ObamaCare Clusterfuck: CO exchange managers triage key system requirements, refuse press inquiries
Solutions, which actually looks like a pretty good (i.e., not kayfabe-ish) policy shop at the University of Colorado, is following the progress of CO's state health care exchange. To a former IT person, this article is a big screaming red alarm bell:*
As Colorado’s health exchange managers sprint [oh, good] toward an October 1 launch, a top manager warned board members on Monday that a recent decision to build a new “eligibility” IT system poses the greatest risk of delay and could undermine the quality of the online health marketplace.
Great. Seeing as how determining who's eligible for the Gold, Silver,
Loser, Bronze plans, or Total Loser Medicaid is only the key functionality of the entire system, and will poses actual life and death "risks" for citizens in the case of #FAIL.
Adele Work, who is leading implementation for the exchange, made a presentation about “key implementation risks” during a technology update for the board.
No. 1 on that list of risks is the new decision to divide one planned IT system into two. The report to the board said that IT developers for the exchange are now having to contract with a “team of eligibility experts” to develop the new engine that will determine if customers of the exchange qualify for federal subsidies. State Medicaid managers are building their own separate system to determine if exchange customers are eligible for Medicaid. Previously, Medicaid and the health exchange were planning to operate one “shared eligibility service,” the report said.
This is just so bad. This is a complete systems integration #FAIL. Now the citizen has to make the key determination -- Medicaid or Exchange -- themselves. Has to, no matter how you slice it, because the systems can't. And what happens to people on the bubble? What would you do? That's right, you'd test both systems to get the best deal, which as a
citizen consumer, is exactly what you should do! So what happens if both systems reject you? What happens if both systems accept you? And if only one system accepts you, how do you even know it's right? (And will both systems ask for the same information? Remember, under ObamaCare, you can be charged with perjury!
“This decision was made about a risk to our ‘go-live’ date,” Work told board members.
Re-implementing key requirements under time pressure is one sign that a project is out of control.
In order to try to open the exchange on time, Work also told board members that IT developers will delay some functions to future years.
Shedding requirements altogether is another sign.
Exchange board member Eric Grossman, an expert on health care technology who works for TriZetto, a health care technology company, asked about planning in case IT systems don’t work.
“The best laid plans go awry,” Grossman said. “What’s plan B? We can’t just keep dumping stuff on the plan.”
Exchange Executive Director and CEO Patty Fontneau responded that she’s putting a halt to any new components.
“We can’t do anything else,” Fontneau said. “We’re done. At this stage, we’re drafting a letter to HHS (the U.S. Department of Health and Human Services) saying, ‘if you tell us something else, we can’t do it.’”
Managers who evade reasonable questions; that's another sign. Grossman asked for "Plan B." Fontneau answered with a feature freeze. That's not a Plan B.
Fontneau also warned board members that the exchange would need to hire and absorb extra costs in the first year for more workers to do jobs by hand in the “back office.” She previously anticipated those functions would be automated through tech systems.
And punting to the systems already in place is yet another sign of a project that's out of control.
Overall, Work said that IT projects are on schedule, but that lack of time could be problematic.
And project managers spouting bafflegab about dates is yet another sign of a project that's out of control.
The other greatest risk, according to Work’s report, is that there could be “functionality gaps or coding errors” in the basic [!!] exchange IT systems. And there will be little time to fix them.
Shorter: "Could be buggy and could suck!"
Solutions reported on March 27 on a variety of tech troubles that could hobble the health exchange. Fontneau and communications consultants declined repeated requests for interviews on the problems. Asked Monday if she wished to talk about how the exchange is handling technology challenges, Fontneau said: “No comment.”
Still another sign that a project is out of control: The political appointee running it clams up and won't talk to the press.
Exchange managers also declined repeated interview requests on Monday and Tuesday to explain the new decision to shift technology plans at such a late date. The exchange board did not vote on this decision.
None of the other managers want to talk either. The board is confused. Oh, man, this is so bad.
