HealthCare.gov is an imperfect website sitting on a series of imperfect databases. Commissioned by the government and built by contractors, it is currently underperforming because no one took responsibility to ensure that the resulting product was stable and sound before it was introduced.
The lesson to take away from this exercise in technological solutionism is not that health care reform is an exercise in futility, despite the latest flurry of outrage distracting attention from the noble goal of insuring all Americans. It is that grand solutions set an unusually high bar for flawless coordination and execution.
In his groundbreaking 2009 New Yorker article on soaring health care costs, Dr. Atul Gawande wrote:
Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later?
Gawande perfectly framed the problem facing HealthCare.gov and the administration's efforts to achieve healthcare reform on a grand scale: the coordination of the work is far more important to long-term success than the capabilities of individual contributors.
Fifty-five companies were contracted to work on HealthCare.gov, earning somewhere between $170 and $300 million; they were joined by the innumerable federal employees staffing the project. There were inputs, outputs, meetings, TPS reports and large doses of optimism that the site would favorably compare to Travelocity. It was a coordination and execution nightmare.
Several contractors testified to the House Energy and Commerce Committee on October 23 that the site was not adequately tested before its launch, pointing to a lack of coordination that is at the heart of the site's current problems.
The excuse provided by the contractors, that they "tested their own components independently but that the Health and Human Services Department was responsible for testing the whole system," echoed Gawande's notion of individual contributors each making their own decision about what was right for HealthCare.gov. Everyone was siloed in their own little worlds, trying to do their jobs, earn their fees and stay in their respective lanes. There was no general contractor overseeing the process and demanding final accountability.
It is troubling not just that there was no coordination in testing, but also that the launch of HealthCare.gov was so poorly executed. Decision-makers in the administration were looking so far down the road that they failed to focus on getting the system right the first time.
What does this mean? It's too early for a post-mortem, and HealthCare.gov may yet prove a success with time. But here are two lessons to help grand solutions succeed:
Go small when you think big. Fifty-five contractors is not a team, it's a diaspora of interests. This is a significant problem, especially when CGI Federal, the lead contractor, claims it was not expected to act as an integrator. Build a smaller team and ask each contributor to play a bigger role.
There are many companies today that are horizontally integrating in order to meet a more diverse set of requirements. Take advantage of that trend. Chasing after capabilities housed in different companies in order to get the very best does not work in grand solutions. Rely on a smaller number of trusted partners to step beyond their boundaries, and invest the time to coordinate their collective efforts to ensure the team is more effective than the sum of its contributors.
Delay is possible. In a properly coordinated team, the contractors' concerns about testing would have been aired early and often, and, most importantly, would have been heeded. Testifying before the House Ways and Means Committee on Tuesday, Marilyn Tavenner, head of the Centers for Medicare and Medicaid, acknowledged that the administration failed Americans in its initial rollout of the website. The administration did not want to delay for fear of providing fodder for Republicans in the short term, but HealthCare.gov would be much more popular today if its launch had been postponed temporarily to ensure the existence of a fully functional platform.
The administration has now selected QSSI, one of the 55 companies already involved, to fix HealthCare.gov. This is a chance to atone for the sins of the initial flawed process. For HealthCare.gov to survive into 2014, the administration and QSSI must work together to play the role of Gawande's general contractor, ensuring that all of the pieces of HealthCare.gov fit together. If QSSSI ultimately needs eight weeks instead of the projected five weeks, take the time. Get it right. There will not be a third chance to introduce America to this grand solution.
Brian Wagner is a Vice President at McBee|Gibraltar, the strategic communications solution within McBee Strategic Consulting.