Kusserow on Compliance: HealthCare.gov failures result of CMS and HHS missteps

The Office of Inspector General (OIG) reported on the implementation of HealthCare.gov in a review that spanned five years. The agency identified major missteps by CMS and HHS that contributed to the website’s breakdown at launch and reported steps taken to correct the problems in time for implementation of the federal marketplace through the second open enrollment period. In conducting the review, the OIG interviewed 86 current and former HHS and CMS officials, staff, and contractors who were involved with the website and examined thousands of documents, including management reports, internal correspondence, and website development contracts

Beginnings. 

HealthCare.gov was created as a federal website under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) to facilitate purchase of private health insurance for consumers who reside in states that did not establish health insurance marketplaces. At its launch on October 1, 2013, and for some time after, HealthCare.gov users were met with website outages and technical malfunctions. After corrective action by CMS and contractors, 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.

Findings.

The OIG focused on several findings revealed by the review, including:

  • absence of clear leadership that caused delays in decision making;
  • lack of clarity in project tasks;
  • too much time devoted to developing policy and too little time spent on properly managing its key website development contract;
  • hampering of progress due to CMS’s organizational structure and culture, including poor coordination between policy and technical work; and
  • CMS’ continued reliance on a failing path despite signs of trouble.

The OIG reported that following the launch failures, CMS and contractors took corrective action 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. However, the OIG noted that CMS continues to face challenges in implementing the federal marketplace and in improving operations and services provided through HealthCare.gov. The agency called on CMS to continue progress in applying lessons learned from the experience to avoid future problems and to maintain improvement across the agency.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2015 Strategic Management Services, LLC. Published with permission.