Tag Archives: healthcare.gov

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How Healthcare.gov could have saved billions of dollars and been delivered in 1/2 the time.

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By September 2014 spending on the 15 state health insurance exchanges and healthcare.gov will climb to over $8 Billion dollars*. This huge expenditure for health insurance shopping sites could have been avoided if the federal and state governments had mandated and followed modern software development practices.

onebillionincash

$1 Billon USD. We’ll need eight for healthcare shopping sites.

How did the governments, on something as high profile as healthcare reform, decide to use a risky 40 year old process to manage the delivery of the health insurance exchanges?

Comparisons were made between healthcare.gov and amazon.com, yet the way in which these two websites are developed could not be more different. Healthcare.gov used the phased or waterfall approach with 55 different contractors responsible for different aspects, and no one responsible for delivering finished product. Amazon.com uses Scrum, an Agile approach that emphasizes small cross functional teams who deliver working tested features every 2 weeks.

To understand how a website like healthcare.gov could have been delivered using the Amazon.com approach, I created a short illustrated video. This video demonstrates, in a simple way, how to deliver a site like a health insurance exchange using a fraction of the budget in about half the time. These techniques are very similar to how companies like Spotify, Google, Square, Valve, Salesforce, Amazon and many others manage getting software development done.

Got a few minutes to save billions of dollars on software development?

I hope you like this talk, please subscribe on youtube if you are interested in future videos. If you are looking for in person training for yourself or help for your organization, please contact me:

http://www.innovel.net or http://www.scrumtraining.com

Cheers
Robin Dymond, CST

*Health and Human Services data

*Report by Jay Angoff on Health Exchange enrollment costs per state


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After 12 billion pound healthcare IT failure, U.K. shows that governments must adopt Agile and have their own delivery organization.

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With the massive failure of the healthcare.gov launch in the US, people are talking about why such an important software development initiative turned into such a failure. The US however is not alone in these kinds of failures. The UK government spent 10 years and 12 billion pounds on the failed NHS-IT electronic patient records program. Now 12 billion pounds is about 16 billion Euros or 20 billion US dollars. Ouch! I picture the Queen in earlier times shouting “off with their heads!” Instead the UK government started listening to people who knew about Agile and technology development. The UK Government has created the Government Digital Services, GDS, a 300 person department with the skills to deliver digital services online. In a recent interview with NPR, Mike Bracken, head of the UK Government’s GDS discussed the successes the GDS initiative has had in the two years since it was formed. Bracken mentions many Agile principles GDS are using to deliver a government that is digital at its core. Some of the highlights are:


  • Optimizing for business value: GDS is only going after the processes and services most used by citizens, such as passports, tax filing, benefits, etc. Within these areas they further optimize, so GDS is delivering digital versions of the highest value services first. Some processes and services may never be automated because the business value is not there, and that is OK.
  • Incremental delivery: GDS is delivering services in an iterative and incremental fashion. They are not trying to get it all right the first time. Instead they are getting the most important parts right, and then learning what works and what needs improvement.
  • Cross functional teams: GDS teams are cross functional, with developers, process and policy experts, UI designers, testers, etc.
  • Collaboration over contract negotiation: GDS has thrown out all of the traditional procurement processes and procedures. Instead of building contracts based on some wild ass guess wrapped in 300 pages of documentation, GDS admits they have no idea of where or what they need to do in 3, 5, or 10 years. Instead they focus on working collaboratively with users and stakeholders, quickly (1-3 weeks) delivering small amounts of working tested software to their users and getting their feedback.

Bracken was visiting Washington D.C. to talk to government officials and influencers to help them understand how the UK government is bringing digital services in a fast and cost effective manner to its Citizens. For everyone’s sake, I hope the bureaucrats in DC are listening. The $600 million spent could be a more cost effective lesson than the UK, or it could be a failure that is repeated over and over, just like in the movie Groundhog Day.

Read or listen to Bracken’s interview on NPR here.


Article on the UK Government’s failed NHS-IT program

US healthcare costs in the are rising disproportionately compared to quality of care, what are the options to solve the problem? For Profit or Single Payer?
US healthcare costs in the are rising disproportionately compared to quality of care, what are the options to solve the problem? For Profit or Single Payer?