Evans Incorporated

HealthCare.gov’s Lifeline: Effective Program Management

By Omoefe Abugo

When Congress asks the U.S. Government Accountability Office (GAO) to audit a government agency or program, it generally investigates areas of fraud, waste, abuse and mismanagement and areas thought to be in need of broad reform. When the GAO looked at the Centers for Medicare and Medicaid’s (CMS) management of HealthCare.gov, it found several factors that contributed to its painful and delayed launch. The GAO found the CMS-led initiative to be a high-risk program for many reasons, among them being: unclear guidance, lack of quality assurance plans and inadequate accountability functions. Our experience with complex organizations has enabled us to help program offices avoid such issues and adopt effective program management and balance crucial program factors.

When faced with a large-scale initiative, there will always be complex challenges and unforeseen problems to solve. When CMS set out to design, develop and launch the complex environment and suite of components known as HealthCare.gov, various issues arose that impeded a successful launch. According to the GAO’s Report to Congressional Requesters, these issues led to major unaddressed performance gaps, millions of dollars in cost overruns and a seriously flawed rollout of the HealthCare.gov website on Oct. 1, 2013.

Program Effectiveness

Photo courtesy of rt.com

Photo courtesy of rt.com

There were several problems that plagued CMS’ launch of the healthcare program, but the failure to adopt established program management (PM) best practices proved to be the weakest link of the HealthCare.gov initiative. The GAO report and testimony by GAO officials point to failure to adhere to effective planning and oversight practices, despite the challenges and level of risk required for effective oversight.  These failures led to scope creep, over-obligation of funding to contracts, and a decision to launchwithout verification that the site met its performance requirements.

In managing a program as complex as Healthcare.gov, CMS leadership should have placed greater emphasis on the human element of program management across its many components and over 60 contracts to ensure that the workforce and stakeholders remained informed and aligned for the transformation ahead.

Certainly, for an initiative of this size, the program office must lead from a clearly defined and communicated set of objectives. Evans’ Game-Changing Program Management approach uses these implemented objectives to drive day-to-day efforts in ensuring program effectiveness:

  • Clear organizational goals for program management
  • PM standards that are aligned with the organization’s process maturity
  • Improved organizational effectiveness and efficiency
  • Increased stakeholder and customer satisfaction
  • An audit-ready program office
  • A value-added and balanced quality assurance function
  • Metrics that realistically track program performance

Balancing Factors

The Project Management Triangle (PMT), also known as the Triple Constraint, tells program managers that every project is balanced on three supporting beams: schedule, cost and quality. Basically, if you want something done well and fast, the price will rise.

Photo courtesy of healthcare.gov

Photo courtesy of healthcare.gov

If a program manager wants something done well and for a low price, it will take longer to achieve favorable results. The main point: you can only pick two of the three sides of the PMT. For a program to achieve the objectives mentioned above, one must define which constraints it will operate around. Otherwise, less favorable tradeoffs will be made.  Unfortunately for CMS, the quality of the project failed and cost accountability evaporated. The deadline for the website became more important than the website’s ability to handle influxes of millions of users. Wanting it fast began to overcome wanting it right. Confusion about who had the authority to approve contractor requests and expend funds crippled CMS’ ability to implement an effective accountability system. According to the GAO’s Report, this led to more than $200 million in piled fees, and no improvements in HealthCare.gov’s effectiveness.

During a high-visibility, high-stress project like HealthCare.gov, it is crucial for the program office to leverage a balanced quality assurance function that helps to assess its process strengths and weaknesses. Instead of establishing a dependable quality assurance function, project roles and requirements were often unknown and unclear. What did this mean for CMS? Every action it took involved great risk. Unfortunately, CMS failed to put measures in place to alleviate these dangers, such as:

  • Clarified roles and responsibilities
  • Established best practices
  • Governance approvals
  • Accountability functions

In Retrospect

As HealthCare.gov’s lifecycle matured, it should have been able to demand more of its contractors and workforce and expect optimized performance and results. However, little to no risk management challenged the program office’s ability to properly facilitate each step of the institutionalization of HealthCare.gov. The program managers could not right-size their use of program standards to make HealthCare.gov more effective because the standards were unclear and unknown.

Communication always tends to be the fall guy when a project fails or performs inadequately, but in this situation, it would be unfair to blame poor communication. If CMS’ program office had implemented strict program management best practices, set rigorous performance expectations and established flexible, adaptive objectives at each level of HealthCare.gov’s process maturity, perhaps we would have seen a more successful, efficient launch.

If you would like more information on our Game-Changing Program Management approach, please contact us at 703-663-2480 or at info@evansincorporated.com.

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