Healthcare.gov – How We Got Here and What Caused It – IDIQ

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Healthcare.gov – How We Got Here and What Caused It – IDIQ

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healthcaregov

Healthcare.gov - What Happened and What Can Be Fixed

On Github cjoh / healthcaregov

Healthcare.gov

How We Got Here and What Caused It

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IDIQ

Indefinite Deliverable, Indefinite Quantity

HHS, along with many other agencies use IDIQ contracts to prenegotiate rates, and renew every 10 years. They buy all information technology through these contracts.

2007

HHS Issues 16 IDIQ Contracts

HHSM-500-2007-[00014I-00029I]

The last two numbers represent a range of ID numbers. Each number correlates to a vendor

IDIQ Contracts Awarded To:Northrop Grumman, CGI Federal, EDS, CSC, IBM, Lockheed Martin, SAIC, ViPS, Buccaneer Computer Systems, IDL Solutions, Quality Software Services, Maricom Systems, 2020 LLC, iFed LLC, Alta Systems, DCCA

2010

HHS issues an RFP for the Federal Exchange to its IDIQ Contract Holders

If they hadn't, it would have taken ~18 months to just do vendor selection.

That's half the time they had to build the site

They got 4 bids back. While almost all these vendors had their fingers in Healthcare.gov, the prime contracts went to QSSI and CGI Federal.

CGI FederalHHSM-500-2007-00015I

Contract Value: $630 Million

Source: CMS Weekly Press Briefing, 11/1/2013

A Contract's Value isn't how much something cost; it's how much money has been set aside to pay for potential work

Healthcare.gov Cost Over Time

Source: USASpending.gov Oh hey, these are some notes. They'll be hidden in your presentation, but you can see them if you open the speaker notes window (hit 's' on your keyboard).

What's Been Spent So Far

$174 Million out of a $630 Million Contract

Source

October, 2013

Just hit the right arrow if you can't stomach it anymore

So What Caused It?

For Gov IT Projects of Greater than $10MM

6.4% Succeed

52% are Over Budget or Delayed

41.6% Fail Completely

Source: Standish Group & Standish Group
You can use the j and k keys to move between points on the timeline

Success = Money + Time + Talent + Accountability

Money: $630 Million

This is enough money for, well, anything

Time: Nearly 3 years

But, But Vendor Selection, Repeal Votes, Supreme Court!

Ok, fine. Time: 18 Months

That's still plenty of time.

Paperwork Reduction Act & Other Nonsense

"Information Collections" like this require a 6 month clearance period.

Once form fields are decided upon, very little flexibility

Talent

Limited Selection

With IDIQ: Open to 16. 4 Bids. 2.5 Years.

Without IDIQ: Hundreds of bids, 12 months?

Clearance

Very Expensive Takes a long time Contractors must incur cost

Clearance > Talent

Clearance Process Lacks Imagination

This Results In Huge Problems!

Government Can Select From A Limited Number of Contractors Who Can Hire From a Limited Set of Talent.

The Outcome

Success = Money + Time + Talent + Accountability

Accountability

How come nobody knew what was going on?

How Do These People Keep Getting Hired?

Project Criteria

Plan Finder Evaluation As Of 11/11/13

Perhaps We're Not Measuring The Wrong Things?

What We Measure

Cost Variance Schedule

Contractor Performance

Contractor "Past Performance" information is kept in a database called PPIRS (pronounced 'peepers')

PPIRS Isn't great

Read The Whole Report

Read The Whole Report

Success = Money + Time + Talent + Accountability

So How Do We Fix It?

Talent

Holistic view of Procurement Ecosystem

Grow New Suppliers

Streamline Business Registration

Make it like TurboTax

Create API, let Private Sector compete for User Interface

Simplified Acquisition Threshold = $150k

  • Raise the SAT to 500k for IT purchases
  • Break down large IT projects into smaller chunks
  • Make Small Businesses the only ones eligible for it.

Streamline Clearance Process

Make it both more secure and cost effective

Write For Humans

Use Write for Humans

Design For Humans

Accountability

GDS

Started after UK had repeated IT Disasters Cabinet Level Office Full Authority over IT from Chief Executive Savings of $20MM/yr

What Does a US GDS Look Like?

Probably something like this

  • Initial Staff of 50 people
  • 30 Developers and Designers
  • 10 Agency Liasons who help Agencies with Contracts
  • 10 Administrative And Overhead
  • Ability to pay them Professional Compensation**We do this for the NIH

The Highest Paid Feds*

*Besides POTUS

(Yes, There is an Electron Kebebew)

Source

If We Can Do This For Docs, Why Not For Digital?

Estimated USGDS Budget: $10,000,000

Healthcare.gov IT Budget: $630,000,000

Executive Leadership

Elevate the CTO Role - "Secretary of Technology" CTO Oversees GDS GDS is On The Hook. When Stuff Breaks, we know who to fire.

Better Measurements

Improve and overhaul PPIRS Allow Contractors to rate Gov Project Managers, too Use Qualitative Data

Some Smaller Tweaks

THE END