Federal List

5 lessons learned from HealthCare.gov

HealthCare.gov Screenshot, September 2014

The Office of Management and Budget is expanding its oversight of federal IT through the creation of the U.S. Digital Service, led by ex-Google manager and now U.S. Deputy CIO Mikey Dickerson.

Many of the lessons in the Digital Service's new Playbook are drawn directly from the troubled launch of HealthCare.gov:

1. Assign one leader and hold that person accountable. The Centers for Medicare and Medicaid Services acted as integrator for the development of the technology that supported the Affordable Care Act. After the website's failure at launch, former Acting OMB Director Jeff Zients was named to lead the "tech surge" to fix the site and staked his reputation on the effort.

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2. Address the whole experience, from start to finish. HealthCare.gov is a sprawling system with several components that were not properly fitted together and tested before launch. As a result, systems that performed flawlessly when tested in isolation failed miserably once connected and subjected to real-world users.

3. Structure budgets and contracts to support delivery. The definitive inspector general report on contracting and HealthCare.gov has yet to be written, but it's clear that CMS has changed its approach to compensation to incorporate performance requirements. At a congressional hearing in July, CMS Principal Deputy Administrator Andy Slavitt told lawmakers that current contractor Accenture "has skin in the game to make sure they deliver."

4. Use agile, iterative practices. There was no beta launch of HealthCare.gov. It opened wide, and it crashed big. The Playbook advises adopting the agile method of breaking big IT projects into discrete deliverables that can be tested and deployed on a small scale.

5. Deploy in a flexible hosting environment. Although HealthCare.gov launched in a commercial hosting environment, capacity was overtaxed due to heavy use and software problems. Among the early fixes was installing dedicated hardware -- something the Playbook seeks to avoid.

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