Washington Techies Hold Retrospective on Healthcare.gov
Last night, I attended the Washington DC Scrum User Group’s monthly meeting, where a group of 25 technology professionals talked about the Healthcare.gov crisis. There’s been a lot of debate in traditional media as to why the website project incurred so many issues.
The group discovered four common themes…
No One in Charge: The congressional hearings revealed the classic accountability problem: Everyone was in charge of their part, but no one was in charge of the whole thing. If there were ever a conflict over which agency or contractor needed to own an issue, there was enough ambiguity to deflect any blame. Also, even if CMS took accountability for stitching together all the pieces, they would have needed the appropriate expertise in house, which by all accounts, was not the case.
Quality: By now, we’ve all heard the story that overall system testing began way too late in the game. Each agency or contractor reportedly delivered their components just fine, but cross-system testing happened too little, too late. The group discussed the value of continuous integration, applied not just to the individual components, but to the entire program.
Big Bang Delivery: The opposite of continuous integration is last-minute, all at once integration, which we saw with Healthcare.gov. The group wondered out lout what problems would have been avoided if the program release support for only 1 state at a time. Releasing one small piece of the capability at a time allows for progressive learning and elaboration of the technical solution.
Volatile Requirements: Several fascinating points were made regarding the scope of the project getting delayed and changed in a way that would put any technology project in jeopardy:
- Scope Unrealistic: One person made the point that the ACA law refers to “the website” 118 times. This means the website project was launched with over a hundred system requirements, which ostensibly, had not been reviewed by technical experts.
- Scope Delayed: Much like any large scale project, the 2012 election created very real political forces on the project. Out of a sense of prudence and self-preservation, the administration held off on several policy decisions that were feared to have a potential impact on the election. As a result, key questions (like the difference between a gold and silver plan) were delayed until after the president and the democratic Senate were safely secured.
- Scope Changed: When the Supreme Court ruled on NFIB v Sebelius in June of 2012, all of the Medicaid expansions were invalidated. Needless to say, that would require any previous work on that piece of the system would have to be reworked.
- Scope Expanded: The website was originally envisioned to be a pass-through portal to the state-run exchanges. However, when Republican governors overwhelmingly decided not to create state exchanges, the federal website would now have to support those states as well. Expanding from 8 exchanges to 34 could not have been a trivial change.