25 Years Of Health IT: A Complicated Journey

The Nov. 15 start of open enrollment at HealthCare.gov ought to be a much happier day than was Oct. 1, 2013, when the website launched and immediately crashed, for months afterwards proving unreliable and user-unfriendly to the consumers (and voters) who were supposed to be helped by the Affordable Care Act.

Not only is the site now much more reliable and easier to use, but it will be returning with 33% more insurance plans offered, providing much better consumer choice, according to Accenture, which provided a preview briefing for a handful of media outlets. "We believe we have a clear path to be successful," said David Moskovitz, chief executive of Accenture Federal Services.

Accenture took over the management of the HealthCare.gov website and back-end systems in January, under contract with the Centers for Medicare and Medicaid Service, the division of the US Department of Health and Human Services that is overseeing the implementation of the ACA.

[Read about the big Defense EHR choice that's coming: DoD EHR Contract: Open Source Vs. Commercial.]

Most of the bragging rights for turning around HealthCare.gov, which wound up working fairly well by early 2014, went to a tiger team of Silicon Valley technologists who reengineered the system on the fly, making it function more like an e-commerce website. The White House later tried to institutionalize the lessons learned with the formation of the US Digital Service under the leadership of HealthCare.gov project leader Mikey Dickerson. Accenture came into the picture after that crisis management exercise was over, taking charge of the day-to-day management of the online systems from CGI Federal, the original contractor.

Dickerson and his cohorts "came into this in October/November [2013] and made a lot of progress," said Matt Tait, the Accenture managing director and project manager. "Our job was to continue the journey."

Moskovitz said Accenture still faced a steep challenge when it began work and was charged with taking over the massive project in the middle of the critical open enrollment period. That meant pulling in hundreds of Accenture's best people and getting them up and running on the project in the space of a few weeks. Only a very few CGI staff members who had been working on the systems were retained in their roles under Accenture's management.

The company had to think twice about taking on the project at all, Moskovitz said, but ultimately thought it had both the healthcare and big government project experience to make it successful. Accenture has also been involved with some of the more successful state-based health insurance exchanges, such as the one in California.

Some recent milestones: Accenture promised it would have systems ready for insurers to test on Oct. 7 and made that date. Accenture also launched an early access version of the SHOP exchange -- the Small Business Health Options Program marketplace -- and says it is on schedule to make it generally available on Nov. 15. This is an expansion of the services offered through HealthCare.gov, assisting small businesses with plan selection in the states served by the federal website. Some states have already introduced their own SHOP exchanges.

Of course, if anything goes wrong with the program on Nov. 15, you can expect to hear a chorus of "here we go again" groans from the media.

Moskovitz said there are always risks in such a big project. "It's our job to help our clients manage those sorts of risks. The question is how do you prepare for them, and how do you manage them when they occur?"

Tait said he won't lose any sleep over what might happen on opening day. "I'm in the Navy, so I always sleep well. We will be ready. I'm sure there will be challenges, whether it is on Day One or Day 30. But I'm confident and hopeful."

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