Healthcare.gov: A Procurement or Program Problem?

The pundits all seem to be asking, “What went wrong with the rollout of healthcare.gov?” But there is a bigger more substantial question for government. Why does government struggle with large procurements?

That is the questions that Raj Sharma asked in his piece in the Public Spend Forum: Healthcare.gov, A Procurement Problem or a Program Strategy Problem?

Chris Dorobek asked Sharma on the DorobekINSIDER program what went wrong in the rollout of healthcare.gov.

“The procurement part of healthcareg.gov didn’t work. I think more than that we have to step back and if we only couch this as a procurement issue, I think we are missing the boat. This has a lot more to do with how government does large programs,” said Sharma.

What went wrong?

“As is typical for many large government procurements, the requirements change. A lot of times it isn’t the vendor’s fault. So with healthcare.gov the requirements changed midstream. There were some estimates made in terms of what kind of volume would be coming in. Obviously we are all looking through a crystal ball,” said Sharma.

• So the way you typically manage that process is you have a phased roll out and you beta test it. You really allow some of the movers to come on early. But in this case they didn’t stage gate the process. We’ve gone through a full-scale rollout at one time and of course the unexpected happens.

Why does defining outcomes matter?

“If you think about how large government programs come about they really start with a large problem. A large social problem a public problem – in this case that is health care. Then a lot of times policy goals are developed with solutions in mind,” said Sharma.

• For example, the Secure Border Initiative. We already had a solution in mind that we were going to put up a fence as opposed to saying we want to slow the flow of illegal immigrants. So a lot of times the policy goals and the solutions are already preconceived when we are coming up with large programs. They are driven by ideology, special interests, lobbyists.

“The right way to start would be to say, “What is the problem, what are the outcomes we want to achieve?” So in terms of health care, what are we really trying to solve? We are trying to insure all those people that are uninsured. What are different ways of doing that? As we go through that process we are really looking the outcome. Then engage industry and all the different stakeholders. Look at fact based solutions and what works and what doesn’t. That’s really the first step in the process that we should be undertaking. Not developing solutions as policy, but coming up with outcomes and stating the problems clearly,” said Sharma.

What the missing link?

“Once we have developed and articulated what problem we are trying to solve, we really need to link policy goals and whatever sort of legislation we put in place with operational execution. What that means specifically is we need to start engaging the right players early in the process. Not write a book of requirements,” said Sharma.

Broader than procurement

“If we are not really looking at how do we execute these massive programs? Does government have the capability required? What capability does industry have? Now let’s form a plan based on that knowledge and only then can we start thinking about a procurement process,” said Sharma.

Stakeholders

“Obviously in this case the stakeholders are very political. If you don’t get buy-in from key stakeholders they can become a big pain for you. The simple fact is these programs are really complex and you need all the key stakeholders on board. In this case we know we have a very divided country on this. We don’t have everyone signed on. Instead of everyone coming to the table with solutions, you are having more barriers created,” said Sharma.

The more the merrier

“The procurement process is really complex. The barriers to entry are so big that it is hard to get the innovative suppliers in the pipeline, especially in IT. These are in areas where we really need the cutting edge thinking. A lot of the players don’t want to play in this arena. We have to simplify this process overall,” said Sharma.

Accountability
“Overall accountability is another key. We have to start holding everyone accountable. It starts on the government side, are leaders being held accountable? Do we have the right program managers? But then also you have to hold the vendors accountable. When we see a lot of failures we have to make sure we take time to understand them. Hold people responsible so we don’t make these same mistakes over and over again,” said Sharma.