Assessment of the 10 Project Management Knowledge Areas in Affordable Healthcare Act Insurance Exchange
On March 23rd, 2010, President Obama signed the Affordable Care Act into law, saying it protects “the core principle that everybody should have some basic security when it comes to their health care”. One of the mandates is every state must establish a public Health Insurance Exchange that serves as a competitive marketplace for individuals and small employers to compare health insurance options. The state has a few options:
1. The state can develop a state-based Exchange (SBE) in which the state has full responsibility in running the marketplace.
2. The state can join the Federally-facilitated Exchange (FFE) in which the federal government is responsible for developing the website.
3. The state can partner with the federal government and share responsibility for running the marketplace.
According to the Kaiser Foundation, in 2015, there will be 27 states using the FFE marketplace, known as HealthCare.gov. The purpose of this paper is to exam how the 10 Project Management Knowledge Areas are used and affected in developing the Federally-facilitated Exchange website (HealthCare.gov).
The Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) invest millions of dollars in developing HealthCare.gov. The lack of coordination between the Obama administration, HHS, CMS and contractors caused thousands of defects. Delays and difficulties in using the website have prevented users from enrolling or even just creating an account. Companies with between 50 to 100 full-time workers are exempt from providing employees affordable health insurance by 2016, due to an inadequate development of the insurance marketplace.
To fully define the project scope, the project manager needs to have access to all necessary requirements and measurement of success in order to roll out the plan. However, the Obama administration delayed in finalizing regulations and guidance for the health care reform program. Without clear regulations, contractors, such as CGI Federal, Experian, and Quality Software Services were not able to begin development for a solution. For example, the final rules for health insurance issuers were not finalized until February 27th, 2013, seven months before the website launch date. These regulations include the standard for minimum coverage, recipients for coverage, and the rule for premium insurance, which is essential information in building the website. Furthermore, Obama care legislation is 900 pages long with more than 10,000 pages of regulations. How deep of an understanding does the project manager have and knowing they are heading to the right direction? The lack of defined project scope, evolving priority and constant change in project scope not only provides the team inadequate time frame to develop the deliverables, but also greatly affects the timeline, cost and quality of the project.
The development of the HealthCare.gov is complex. It requires communication across multiple federal, state and private stakeholders to develop a comprehensive approach in planning, organizing and coordinating the project. CMS selected Agile Project Management approach, which they had limited experience in using, to develop the Marketplace. Agile requires close collaboration and commitment among multiple stakeholders. Stakeholders need to work together closely, communicate constantly and make decision frequently. An earlier report from GAO also pointed out fourteen challenges with adapting and applying Agile approach in the federal environment, such as federal reporting practices, traditional artifact review and status tracking does not align with Agile. CMS was hoping to use Agile approach to save money, but it also increased challenges and risks, such as delay and security birch. Since the development of the federal Marketplace is so complex and time restrained, the CMS could use more training, defined requirements and strategic plans if using Agile was necessary. A better-defined guideline on responsibility and reporting relationship would help allow CMS develop better communication coordination among stakeholders. Using tradition waterfall life cycle model would also be suitable to deliver project on time.
The risk associate with implementation the system across multiple stakeholders includes sacrificing the quality and delaying in project timeline. Centers for Medicaid & Medicare Services (CMS) has the full responsibility in building the website, however, the development of information technology system was outsourced to 60 different contractors. In April 2013, McKinsey & Company pointed out there was “no single empowered decision-making authority” across contractors to make critical decisions and to communicate critical milestones in order to complete the project. The lack of centralized leadership