HealthCare.gov contractor had high confidence but low success

At 9 a.m. on Aug. 22, a team of federal health officials sat down in a Baltimore conference room with at least a dozen employees of CGI Federal, the company with the main contract to build the online federal health insurance marketplace. For six weeks, the federal officials overseeing the project had become increasingly worried that CGI was missing deadlines, understaffing the work and overstating its progress.

As the meeting began, one of the officials reminded the CGI employees that HealthCare.gov was “the president’s number one priority,” assured them that the discussion would be a “blame-free zone,” and then bored in. “We must be honest and open with each other,” the official said, according to documents obtained from participants in the session. “I have to know what I don’t know.”

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The top CGI executive in the room sounded contrite. “We recognize we have to build trust back . . . ” said Cheryl Campbell, the company’s senior vice president in charge of the project.

For that day and the next, CGI staff huddled with government officials in the semicircular conference room at the headquarters of the federal Centers for Medicare and Medicaid Services (CMS), the agency overseeing the project. They combed through 15 pages of spreadsheets they had brought, which spelled out the company’s level of confidence — high, medium or low — that individual components would be ready.

By the time HealthCare.gov launched 51/2 weeks later, many of those predictions proved wrong, according to internal documents obtained by The Washington Post and officials familiar with the project.

A final “pre-flight checklist” before the Web site’s Oct. 1 opening, compiled a week before by CMS, shows that 41 of 91 separate functions that CGI was responsible for finishing by the launch were still not working.

And a spreadsheet produced by CGI, dated the day of the launch, shows that the company acknowledged about 30 defects on features scheduled to have been working already, including five that it classified as “critical.” For instance, one critical defect was that people who had finished creating applications — an early step in enrolling — got incorrect messages that their applications were incomplete if they tried to sign back in.

All told, of the 45 items in which CGI had expressed high confidence at the late August meeting in Baltimore, most were still not ready by the time consumers were supposed to be able to start to buy health plans online through the federal marketplace, according to a government official familiar with the project who spoke on the condition of anonymity to discuss private information.

During those crucial final weeks before the marketplace opened, the official said, CGI often delivered components on time, but they contained such faulty computer code that features did not hold up under closer scrutiny — or failed later if more than several thousand people at a time tried to use them. These included essential but arcane parts of the Web site, as well as facets that have attracted substantial public and congressional attention, such as a feature — still not working — that was supposed to let insurance-seekers browse the health plans available to them without first registering for an online account.

Asked to discuss its performance, a CGI spokeswoman referred to a statement the company’s president and chief executive, Michael E. Roach, made during an “earnings call” earlier this month: “As is our practice, we honor our confidentiality agreements with customers and, accordingly, we do not discuss individual contracts on analyst calls or any public forum.”

The statement said that the company is “continuing to work in close partnership” with CMS and another IT company, QSSI, which the Obama administration last month put in charge of overseeing fixes to the Web site. “Our partnership is collaborative, and we are focused on an successful outcome.”

When pressed again for comment, the company declined, citing its contractual obligations with the government. The Post initially gave the company until noon Saturday to comment, but decided to proceed with publication after a similar description of the late August meeting was reported elsewhere. The company was offered another chance to comment late Friday night but declined again.

In the eight weeks since the opening of the federal insurance exchange — a launch that White House officials have acknowledged was “disastrous” — government employees and contractors, including CGI, have been scrambling to fix the site. Health officials have emphasized pieces of progress — including doubling the number of people who can use it at once before it malfunctions — but there is no known tally of the percentage of flaws that have been corrected.

During the past two months, it has become evident that no single reason explains why HealthCare.gov, a top administration priority, was not ready 31/2 years after President Obama signed a sprawling law designed to reshape the U.S. health-care system. Work to build the online marketplace was hindered, in part, by White House micromanagement and political sensitivities that delayed policy and regulatory decisions, fierce Republican opposition to the law, and the fact that no one at the CMS or elsewhere at Department of Health and Human Services, of which the agency is a part, had the job of managing the project full time.

But the documents and interviews make clear that CGI, by far the most central of about four dozen companies with contracts to help build the exchange, made repeated missteps. The government’s contract with CGI was $197 million as of August.

A spokeswoman for CMS said that the agency had engaged in “hundreds of operationally focused planning conversations” to prepare for the launch of online enrollment on Oct. 1. The spokeswoman, Patti Unruh, said that the agency postponed some aspects of the project when it became clear that not all of the system could be ready on time.

