The team that built the HealthCare.gov public exchange enrollment and administration system started out with an unclear, disjointed organizational structure.
Officials at the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) have described the management problems that led to the Patient Protection and Affordable Care Act (PPACA) public exchange program’s troubled birth in a new report.
The Centers for Medicare & Medicaid Services (CMS), the arm of the U.S. Department of Health and Human Services (HHS) that oversaw the construction of HealthCare.gov and other HHS exchange systems, had no project leader below the level of the CMS administrator, HHS OIG officials say.
“Lack of clarity about roles and the absence of a clear project structure led to staff working at cross-purposes, and to managers and leaders receiving poor and incomplete information,” officials say.
The officials who were working on the project spent too much time thinking about policy and too little about getting the enrollment website to work, officials add.
Another problem, officials say, is that the team failed to do much to prepare for the possibility that HealthCare.gov would have problems.
“Contingency planning for HealthCare.gov was almost nonexistent prior to the breakdown,” officials say.
HHS OIG officials repeatedly mention that key HealthCare.gov team members resisted communicating and heeding warnings of bad news.
In the summer of 2013, because managers reacted badly to hearing bad news, “CMS technical staff began to avoid reporting further bad news about the website,” officials say.
Eventually, however, CMS project managers adopted a strategy of “ruthless prioritization,” and that helped the managers get exchange program projects back on track, officials say.
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