Accenture 'confident' about open enrollment

The launch of HealthCare.gov in October 2013 was the stuff of a federal IT contractor's nightmares: grindingly slow systems, long wait times, unexplained errors and heated congressional hearings. The second open-enrollment period kicks off Nov. 15, and Accenture, the lead contractor on a key public-facing piece of HealthCare.gov, is expecting things to go more smoothly this time.

Accenture wasn't on the job when HealthCare.gov launched. Its part in the story begins last November, when Dan Kane, head of procurement at the Centers for Medicare and Medicaid Services, invited the firm to participate in a limited and necessarily abbreviated procurement to take over from CGI Federal as the lead on the Federally Facilitated Marketplace -- the public-facing portal for insurance shopping in the 36 states that don't have their own exchanges and a back-end system that connects applicants with carriers and processes financial transactions.

Accenture won the contract. Matt Tait, the project lead for Accenture, remembers that officials signed the contract on a Saturday and started work the following Monday, on Jan. 13. Tait told FCW that over the next six weeks, Accenture brought in 500 people to manage the transition, developed a governance model and workflow, and conducted 450 "knowledge transition sessions" to get his team up to speed on outstanding issues.

In late February, "earlier than we ever thought possible," Tait said, Accenture developers started implementing code changes. By March 1, in the midst of open-enrollment season, Accenture was leading an around-the-clock operation that runs the marketplace application.

It gave Accenture the "ability to move at speed," said David Moskovitz, chief executive of Accenture Federal Services.

In one room, cross-functional teams of developers, testers, business analysts, exchange experts from industry and CMS, and others developed requirements. Audio recordings of those meetings would be fed to another team preparing data flow diagrams and other documentation in time for the next day's scrum sessions, Moskovitz said.

Accenture immediately began working on problems that were blocking users from navigating through the system. But a lot of the work was focused on the upcoming open enrollment, especially getting the back-end business systems ready.

As CMS Deputy CIO Henry Chao revealed in a congressional hearing last October, those systems were not built in time for the website's launch, and their delay has meant that insurance issuers had to find manual workarounds for a variety of functions, most notably risk adjustment and reinsurance calculations that were designed to protect carriers in the early years of the program.

Some of those functions are being rolled out for the current open-enrollment season, and Tait said Accenture is especially proud of the "edge solution," which allows big carriers to run the software on their own servers while smaller operations can access the system via the Amazon cloud.

Insurance carriers also use the system to manage plans and determine which ones meet the health care law's coverage requirements. Accenture re-architected the plan-submission process and automated a reporting function that alerts insurance carriers to potential problems. That automation helped increase the number of plans available via HealthCare.gov by 33 percent, according to Tait.

Insurers are still concerned about communication issues in those back-end systems, including notification when customers switch plans or providers, according to a recent article in the Philadelphia Inquirer.

In addition, the Small Business Health Options Program Marketplace is due to launch with the open-enrollment period that begins Nov. 15. SHOP allows businesses with 50 or fewer employees to offer health insurance premium support for their workers, with some businesses qualifying for tax credits. The SHOP tools are being tested in Illinois, Ohio, Missouri, New Jersey and Delaware. Tait said the interface has the same look and feel as the Federally Facilitated Marketplace.

The New York Times reported that some bugs have been found in the SHOP system, but federal officials say the problems are being fixed.

Accenture declined to comment on the ongoing testing process, referring questions to CMS.

"Based on what we know today -- and we're focused on this every day -- we're making good progress to ensure we're ready for a successful second open enrollment," CMS spokesman Aaron Albright told FCW.

Accenture officials also expect things to go well when the virtual doors of HealthCare.gov open for the second open-enrollment season. "I think we're confident about what's going to happen," Moskovitz said. "We also acknowledge that there are going to be challenges and bumps in the road. The complexity of this ecosystem is not going away."

Accenture's contract was extended through July 2015 while CMS works through the process of awarding a new contract for the Federally Facilitated Marketplace. Moskovitz wouldn't comment on an open procurement but said, "We are enjoying the partnership we have with CMS."

CMS expects to award a new contract in February 2015.