The Obama administration has set a Nov. 30 deadline — next Saturday — by which officials have promised that HealthCare.gov will work smoothly for about four out of five consumers who attempt to use it to sign up for health plans. Even now, the official familiar with the project said, CGI’s work on the repairs is not always going well; roughly one-third to half the new computer code the company is writing cannot be used because it is revealing flaws when it is fully examined by a group of outside testers, including some insurance companies.

HealthCare.gov was intended to be the main method used by a group of consumers in 36 states to get health insurance. The federal exchange, and similar ones just opened by 14 states, are designed to provide health plans to people who can’t get affordable insurance through their jobs or for small businesses. The coverage is to become available starting Jan. 1.

CGI officials and other contractors have said previously that their work was delayed at times because the Obama administration was slow to make decisions — such as the minimum coverage standards for health plans sold through the exchanges — that IT workers needed to know how to build the Web site.

Inside CMS, a dawning awareness of CGI’s performance can be glimpsed in a series of e-mails starting in early July among agency employees working on the project. The e-mails have been made public by House committees, led by Republican opponents of the law, that are investigating the bungled rollout.

On Monday, July 8, a CMS technology adviser named Jeffrey Grant fired off an e-mail titled “IT support” to two colleagues at 3:15 p.m., warning, with respect to a vital part of the project, “our entire build is in jeopardy” because he had just learned from colleagues that CGI had fewer people working on the Web site’s construction than government officials had been led to believe. Grant was referring to the Web site’s financial management system, which handles payments of government subsidies to insurers; he said it “appears to be way off track and getting worse.”

About three hours later, Henry Chao, the agency’s deputy information officer, pivoted and wrote to a group of CGI employees: “Can you get me a response on this to refute what Jeff is saying?” By later that month, Chao’s tone had become more exasperated. At 9:51 p.m. on July 29, he wrote to a group of CGI and CMS employees: “We are in bad shape. Perhaps worse than ever before and we are not even touching the hard stuff yet.”

Between early July and the large session in Baltimore on Aug. 22 and 23, CMS officials had at least two dozen conversations with the contractors’ staff, prodding them to improve their work.

Unruh, the CMS spokeswoman, said that the two-day meeting “was part of the ongoing discussion. . . . This was a complex project with a short timeline.”

By the time Campbell and CGI employees drove from their Herndon offices to CMS’s Baltimore headquarters, the agency’s staff had decided it had no choice but to try to find out exactly how far along the contractor was, and set priorities for having less done by the launch date than anyone had hoped. Toward the start of the meeting, one official asked the CGI team point-blank: “How much of the function is developed? How much is left to develop? How much of the function’s requirements will be met? How sound is the development?” according to documents from the session.

CGI’s rankings of high, medium and low were only for parts of the insurance exchange that, at that point, were supposed to be ready by Oct. 1. The two spreadsheets they presented show that, for each item, CGI employees had written a date when they said it would be built and tested enough by the company that it was ready to be evaluated by outsiders. During the meeting, CGI employees acknowledged that they considered an item ready for outside testing if the computer code for it was 75 percent ready, documents show.

Of 95 elements that CGI evaluated, employees said they had high confidence in 45 of them. Of the 45, 16 of the high ratings were for SHOP, the part of the exchange to sell health plans to small businesses — a function where further testing found that it worked so poorly that it is still not yet available.

The “anonymous shopping” feature — in which consumers were to be able to browse health plans without creating an account — also was rated as a high-confidence item. It never made it onto the “pre-flight” assessment because, by then, government officials had decided that it was too flawed to offer at the outset.

A senior administration official, who asked not to be identified because of the sensitivity of the matter, said he was not aware of any indication the “pre-flight” review ever reached the White House.

CMS Administrator Marilyn Tavenner has publicly said that delays by CGI have been a hindrance, including the financial management system that processes payments to insurers. “We’ve had some issues with timing of delivery,” Tavenner told the House Ways and Means Committee on Oct. 29, explaining under questioning that CGI handled that aspect of the project.

“So it’s the contractor, in that instance, that’s not meeting expectations?” asked Rep. Jim Gerlach (R-Pa.).

“Yes,” Tavenner replied. “But we’re working with them.”

The internal view of what went wrong contrasts with public statements by Campbell, the senior vice president. In written testimony for an Oct. 24 appearance before the House Energy and Commerce Committee, she said: “CGI Federal delivered the functionality required by CMS to enable qualified individuals to begin enrolling in coverage when initial enrollment began on October 1.”

She testified at the hearing that the company had tested the components of its work. She was not pressed by lawmakers exactly on what those tests had shown — or whether the company had met its predictions of when they would be ready for anyone else to check the work.

 
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