Looking Back on Health Care Exchange Implementation

It is now almost two years since I started working with the Hawaii Health Connector, a state exchange implementing the Affordable Care Act. For me, that project ended mid-last-year. I began the project by helping them with the vendor selection process and later became the subject matter expert and business owner for the financial management side of the exchange.

I was impressed with the process in both positive and negative ways.  I watched a full-time staff that was totally dedicated to the success of their mission.  They worked through a complex process where the rules were being dynamically defined throughout the implementation as they tried to accomplish something that simply had never been done before.  I have nothing but the highest respect for the Connector staff I worked with in Hawaii.

On the other hand, I watched an enormous amount of federal money spent across the country to do something I believe in but it wasn’t necessarily spent wisely.  As everyone knows, the roll-out was a disaster across the board.  It was difficult in Hawaii and even more so in other states and even for the Feds.  The software should not have been that difficult to write nor the hardware that difficult to configure, yet at the very last-minute many were surprised that things didn’t work.  I hold the vendors responsible for the failure particularly as they assured everyone of success right up to the go-live date when everything failed.

Having come from the vendor side of software implementations, I was saddened to see incompetence in the vendors and further saddened by how easy it was for vendors to manipulate their clients to ignore the very deadlines and metrics that were necessary for success.  What many of the states needed was someone with vendor experience to help them navigate the process of bringing up a large system.  They needed someone to translate what the vendor was saying into what it actually meant to the project.  It is not for the faint of heart.  Politically, October 1, 2013 was an absolute that couldn’t be moved.  On the other hand, much earlier on, there needed to be people involved who would just-say-no and force the vendors to follow their own contracts and agreements.

As I check back with friends in Hawaii and in other states, I am still surprised that the vendors weren’t held responsible for what they did.  In one case, the financial system provided by Aldera (previously Healthation) for the exchange still cannot generate accurate financial reports or even accurate financial transactions after more than a year in production.  What’s more, they don’t even seem interested in fixing the problems.

I still believe in what the Affordable Care Act was trying to accomplish though I have never seen so many political “leaders” doing everything they can to make it fail rather than taking their responsibility to serve their constituents.  Just think of what it could be if both parties worked together to make the vision a success and fix shortcomings rather than exacerbate them.  We can only hope that politicians in Washington will eventually become at least civil to each other.

This was one of my first experiences with large government projects. I hope that others are better envisioned and implemented.  At this point, my prime interest is to return to helping associations and other non-profits to select and implement software.