpayers may know more, or not.  Certainly the time to fire the guilty parties is now. After all, the government just fired the vendor.  Worst case CGI is only partly responsible for this debacle. DHHS was minimally responsible for defining its requirements, acceptance testing the software, managing its vendor and reporting status and advising the White House.  Clearly they failed badly.

Lastly, spare a thought for the poor foot soldiers that burned endless hours and days working around the clock to rescue a hopeless situation.  The rank and file from CGI and the government gave up their lives for months to try and rescue their managers and masters from their own hubris and incompetence.  I hope there is some solace in all this for them, but it’s hard to see what.   

(George Grieve is a popular writer and speaker on the subject of insurance technology solutions and is the author of the book Shop Talk. He is CEO of the consulting firm CastleBay Consulting.)

(The views and opinions in this column are those of the author and do not necessarily reflect the views of the Insurance Technology Association and its members.)


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