The Washington Post

Private consultants warned of risks before HealthCare.gov’s Oct. 1 launch

The Obama administration brought in a private consulting team to independently assess how the federal online health insurance enrollment system was developing, according to a newly disclosed document, and in late March received a clear warning that its Oct. 1 launch was fraught with risks.

The analysis by McKinsey & Co. foreshadowed many of the problems that have dogged HealthCare.gov since its rollout, including the facts that the call-in centers would not work properly if the online system was malfunctioning and that insufficient testing would make it difficult to fix problems after the launch.

The report was provided to The Washington Post by the House Energy and Commerce Committee.

This risk assessment, which was encapsulated in a 14-slide presentation, was delivered to senior White House and Department of Health and Human Services officials in four briefings between March 28 and April 8, the committee said.

HHS Secretary Kathleen Sebelius; Marilyn Tavenner, then acting administrator of the Centers for Medicare & Medicaid Services (CMS); and White House Chief Technology Officer Todd Park attended a session about the report on April 4 at HHS headquarters. Obama health policy adviser Jeanne Lambrew and then-White House Deputy Chief of Staff Mark Childress received a briefing April 8 at the White House.

ACA enrollment numbers, state-by-state

Rep. Tim Murphy (R-Pa.), who chairs the panel’s subcommittee on oversight and investigations, said the presentation suggests that, in the run-up to its fall debut, the enrollment system was more troubled than administration officials have let on.

“Despite assurances from Secretary Sebelius, Marilyn Tavenner and [CMS official] Gary Cohen that all was well and on track with the launch of the Affordable Care Act, we now have documents dating back to April that call into question the assertions made to this committee,” Murphy said.

The CMS said in a statement that the McKinsey assessment was “part of a standard process to identify potential risks and develop mitigating strategies.” It added that “the review was completed six months before the beginning of open enrollment, was in line with industry best practices and was followed by concrete action to address potential risks — as was intended.”

White House spokesman Eric Schultz said “flags were definitely raised throughout the development of the Web site, as would be the case for any IT project this complex. . . . But nobody anticipated the size and scope of the problems we experienced once the site launched.”

Administration officials noted that the assessment was not a technical review of the Web site’s functionality. They said a number of the recommendations were acted upon, including stepping up communication with states and funneling more resources to in-person helpers and the call center.

The document did not predict whether the project’s problematic design stage would hamper its rollout but instead made it clear that programs of this scale are ideally pursued in a more orderly process, with “significant testing and revision” before they launch.

Some of the concerns raised did not come to pass. For example, the report cited the “data hub” — the massive network that connects federal, state and insurer databases — as a vulnerability. Officials say the data hub has been working well since the launch.

In addition, the report warned of long call-center wait times. Wait times were down to two minutes a few days after the launch, and they are now just seconds.

But with many of the project’s shortcomings now glaringly obvious, the report appears prescient in other respects.

One slide notes that the policy and requirements of a program are best defined at the outset, leaving sufficient time for testing and revision. By contrast, McKinsey noted, the federal marketplace’s design was marked by “evolving requirements” that shifted throughout the design phase, leaving scant time to test the system before its launch.

It also warned that the federal government largely depended on contractors to construct the marketplace, and that it lacked an overall “end-to-end operational view” of the system to ensure that its different parts worked well together.

Federal officials asked McKinsey to lay out how the consumer experience was likely to unfold over the first year based on the existing trajectory of the project and to identify things that might go wrong. The firm reviewed more than 200 documents and sources, and interviewed about 40 people across a variety of federal agencies, but did not talk to insurers or study computer code.

McKinsey — which declined to comment Monday, citing client confidentiality — did not assess whether the administration should have delayed the Oct. 1 launch.

Its presentation noted that federal officials were trying to fix the problems stemming from the botched design process. “CMS has been working to mitigate challenges resulting from program characteristics,” it says in bold.

The consulting firm suggested that some of the project’s troubles occurred because there was “no single empowered decision-making authority,” or person in charge, who could make changes or define what constituted success.

One industry source close to the project, who spoke on the condition of anonymity to discuss the matter frankly, said this lack of an overarching project leader complicated the system’s development because contractors received “absolutely conflicting direction between the various entities within CMS.”

McKinsey suggested some ways to mitigate the risk, including creating a “version 1.0” that was fully tested before the project was finished and assigning a single leader to oversee its implementation. It urged federal officials to set “shared metrics for success” on April 12, more than five months before the rollout.

The administration did not develop metrics to evaluate the site’s performance until late October, The Post reported Sunday.

The Web site has been performing better over the past 11 / 2 weeks, but significant glitches remain.

Juliet Eilperin is The Washington Post's White House bureau chief, covering domestic and foreign policy as well as the culture of 1600 Pennsylvania Avenue. She is the author of two books—one on sharks, and another on Congress, not to be confused with each other—and has worked for the Post since 1998.
Sandhya Somashekhar is the social change reporter for the Washington Post.

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