From: GOVERNING
To: Lee Perry,
Subject: Better, Faster, Cheaper: Lessons from the HealthCare.gov Fiasco
Date: Wed Dec 18 19:08:02 MST 2013
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Better, Faster, Cheaper Ideas


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HealthCare.gov:
Lessons from a Fiasco

BY Stephen Goldsmith

The tumultuous launch of HealthCare.gov presents issues of complexity, failure and consequence unlike anything likely to be faced by state or local government officials. Yet just about every government has experienced some major information technology project that went awry.

I remember when I was deputy mayor of New York City and Mayor Michael Bloomberg had had enough of the delays and expenses associated with a payroll modernization implementation known as CityTime. Bloomberg asked me to remediate the project. The project's costs had ballooned from $63 million to nearly $700 million. In the end, the prime contractor had to reimburse $500 million to the city and the effort was brought to a successful close by moving the project management to a city agency.

Implementation snags almost inevitably come up on projects of such a large scale. Those of us who follow statewide benefit system modernization efforts have seen major issues from Florida to Texas to Indiana, where the state and IBM ended in court in a very messy and expensive exercise in finger-pointing over a $1 billion welfare IT system.

So what can we learn from these large, complicated and flawed implementations? I would suggest the following:

-- Nothing will work in the absence of high-level executive leadership and a skilled government project manager. The more agencies a project touches, the stronger that leadership needs to be. Of course, a good leader manages collaboratively -- until a decision needs to be made. Negotiating and listening have their place, but decision-making delays not only slow a project down but also magnify problems.Keep reading >>

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Health and Human Services Special Report: Health Care Policies and Practices that Work

Read this special report to learn about the best practices and most noteworthy solutions currently on the ground in the HHS sphere. Click here to learn more.

Cities and the Fiscal Challenge of Retiree Health Care

BY Charles Chieppo

As state and local governments focus on how to fix their pension problems, a recent report demonstrates the dramatic measures large American cities will have to take to address another issue: huge retiree health-care liabilities. The overarching lesson of the study from ElderBranch, an online information portal that helps people find and evaluate long-term-care providers, is to address the retiree health-care issue before it gets out of hand.

For many cities, it's already too late. In fiscal 2012, only five of the nation's 25 largest cities had set aside 95 percent of their annual required contribution (ARC) -- the amount that would put them on track to pay for the health-care costs of all current and future retirees over 30 years. More than half the cities contributed less than half of ARC.

That leaves most large cities with three distasteful options: raise taxes, cut spending and/or reduce health benefits.Keep reading >>

 

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