Poor Leadership Derailed Obamacare Rollout, Not Technology

Management really does matter. That’s the takeaway message of a case study of how the Centers for Medicare and Medicaid Services fumbled the implementation of HealthCare.gov, the website through which people may purchase health insurance under the Affordable Care Act, President Obama’s signature domestic policy initiative.

“Most critical was the absence of clear leadership, which caused delays in decision-making, lack of clarity in project tasks, and the inability of CMS to recognize the magnitude of problems as the project deteriorated,” Daniel Levinson, the Health and Human Services inspector general, wrote in the 92-page case study.

While establishing the federal insurance exchange and a secure, user-friendly website so people could sign up for the health plans presented complex technical problems, those challenges were made significantly more difficult because of lousy management—misplaced priorities, poor communication, insufficient contracting know-how, and a reluctance among senior officials to receive “bad news,” to name just a few of the problems the IG identified.  

“CMS continued on a failing path to developing HealthCare.gov despite signs of trouble, making rushed corrections shortly before the launch that proved insufficient. These structural, cultural, and tactical deficiencies were particularly problematic for HealthCare.gov given the significant challenges of implementing a new program involving multiple stakeholders and a large technology build,” the IG wrote.

When HealthCare.gov launched on Oct. 1, 2013, it crashed repeatedly with glitches so serious federal officials soon had to take it offline. Agency executives and managers had been warned repeatedly by many people inside and outside the agency that the website wasn’t ready for launch, yet “CMS leadership and staff took little action to respond to warnings,” the IG wrote, noting that officials had become “desensitized to bad news” and were perhaps so used to the kind of problems that routinely plague large government technology projects that they failed to recognize the extent of problems with HealthCare.gov.

After the disastrous rollout, the agency and its contractors found the will and the leadership to largely fix the mess. While challenges remain, as of February 1, more than 9.6 million consumers had selected a health plan through the federal marketplace or had their coverage automatically renewed.

The case study offers a list of lessons learned that should be of interest to managers and executives in any organization:

1. Leadership: Assign clear project leadership to provide cohesion across tasks and a comprehensive view of progress.
2. Communication: Promote acceptance of bad news and encourage staff to identify and communicate problems.
3. Alignment: Align project and organizational strategies with the resources and expertise available.
4. Execution: Design clear strategies for disciplined execution, and continually measure progress. 
5. Culture: Identify and address factors of organizational culture that may affect project success.
6. Oversight: Ensure effectiveness of IT contracts by promoting innovation, integration and rigorous oversight.
7. Simplification: Seek to simplify processes, particularly for projects with a high risk of failure.
8. Planning: Develop contingency plans that are quickly actionable, such as redundant and scalable systems.
9. Integration: Integrate policy and technological work to promote operational awareness.
10. Learning: Promote continuous learning to allow for flexibility and changing course quickly when needed.

(Image via S_L/Shutterstock.com)