This is the second blog post with Ruth Ann Dorrill, Deputy Regional Inspector General at the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS), surrounding HealthCare.gov. Find the first blog on HealthCare.gov’s management challenges please here.
The main issues behind HealthCare.gov stemmed from organizational failures, such as a prolonged policy process that didn’t address the operational needs of the project, lack of acquisition strategy, and issues in the implementation phase. HHS compiled a case study, HealthCare.gov: Case Study of CMS Management of the Federal Marketplace, to look at those organizational challenges and unearth lessons learned.
Dorrill sat down with Christopher Dorobek on GovLoop's DorobekINSIDER program to delve into how to manage big projects from the lessons learned through the first failed launch of HealthCare.gov.
“After the breakdown, the Centers for Medicare and Medicaid (CMS) was able to improve processes and work better with contractors to be able to not only fix the website, but also to institute some broader organizational changes to avoid this kind of problem in the future,” Dorrill said.
A Changing Culture
CMS needed to change their organizational culture if they wished to resolve the issues behind the failed HealthCare.gov portal.
First, CMS had to acknowledge that this was a vastly different project than the ones they had done previously. “The Federal Marketplace was a different type of endeavor for CMS,” Dorrill explained. And since CMS hired private market expertise there was a “culture clash between old guard government programs like Medicare and the new private market.” As a result, CMS came into the second attempted launch of HealthCare.gov knowing that these relationships needed to be actively addressed and monitored, Dorrill furthered.
Dorrill shared that CMS began changing their cultural approach towards their contractors. They adopted something called a “badgeless culture where it didn’t matter where you came from, it didn’t matter what your title was, you were all working together as a single team.”
But, every team still needs a leader.
A clear sense of leadership is important for the overall success of any project, but it was especially true with HealthCare.gov. “Because this project didn’t have the overarching leadership, individuals began to operate in their own kingdoms without proper communication between functions,” Dorrill explained.
And communication is crucial for leaders to identify where and what the problems are. “If you have a single entity responsible for the project, you can see all the pieces and it makes identifying problems and determining a new course of action more realistic,” Dorrill stated. To address the lack of clear leadership, the President, on 22 October 2013, brought in Jeffrey Zients, a former official of the Office of Management and Budget. Zients had prior operational experience and provided short-term management assistance to the HealthCare.gov project. Additionally, CMS instituted something they titled “Executive On Call,” in which they had six top CMS executives available 24 hours a day to respond to any inquiry. If there was a problem, employees could immediately reach out the CMS executive “on call”. The CMS executive could, in turn, make a quick decision or designate someone to make the necessary call so that it wouldn’t have to lag behind the chain of command. “It was on-the-ground simplification of the policy and tech process,” Dorrill said.
However, simplification requires setting achievable objectives.
Due to the complexity of HealthCare.gov, leadership enacted a strong push for setting priorities and goals.
Right after the first step in enrollment ended, Dorrill shared, CMS leadership asked all of the managers across the organization involved in the marketplace to create a list of all the items that needed to be done to improve the website. They compiled the list, including the cost in terms of man-hours and resources, and cut that list in half to further prioritize the main issues and to accommodate the new timeline. “Ruthless prioritization allowed them to focus on what was most important,” Dorrill stated.
Proper project management is no easy task, especially when you are approaching an innovatively complex project such as HealthCare.gov. But, “as technology becomes more and more important, we have to find more effective ways within the rubric of good governance to have close relationships with contractors-as a single team,” Dorrill highlighted.