April 20, 2015
America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System by Steven Brill
Published in January of 2015
How many campus technology projects have you been involved in that have gone horribly wrong? Do you shudder at the words: ERP, SIS, or CMS? My guess is that your worst campus technology disaster was a resounding success in comparison to the initial rollout of healthcare.gov.
Steven Brill’s America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System is billed as a book about U.S. healthcare reform. What the book is really about, however, is how not to run a major technology project.
If you read Brill’s book you will learn a good deal about why healthcare in the U.S. is so expensive (we spend 17.5% of our GDP on healthcare, almost $3 trillion dollars), and why for all the money we spend our health outcomes lag behind most other advanced (and some not so advanced) countries. You will learn how the Obama administration was able to get the Affordable Care Act (ObamaCare) passed in 2010. You will come away with a few good healthcare policy ideas, and you will be more knowledgable about the entrenched interests that stand in the way of meaningful healthcare reform. These are all good reasons to read Brill’s book - but these are not the reasons why I’m recommending that you should. The reason that I’m recommending America’s Bitter Pill is that I’m betting that you are currently involved, or will be soon, in a major campus technology project.
The Obama administration made 3 critical mistakes in managing the initial build and rollout of the HealthCare.gov site:
Mistake #1 - Nobody Was In Charge:
How obvious does it seem that one person needs to be accountable and responsible for every large and complex technology project? How clear is it that this person should have enough power, authority, and experience to make sure that decisions get made and things get done? Nobody would disagree with the need to have someone in charge, and yet, how many big higher ed tech projects diverge from this necessity for success?
We fool ourselves in higher ed if we think we will be much better than the government in running our big tech projects. We are just as susceptible to managing by committee. We are just as likely to fail to invest in a dedicated team, and fail to hire the right (often expensive) talent, as higher ed can be as penny wise and pound foolish as government. If you are the executive sponsor for a big tech project on campus are you sure that there is one person who has the authority, skills, and accountability to run the project? If not, what are you going to do about it?
Mistake #2 - Requirements Were Not Defined:
Every campus tech project that I have ever seen fail (or be horribly delayed, over budget, and underwhelming in performance), lacked a clear set of requirements going in. Knowing exactly what the requirements are for the platform, system, or service is a necessary condition for any chance of tech project success. In the case of HealthCare.gov, the requirements were written on the fly. The feature list became bloated and unwieldy. Must-have features and nice-to-have features were not prioritized. Hard decisions about what not to do were not made.
Does this sound familiar? How many campus technology projects stall because of a search for the perfect platform - the software that will meet everyone’s needs? When it comes to our campus tech projects, we have as hard a time saying “no” to powerful stakeholders as does the federal government. The result is that we often deliver a platform or service that tries to meet everyone’s needs, and ends up meeting nobody’s.
Mistake #3 - No Gradual Launch or Pilot:
The final sin of the initial HealthCare.gov launch may be the least forgivable. At launch in October of 2013 the site crashed so dramatically that only 1% of visitors to HealthCare.gov were able to successfully enroll in coverage. The massive technical problems of HealthCare.gov made the political work of selling healthcare reform infinitely more difficult.
This is one area that higher ed seems to do better than our colleagues in the government. I can’t imagine that we would attempt the launch of a major platform or service without first running a pilot, and then without a gradual rollout. Do campus technology division ever do big bang platform cutovers? Higher ed tech enterprise tech culture is naturally conservative and cautious. This is one area where our risk adverse technology inclinations may just pay off.
What are the biggest campus technology nightmares that you have witnessed?
What lessons from HealthCare.gov can you find for our big higher ed tech projects?
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