Despite the fact that the health exchange is a public entity that is spending tens of millions of taxpayer dollars and must be responsive to the public, exchange managers are now refusing to conduct interviews about exchange operations with Solutions and will only answer questions in writing.
In a written response [ha ha] from communications consultant George Merritt, managers said that: “COHBE (the Colorado exchange), HCPF (state Medicaid managers) and OIT (Colorado’s Office of Information Technology) collectively decided earlier this year for COHBE to build the portion of the eligibility system related to access to new federal financial assistance to reduce the cost of health insurance and for HCPF to build the system that determines eligibility for Medicaid and CHP+.
"Collectively decided" is rich. I thought they were paying Fontneau to be an executive?
“This plan is on the back end, does not affect the customer experience and will not cost more. Customers will still apply (sic) be able to apply for coverage through COHBE or through PEAK (the state benefits system) and our systems will share information. This plan creates a path to a successful launch in October that best serves Colorado consumers,” Merritt wrote.
I can't see how this can be. The back end drives the front end. The front end cannot create information that is not anywhere to be had. If there were a single system for determining eligibility on the back end, there would be a single user experience on the front end. As it is, there are two systems on the back end, and it can only be the user who chooses between them, since otherwise they would have been able to integrate the eligibility systems. (Imagine the difference between a web site where is asked "Please fill out this form," and then the site directs them to Gold, Silver, Loser, or Total Loser, depending on the answers, and a site that asks: "To choose your plan, please click on the [Gold, Silver, Loser] button, or the [Total Loser] button." Only the computer knows which button you should click, but it is asking you...
State Medicaid managers also said consumers [citizens] should not be affected by the change.
“The engine decision will not impact clients [citizens] as both the exchange and Medicaid will have a ‘no wrong door’ approach so that no matter which system a client chooses to use, they will be able to apply for benefits,” Rachel Reiter, communications manager for HCPF said in a written statement.
Again, I can't see how this can be. Leave aside the issue that having two separate eligibility systems destroys trust in both. Leave aside that if Reiter is correct, and there is a seamless user experience, the citizen won't know which system determined their eligibility, which isn't going to help them with their appeals or their defense against perjury charges, and won't help the IT people with debugging, either.
How exactly does the "no wrong door" approach work? Remember, ordering health insurance online is supposed to be as easy as buying an airline ticket. So imagine you've bought a ticket for $500 (that's your income) but you don't know if that gets you a ticket in Business Class (that's Gold, Silver, Loser) or a Cattle Car (Total Loser). So you're the optimistic type, you figure Business Class, pick your wine list, the thread count on the sheets for your reclining bed, the gender of your personal steward(ess), etc., and then come to the end of the process, and the Business Class eligibility engine says "I'm sorry. $500 means you're not eligible for Business Class. Please start over with Cattle Car." Or you're the pessimistic type, wade through the 28 pages of Cattle Car, bemoaning the lack of pore cleansers and hot towel massages, get to the end, and then the Cattle Car eligibility engine says "I'm sorry. $500 means you're eligible for Business Class. Would you like to fracking start over?" Or whatever. What I'm saying: At some point, trying to wrap a single application process around two separate and unintegrated eligibility engines is bound to create a conflicted and inefficient user experience.
Oh, and one more thing:
While outside analysts say the federal data services hub — with which exchanges must communicate in real time to determine if customers are citizens and eligible for federal subsidies — is only 40 percent complete, Work’s report said there’s been “significant improvement” on the hub. She expects to begin testing with the hub by May.
So, does that mean that Sibelius was lying when she said the Federal data hub was "built and paid for"? Inquiring minds want to know!
NOTE * Yes, as a long-time single payer advocate, I would say that. But a clusterfuck is a clusterfuck!
NOTE Slipping milestones is also a sign of a project that's out of control. Denver Business Journal, December 8, 2012:
Benchmarks for 2013: COHBE officials will begin testing the exchange early in the year and expect to make the last major changes to it by March or April. Internal pilots will begin in June, and the major public outreach will occur during summer. By September, Fontneau believes it will be ready.
Well, they aren't making the last major changes by March or April. They're starting a major subsystem from square 1.