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Healthcare.gov – 3 Tips for Improvement with Clay Johnson

Last Tuesday the Obama Administration unveiled healthcare.gov. Affordable Care Act mandated the Department of Health and Human Services to build an online exchange, or Internet store, to let uninsured consumers compare and buy plans offered by private insurance companies.

But almost immediately problems started to pop up. The website was overwhelmed by up to five times as many users as it was designed to handle. It has been difficult if not impossible to sign up, and customer service has been inadequate.

More than 8.1 million consumers visited the site from Tuesday through Friday last week, according to the White House.

So what went wrong and can it be fixed? Clay Johnson is the CEO of the Department of Better Technology. He told Chris Dorobek on the DorobekINSIDER program that healthcare.gov crashed in a similar fashion to early helicopters.

“Look the history of large federal IT projects, it is sort of like the history of helicopters, which is really the history of crashes. It seems to me like the number of people and the amount of money the federal government spends on IT projects, the greater the likelihood that the IT project will fail. We are seeing that phenomenon here with healthcare.gov. We saw the same phenomenon exactly a year ago with Sam.gov launched. Sam.gov paled in comparison to the costs of healthcare.gov but it was still about a $100,000,000 website. A preposterous amount of money and a preposterously big problem,” said Johnson.

Why were there so many snags?

“Part of the issue is that the federal government can’t get access to the some of the great technical talent that this country has. Therefore, the federal government has to go to the same vendors over and over again. Those are the vendors that have proven time and time again that they are not particularly good at things like this. So we have a bit of a procurement problem. I would call upon federal CTO Todd Park and CIO Steven VanRoekel and Joe Jordan over at OFPP and say ‘We are going to put a stop to large enterprise IT integrations. Period.’ These procurements are not something the federal government should be doing,” said Johnson.

What should the government have done? Johnson’s three ideas:

  1. Solve the choice diversity problem: This is a very long-term solution. The biggest problem that the federal government has and the reason they keep coming up short, is that they don’t have enough people who do this type of work. The government needs to do things like RFP-EZ, grow a better, more diverse and stronger contracting community and open the doors to not just small businesses but new businesses that may want to explore contracting with the federal government.
    1. The SBA needs to be saying, “Hey wait a second, a big part of our job is getting these new businesses involved in government contracting. We need to help agencies meet their small business set-aside scorecards.’ That’s a huge function of the SBA, that business development angle. In the technology community just isn’t happening, yet. We are not growing relationships with new contractors. We need to start converting some of the smaller procurements into engagement opportunities with small businesses to sort of earn their legs and to understand what federal work is really like and grow them into larger contractors. Then down the road we have more supplier diversity in IT.
  2. Build better requirements: We need to have a more collaborative relationship with the vendor community. We have this process now where we get our heads together – generate a list of requirements – throw them across the wall – check with Fed Biz Ops or the GS schedule or the Alliance Schedule – then we cross our fingers and we hope that what we get back will be useful. Then we end up doing change order, after change order, after change order until we get to a function process. That’s just not an effective process.
  3. Better technology training operations for the contractors: Contracting officers don’t have time or an incentive to really learn about this stuff and what is out there. If you look at every Gov 2.0 conference, usually they are geared towards the Leslie Knope’s of the world. The ambitious, type A personalities who are either appointed or career employees who are really live to work people. A lot of contracting officers don’t have those same incentives. The amount of skill and knowledge that is takes to run these large procurement’s is massive. This takes a lot of work. The problem is, it is often times contractors are required to do low value work. Not the high value work that they need to do. Like market research and government cost estimation. When they are getting to do market research they aren’t consulting the right people. They are consulting incumbent vendors.

Will government procurement change?

“Government is a battleship. It doesn’t move quickly. I don’t think that there is anyone running for Congress on the platform of comprehensive IT reform. Certainly there is a lot of inertia there. I liken it to Elon Musk, the guy that created the electric car the Tesla. He’s got it easy. All he has to do is deal with gravity. Institutional inertia is way more of a force to deal with than gravity. What gives me hope and why I am a 6 or 7 on the hope scale is that there are a lot of young and very bright contracting officers out there. During my term inside the SBA and White House I saw a lot of really great people out of the rising acquisition community and the other things that gives me a lot of hope.

Johnson’s reasons for hope:

  • The fact that RFP-EZ got 250 new businesses to identify themselves and say we’ve never done federal contracting work before but we would like to have the federal government as a client is indicative of that.
  • The future is actually pretty bright but it is going to take time and a lot of effort to get us there. We have the technology. We can build bionic-procurement if we want to. The question is will the IT leadership in the federal government put an end to this idea that the cost of a project implies that it is low risk. Look this process is proven to not work. Can we stop doing this.

“Healthcare.gov is really the President’s legacy project. 10 years down the road people are going to go to healthcare.gov and think Barack Obama made this website,” said Johnson.

Administration officials implementing the new health care law will be on the hot seat Wednesday as the House Oversight Committee hopes to find out what the problems were, reports CBS.

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Jaime Gracia

This is a classic failure of big federal IT, a textbook version actually. However, politics were in the thick of it, adding unnecessary delays to the schedule and a lack of focus on requirements and effective software development due to the infighting between the White House and HHS (CMS, in particular).

Apparently no one was really in “charge”. Communications between the government and industry, not to mention government to government, were poorly executed. Further, lessons learned and valuable knowledge from the states and companies who have already created and implemented these exchanges was never captured.

When are federal IT managers and leaders going to get it through their thick skulls that “Big Bang” approaches to software development do not work. Anyone ever hear of Agile development? System for Award Management should have been a breeze compared to Healthcare.gov, and even that was a predictable disaster.

Healthcare.gov is an abysmal failure of IT execution and program management, and it should never have happened. It is not like Healthcare.gov needed to get built overnight, although that seems to have been the outcome. It really is a wonder how this Administration touts itself as tech savvy, and then launches one of the worst botched federal IT programs in recent memory.

The “technical surge” will cost how much more? How much has already been spent on the same formula that federal IT loves to follow (e.g. garbage in = garbage out)?

I wonder who is laughing all the way to the bank. Not the taxpayers…