Issues with Deployment of Healthcare.gov

Richard Garling

2/25/2018

 

 

Abstract

Why Healthcare.gov Project Was So Important

Healthcare.gov provided and facilitated access for individuals and small businesses to purchase private health insurance plans, and signing up for Medicaid. The site allowed users to do comparison shopping to find an insurance policy that fit their needs, while also determining if they qualified for assistance in paying for the policy. The purpose of healthcare.gov was to allow for easy implementation of the healthcare goals outlined in the law. The main goals of the law were to provide adequate health care at a much lower cost. It was to allow for greater participation by the individual in the decision-making process of their care. It required medical care professionals to keep accurate electronic records of their patients and to strive for the goal of providing preventive, rather than reactive, care. It was thought that preventive care would lower the overall cost of healthcare nationwide (ACA, 2018). This paper examines what went wrong and what could have been done to prevent the problems that occurred in deploying healthcare.gov.

 

Key Risk Factors in Implementing Healthcare.gov

One key risk factor in this project involved the number of users that would be accessing the system simultaneously. The question to answer would be how to ensure the system was capable of handling large numbers of users at the same time. How should the team mitigate for the potential of one million users hitting on the system all at once? Stress tests on the system should be part of the solution. One of the main issues the site encountered was becoming overwhelmed with the number of users that tried to use the site at the same time. The original estimations were that only one percent of interested users could access the system the first week of operation.

A second risk involved the number of teams used to develop the site and the lack of one person responsible for the oversite of the entire project. One of the reasons for a Project Manager is to ensure that all of the work streams in a project come together into the final approved product or process that deems the project a success. Many a project fails due to either the lack of or the incompetence of a single authoritative manager at the helm.

Factors Responsible for Implementing Healthcare.gov

The first major problem with the project as a whole was the lack of one manager, a project manager, in charge and responsible for the overall project. A project manager is responsible for planning and executing the whole project. Project managers see the whole picture. They ensure the many moving pieces are brought together to create the whole. Healthcare.gov was doomed from the start because there was no Project manager to communicate and ensure everyone involved understood what their part was and how it fit into the overall project plan (Gido, 2012).

The second major problem dealt with underestimating the number of people who would be using the system simultaneously. Initial estimations were that approximately 50,000 – 60,000 would visit the site. What the site got in visitors was five times as many. Due to the lack of a project manager, stress tests would not occur until the day before deployment. These tests showed the system could only handle less than eleven hundred simultaneous users. Had there been a Project manager, the team would hopefully know that regression and stress tests are run months before deploying any application or website.

The site required users to create an account before they would be allowed to use the features offered. Users had to input personal information, which likely took time thus causing huge amounts of bandwidth used simultaneously. The system required people to submit personal information that was utilized by several independent systems. Should any of these systems fail, it would cause the whole system to fail as it would block users from using the system. A regression test would have determined these problems early on, but there was no one person to keep track of these tasks (Fleming, 2003).

Economic, Political, and Social Impacts

Obamacare was a significant change in the way people purchased medical insurance. It guaranteed minimum coverage, no consideration of pre-existing conditions, and insurance companies could not drop insured customers so long as they paid the premium. Coverage was 100%. Politically, this was a game changer from previous coverage. Before Obamacare, an individual’s pre-existing conditions were a major consideration in providing insurance. An insured person could be dropped from coverage if the insurance company decided that person was too costly. And the insurance could refuse to cover an individual considered high risk; in other words, the insurance company could refuse to cover you if they thought you would cost them too much money (ACA, 2018).

Healthcare.gov was supposed to provide an easy online means in which to shop for coverage provided in your state. It was supposed to allow the user to compare insurance policies, determine if the individual qualified for subsidy’s to help cover the costs of the premium or determine if the individual qualified for Medicaid.

From the beginning, only one political party supported Obamacare. The opposing party was looking for any excuse to point out why Obamacare was wrong for the nation. Healthcare.gov’s failed launch gave the opposition plenty of fodder in which to highlight Obamacare’s failure.

