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Category: Project Management
Tags: agiledevelopmenthealthcarelaunchsoftware
Entities: Affordable Care Acthealthcare.govPresident ObamaSilicon ValleyStaca RobertsUS Department of Health and Human ServicesUS Digital ServiceYale College
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Hi, my name is Staca Roberts and I'm a senior in Yale College double majoring in the history of science, medicine, and public health and East Asian studies. Today, I'm going to be talking with you about healthcare.gov and some of the
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issues that caused this project to fail upon launch. To start off, let's review some context about healthcare and the Affordable Care Act.
In the United States, healthcare payers fall into at least one of these following categories. Private insurance, which is secured
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individually, employer provided insurance, which is secured through a job. Social safety nets like Medicare and Medicaid, government provided insurance like veterans healthcare, or they pay out-of-pocket fees if they do not have any healthcare plan.
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The Affordable Care Act was a reform act, also known as the ACA, which provides subsidized healthcare insurance to uninsured individuals. A key component of the ACA rollout was healthcare.gov, a marketplace for individuals to purchase healthcare
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insurance. Now, let's watch a short video clip.
Good evening. in the urgent and ongoing effort to fix the roll out of the new federal health care plan website and find out what went wrong with it.
Today,
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the architects of it were called before Congress to explain what happened. They talked about the days and weeks leading up to the big launch and today disclosed the entire system was not tested end to end, as they put it, until two weeks before it was open to the public.
We've
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seen what has happened since. From the video, you can see there was an issue with timing.
Now, let's dive deeper into the timeline for the healthcare.gov project. In 2011, funding was allocated for the project.
In 2013,
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the first set of system requirements was created. And on October 1st, 2013, the product launch.
Now, as you saw in the video, there was virtually no stress testing. The endto-end testing was not done until 2 weeks prior to the launch date.
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There was a focus on completing the components and on the launch date some of the back end was unfinished. Something to remember throughout this presentation is that the timeline was fixed.
There were no changes despite any issues that occurred during the development.
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Now let's discuss software life cycles as it relates to healthcare.gov. As a reminder, on the left we have the waterfall model which is a more traditional sequential model and on the right we have the agile model which is an iterative and more modern model.
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Healthcare.gov uh attempted to implement an agile model but it did not go as planned. Web developers and policy makers have very different mindsets.
The policymakers altered the business and technical requirements constantly and
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the policy requirements were necessary for the technical implementation. So as soon as something was completed, it was often outdated.
The department of health and human services failed to enforce a potentially functioning agile model. There was never any done is done.
The components were
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constantly revisited after they were supposed to have been completed. This led to the desensitization of the web developers.
On launch day, several issues occurred due to the poor timing of the project
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and lack of following a proper process. There were five times the amount of traffic as expected on the first day.
On the first day, there were 250,000 people that tried to log on to healthcare.gov. Out of these 250,000, there were only
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six successful signups. And by the end of October, they were still only 10% of the way towards their goal, having achieved only 26,794 signups.
Now, we will discuss some of the detailed issues based on a report published by the Office of the Inspector
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General of the US Department of Health and Human Services in February of 2016. The cover for this is shown on the right.
Firstly, the agile model made it easier for policymakers to see frequent and late changes as seen in the previous slides.
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There's also a compressed timeline for the technical build. As we saw in the timeline slide, the system requirements were first created in early 2013 and the product was launched in October of 2013.
This only gave about 9 months for the
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website to be developed and the attempts to resolve issues with the site were too little and too late. As shown in the video, the endto-end testing was only done two weeks prior to the website launch.
This was not enough time to resolve the issues with the
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site. And as we saw on the launch fail launch day failure slide, there were several issues on launch.
Another issue was that leadership failed to grasp the poor status of the website and to alter course.
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The contractors also prioritize delivering the product on time over testing and resolving issues. And lastly, healthcare.gov launched on October 1st, 2013 as planned and never seriously considered delay.
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This point is a very important as delaying the project would have given adequate time for testing which was the biggest issue on the healthcare.gov project. Now, let's discuss the aftermath and recovery of healthcare.gov.
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Following the failure of the launch, there were daily meetings between President Obama and the Secretary of Health and Human Services to discuss the website. A Silicon Valley team was called in to rescue the website and there were some important changes in the workplace culture.
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Firstly, there was a shift to a badges culture or a more horizontal structure without leadership chains which was a hindrance in the original development line. They also prioritized quality over
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handing in the product on time which enabled greater testing to be completed. There was also an overall simplified process which aided in the development process the second time around.
Lastly, the Office of Management and Budget established the US Digital
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Service in 2014 to aid in simplifying digital services delivery. Thank you for listening.
I hope you've learned about healthcare.gov and some of the issues that cause that project to fail upon launch. I also hope that you've taken away the importance of planning and organization during big
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software projects. Coding is important, but so is the organization and planning that goes into those projects, too.
Thank you and goodbye.