CMS, Healthcare.gov, and a ‘contractor partner’: Here we go again!

So CMS has decided to give a contract to Accenture to ‘maintain’ the healthcare.gov ‘website’ (I found no mention of a competitive bid and award process). The word  ‘website’ is in quotes, because the end-to-end system is much, much more than a website.  The website is only the entry point for millions of users to shop and enter their information.  The rest of the system interfaces with 8 or 9 other government systems for eligibility and subsidy determination; accepts plan information on thousands of plans from hundreds of insurance companies; and makes payments to the insurance companies (presumably matching customers’ payments and the matching government subsidy where there is one).  I’m sure that there is much more, but that will do for this discussion.

According to The New York Times article of a few days ago, CMS and Accenture have not yet agreed on the scope of their work.

http://www.nytimes.com/2014/01/11/us/us-parts-ways-with-contractor-for-troubled-health-website.html?nl=todaysheadlines&emc=edit_th_20140111&_r=0

That also means that neither party knows the price or cost.  History would tell us that the government will attempt to minimize cost as the ‘contractor partner’ tries to maximize price and revenue.  Even if they agree on an ‘initial cost estimate’, as the contractor gets better insight into the system, the team will discover more areas of work to be done.

Here is what I think will happen:

Upon initial examination of the system turned over by the prior contractor Accenture will find a myriad of ‘issues’ with the current architecture.

CMS will acknowledge that there are problems, but tell the contractor to proceed with patching and maintaining while getting ready for the next open enrollment period next year.  After all, they can’t afford or run the risks of another build or re-building and launch effort.

Accenture will put its best and brightest on the job assembled from around the world.  Staffing costs exceed original projections

After about 4 months as the Accenture management and staff better assess the technical challenges, they make another push on government to swap out some of the components for more modern and efficient ones.  CMS relents on some components, holds fast on other key elements that worked well during initial rollout.  Cost of replacement components are high, and the cost of integrating them exceeds original projections

In the summer, in preparation for the 2014 open enrollment season, it becomes clear that performance is still slow, requiring higher speed and more reliable computer and communications equipment.  Costs of acquisition and integration of the new components exceed original projections.

Government attempts to stem the tide of unanticipated cost growth by having serious executive meetings with the contractor’s highest level executives.  The contractor advises the government of all of the residual risks to a successful enrollment season (all contained in monthly progress reports and other documents that the government may not have fully deciphered and appreciated.  Further, the executives inform the government that the firm cannot be held responsible for any negative results unless the government fully implements it’s recommendations.  The costs exceed original projections.

If the Congress hasn’t been paying attention up to this point, with elections on the horizon, there will be hearings.  More that C-SPAN can air.  GAO will have provided the Congressional committees with some version of the above scenario.  Outrage exceeds original projections.

To avoid this or similar scenarios, CMS must end it's misconception that the contractor is a PARTNER (with shared risks, values, money or skin in the game).  The contractor is a contractor seeking to maximize revenue, and make bonuses  The contractor must be managed and controlled by a knowledgable contracting officer and an astute program manager.