Delayed or failed federal IT projects, such as the Department of Veterans Affairs' decision to scrap plans to update its scheduling software after spending $127 million, is a "high-risk" budget issue, according to a report by the Government Accountability Office, the Washington Post reports.

Report Details

The biannual GAO high-risk report lists various federal programs that are particularly vulnerable to "fraud, waste, abuse and mismanagement" (Hicks/Wax-Thibodeaux, Washington Post, 2/12). This year's report highlighted 32 "high-risk" areas across the federal government that could cause budget issues (Daly, AP/Washington Times, 2/11). According to FCW, the VA and IT acquisition projects were two new additions to the 2015 report.

Report Findings

Chris Mihm, managing director of GAO's strategic issues team, said that the federal government invests about $80 billion in IT projects annually, across all federal agencies. He added, "Unfortunately, fairly consistently, we find problems with these projects. And these seem to center on a lack of discipline and effective management practices, the need for improvements in project planning, and poor program oversight in governance" (Rockwell, FCW, 2/11).

Specifically, the report cited problems with VA, noting that it has failed to completely address more than 100 GAO recommendations regarding its:

• Lack of oversight and accountability;
• Outdated health IT systems;
• Poor care coordination and data interoperability; and
• Inadequate training for VA staff members.

For example, the report cited ongoing efforts by VA and DOD to secure interoperability between its electronic health record systems (Bresnick, EHR Intelligence, 2/11).

In February 2013, DOD and VA officials announced plans to halt a joint integrated EHR, or iEHR system, and instead focus on making their current EHR systems more interoperable (iHealthBeat, 1/9).

GAO wrote that "the quality of care may be adversely affected if important clinical information is not promptly communicated between VA and non-VA providers" (EHR Intelligence, 2/11).

In addition, the report noted that the VA spent $127 million to update its appointment scheduling software before deciding to halt the project (Washington Post, 2/12).

Meanwhile, the GAO report also cited issues with other federal health agencies and projects, such as:

• HHS' HealthCare.gov website (FCW, 2/11); and
• Future Medicare spending as the agency works to move towards value-based models and advances health IT implementation efforts, such as the meaningful use program.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments (EHR Intelligence, 2/11).

Several simple steps -- such as implementing a decision-support tool and providing explanations of health insurance industry vocabulary -- could significantly improve the usability of HealthCare.gov, according to a study published in the Annals of Internal Medicine, the Los Angeles Times' "Science Now" reports.

Details of Study

The study was conducted by a team of health economists, health policy experts, lawyers and physicians from the University of Pennsylvania. They observed 33 volunteers between the ages of 19 and 30 as they attempted to navigate and sign up for coverage on the federal health insurance exchange website (Kaplan, "Science Now," Los Angeles Times, 7/7).

The volunteers were considered "highly educated" and they "explained their thinking in real time."

After they were finished navigating the site, researchers interviewed the volunteers about their experience, impressions and suggestions for improving the federal health insurance exchange site (Annals of Internal Medicine, 7/8).

Findings

Overall, researchers found that participants faced several obstacles to using the site.

For example, volunteers often did not understand health care industry terminology on the site, and many terms were "inadequately explained," according to the study.  For example, the term "catastrophic" was misunderstood by some of the participants to mean that the health plan did not cover preventive primary care.

Participants also had trouble matching their preferences with available health plans, in part because of an "overwhelming" amount of information displayed on the site, the study noted.

In addition, health plan costs listed on the website did not always adequately reflect tax credits or cost-sharing options ("Science Now," Los Angeles Times, 7/7).

Recommendations

Researchers identified six actionable improvements for the site that could be implemented prior to the upcoming open enrollment period, which begins Nov. 15:

• Provide more accessible and understandable explanations of health insurance industry vocabulary;
• Highlight the mandatory inclusion of preventive primary care services in all available plans;
• Clarify or expand options for adult dental coverage earlier in the sign-up process;
• Implement a sorting or decision-support tool to help consumers determine health plan options that align with their preferences;
• Include potential premium tax credits and cost-sharing subsidies in the cost of health plans; and
• Rename the "catastrophic" health plan category to "value" or "minimal" to reduce confusion.

Researchers said the findings show how relatively small changes to the website "could improve [users'] understanding of a typically difficult process" and the usability of HealthCare.gov (Annals of Internal Medicine, 7/8).

Designer Directory

CMS Seeks Small IT Vendors To Take Over HealthCare.Gov Operation

CMS is soliciting information from small IT service vendors that might be interested in taking over the operation of HealthCare.gov after the agency's one-year contract with Accenture expires, according to documents released Thursday, FCW reports.

Background

In January, CMS announced that it was awarding Accenture a one-year contract to oversee HealthCare.gov and prepare for next year's open enrollment period.

The announcement came one day after CGI Federal -- the previous lead contractor on the federal health insurance exchange website -- said its three-year contract would not be renewed when it expired on Feb. 28 (iHealthBeat, 1/13).

Notice Details

The "sources sought" notice, published on the Federal Business Opportunities website, outlines qualities CMS will be looking for when it begins reviewing candidates to fill the contracting slot (Mazmanian, FCW, 4/21).

see https://www.fbo.gov/?s=opportunity&mode=form&id=cb602ee639f1545f87acf2ce...

According to Modern Healthcare, Accenture would not qualify if it sought to continue its working relationship with CMS because the company earned $7.13 billion in 2013.

In the notice, CMS asks interested and eligible small vendors -- defined as those with annual revenues under $25 million -- to submit their information by May 2.

A small vendor could potentially be allowed to team up with a larger company for the available contract, but the larger company would be regarded as a subcontractor and will be permitted to work on no more than 49% of the work.

Next Steps

If the response rate from small vendors falls below expectations, CMS could issue a general request for formal proposals, which would permit contract bids from any company, including Accenture.

According to Modern Healthcare, Accenture would train any replacement during a 60-day transition period before handing over operational control.

Accenture's Performance

Some industry experts note that CMS' solicitation for information does not necessarily signify that the agency is dissatisfied with Accenture's work.

Kev Coleman, head of data and research at HealthPocket, said the two entities' relationship would only be determined by examining the exchange's security and performance in November, when the second open enrollment period begins (Dickson, Modern Healthcare, 4/21).