Steps Needed to Prevent Negative Outcome in Project.

First and foremost, the whole project needed to have a Project Manager assigned from the start of the project. A Project Manager is responsible for overseeing the entire project from planning to closing. A Project Manager would have maintained communication with all the various teams and the stakeholders. A Project manager would have managed the plan, informed the various work streams of work that needed completion and when it was due. These work streams would have been reporting to the Project manager the status of the work they were doing. Decisions could have been made when timelines were not met. Tasks would have been planned and executed in order ensuring completion of each task on time, within scope, and budget (Campbell, 2012).

Three (3) Methods Used in Helping Managers Select Information Systems Projects

An organization has many factors to consider when determining which projects to pursue and fund. The first method used to determine the viability of a project is to determine if it fits into the organization's strategic plan.The strategic plan defines the direction an organization is going to accomplish its mission. The strategic plan will be used to help identify the projects that will deliver the most business value. An information systems plan is developed from the strategic plan. An information systems plan that supports the overall strategic plan is used to determine project viability. An information systems plan contains the key factors needed to make decisions including hardware, software, personnel, training, and budgets. Both of these plans will serve as road maps to choosing the most effective projects for the organization. Each of these plans can use key performance indicators (KPI’s) that provide accurate hard information which supports the decision-making process.

Two Major Types of Planning and Control Tools

Gantt charts and PERT charts are two commonly used methods in which to plan and control projects. Both forms of planning are available in many project software applications, such as Microsoft Project.

Gantt charts list project tasks start and finish times and visually represents them in a table format and a bar-graph showing a horizontal bar representing the duration of that task. One issue with Gantt charts is that while they show the various tasks needed to complete the project, they do not show dependencies very well.

Program Evaluation and Review Technique (PERT) was developed by the U.S. Navy during the 1950’s to manage the Polaris Submarine missile program and was subsequently adopted by many industries to manage their internal projects. PERT portrays a project as a series of rectangles and circles called nodes. Each node shows the name of the task, duration, start and finish times, and is numbered. An arrow goes from one node to the next node to show sequencing and dependencies (Laudon & Laudon, 2016).

While each method is used extensively in the project, PERT is considered the more detailed of the two. PERT graphically displays the various tasks showing the sequence of events and the dependency of the task on the completion of the prior task. Showing the sequence and dependencies allows the Project Manager to make decisions concerning the assignment of resources, where and when they are needed to ensure completion at the right time. PERT also shows the Project Manager where the critical path is in their project (Archibald, 1966).

 

Conclusion

Much has been written on the importance of Project Managers role in a project. A Project Manager is the Captain of the ship guiding it along at the helm ensuring the ship is going in the right direction. A prime example of the need for a Project Manager concerned the timing of the stress tests conducted on healthcare.gov. As stated earlier, these tests should have been conducted months before deployment. Problems would have been discovered much earlier that would have prevented the system crashing if more than one thousand people used the system simultaneously. Project Managers know very well that deploying a system that will not work is a guaranteed career killer.

 

 

 

 

 

 

References:

 

Affordable Care Act (ACA) - HealthCare.gov Glossary. (n.d.). Retrieved February 24,

 2018, from https://www.healthcare.gov/glossary/affordable-care-act/

Archibald, R. D., & Villoria, R. L. (1966). Network-based management systems

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Campbell, P. M. (2012). Communications skills for project managers. New York, NY:

          Amacom American Managemen.

Fleming, Q. W. (2003). Project procurement management: Contracting, subcontracting,

          teaming. Tustin, CA: FMC Press.

Gido, J., & Clements, J. P. (2012). Successful project management. Australia [etc.:

          South-Western Cengage Learning.

Laudon, K. C., & Laudon, J. P. (2016). Management information systems: Managing the

          digital firm (14th ed.). Boston, MA: Pearson Education, Inc.