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The Price of Not Starting Right: The Affordable Care Act Project

The Price of Not Starting Right: The Affordable Care Act ProjectThe Paid Protection and Affordable Care Act (PPACA a.k.a. Obamacare) political pinball is sure to bounce around for some time, focused mainly on the "who" and "why" behind what happened to the system and its web portal, and doing some damage to various reputations in and out of government.

Peel back that layer of the situation, however, and we can see that the “what,” “how,” and “when” of the problems could have some valuable — and apolitical — lessons for major government systems efforts … a cautionary tale might be a better word.

I have attempted below to sift the public testimony and reporting to find and explore some of those lessons. What I found applies across party and policy lines, growing instead from the relationships among government agencies, contracting communities and legislatures.

The “How” - Contracting

It’s an oft-ignored truism that in government, how a project is contracted will impact its chances for success. Over time, governments, especially federal, have instituted laws and regulations aimed at providing contracting approaches that minimize abuse. To some extent this has worked but at the cost of often rigid regulations that can seriously compromise contracting efforts, especially if the vehicle chosen isn't appropriate for the nature of the effort being contemplated.

So, it appears with the PPACA system, apparently procured using a vehicle called the IDIQ or “Indefinite Delivery/Indefinite Quantity.” IDIQ, similar to the GSA “Multiple Award Schedule” contract, was designed to shorten and simplify situations where the contractor and buying agency have an existing relationship. Rather than start from scratch each time a new requirement appears — usually taking many months — an agency, having pre-certified a number of contractors, merely issues a task order contract to one or more of them under the IDIQ and immediately moves ahead.

The reporting and testimony about PPACA suggests that the involved contracts took the form of task orders under an existing Health and Human Services department IDIQ contract on which 16 contractors had been pre-certified. This fact alone suggests that there was probably no true competition among the hundreds of contractors and expertise available in the marketplace. Instead, the government apparently requested bids from some of the certified contractors — four of the 16, according to news reports — and chose the one they thought most appropriate — or best connected — calling that process “competition.” It was, as we now know, anything but.

Unfortunately, the IDIQ also assumes that the buying agency will conduct the necessary diligence to select a contractor fully capable of doing the particular job at hand. As you might imagine, this doesn't always happen and in the case of the PPACA effort, it appears to have failed almost completely. The apparent “lead” contractor for this project, although certified by HHS and CMS, had a less than stellar record in complex, web-centric transaction support efforts of the type required for the PPACA. From that start, without careful attention to the organization and management of the effort, all manner of problems could arise … as they have.

IDIQ contracts as well, per the Federal Acquisition Regulations, are exempt from protest, closing off the process by which losing or ignored competitors may question an award. Further, if the contract is of the “time and materials” type popular in the IDIQ community, meaning that the government is buying hours and materials with no guarantee of a particular successful outcome, the already tenuous legal link between payment and performance is virtually eliminated.

The “What and When” - Planning and Approach

Another truism in the automation world holds that with sufficient technology, the effort will go acceptably well, and failure must be due to a lack of technology. That same implicit assumption also holds that most problems can be solved if enough additional technology is brought to bear. Neither is true if the technology is built and deployed on a faulty design. Indeed, it is usually not the technology that fails but the way it is deployed and the assumptions made about how and how well it will work in the particular setting for which it is intended.

Another sad fact is that in the case of faulty design, loading on a ton of additional technology without a serious redesign effort, as reports suggest is being done with the PPACA system, is often like putting more cargo weight on a sinking ship.

 

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