What’s really wrong with healthcare.gov?

Everyone is focused on getting the health exchanges working well (or criticizing those who failed to get them working). But the greater risk and opportunity long term is the ability to manage change. With software you often get one chance to get it right – that initial design and architecture needs to be well conceived. Adding features, patches, and fixes, particularly under pressure, often creates hard problems down the road.  

So think of the vast number of changes that await. Modifications to various rating systems within hundreds of  benefit and risk levels; revised procedures and laws that allow brokers to enroll – not to mention the small business health options (SHOP) programs; and improvements to back-end functions to support online and offline processing. And these are changes to the Act itself. Changing demographics, ramping customer experience demands, and advancing mobile opportunities also will drive change. My biggest fear, as we pull the bus out of the ditch, is whether hastily applied extensions to deal with the initial crisis will make it difficult to adapt going forward. Hence, the real challenge is whether healthcare.gov has been built to handle the incredible number of inevitable changes with this transformational law.

We just completed our second report on Business Agility Performance and looked at what factors can make the government more agile. Of our 10 dimensions, the most important dimensions for the exchange going forward are Process Architecture and Software Innovation.

To match the new power of customers, the exchanges must evolve a Process Architecture that include skills in technologies such as dynamic case management, business process management suites (BPMS), analytics, and business rules that add flexibility to underlying systems. For example, are changes to eligibility rules for each benefit level using a business rules capability? With these tools, the exchange can manage work patterns, rules, and templates for communication more directly without needing core system changes.

A second agility dimension of importance is Software Innovation. To innovate, exchanges must pounce on real-time feedback and build bench strength in core skills like mobile development, SaaS implementations, and social applications, backed by agile deployment methods.

I don’t want to seem to be piling on but we need some professionals to look at the business agility potential of healthcare.gov.