As Maryland prepares for a major overhaul of its troubled health exchange — switching out its buggy software for Connecticut's proven technology — lawmakers and information technology experts are raising new concerns about whether there is enough oversight to prevent a second failure.
State legislators from both parties said building a successful site will take more than plugging in new software — a view echoed by technology experts. While cautiously optimistic about the switch, lawmakers don't want to see the same management problems and potential waste of taxpayer money that plagued the creation of the exchange.
"Software is the core of the exchange, but how you manage the development, implementation and testing of the software is as critical as the software itself," said Dan Schuyler, senior director of the exchange practice of Leavitt Partners, a health intelligence and health care consulting firm.
Several lawmakers also said their confidence in the exchange leadership is shaky. They want more transparency in decision-making and spending on the exchange, which has cost $129 million so far.
Del. Mary-Dulany James of Harford County, chairwoman of a key House subcommittee that oversees spending on the exchange, said there are "huge budgetary implications" in switching to the Connecticut model.
Maryland officials have been "opaque" about how much it would cost, said James, a Democrat. Without clear evidence of major staffing changes at the exchange, James said, there continues to be "an issue of confidence in the people that were there before the rollout. And it's a question mark about the competency of those same people."
While acknowledging that she is not a technology expert, James said the shift to technology used by Connecticut is likely more complicated than is being portrayed.
"I don't think it's as simple as flipping a switch," James said. "We just can't make this mistake going forward."
The Maryland exchange crashed Oct. 1, the day it was launched, and has been riddled with technical problems such as frozen screens and locked accounts throughout the enrollment period that ended March 31. The troubles became a hot political issue, and as the state struggled to right the project, it cut ties with the exchange's executive director and Noridian Healthcare Solutions, the prime contractor.
Officials said they exceeded the total enrollment goal of 260,000, with more than 295,000 Maryland residents signing up for coverage, mostly through Medicaid, during the enrollment period.
State officials also had hoped to enroll 150,000 Marylanders in private insurance plans but changed that goal to 70,000 in February, blaming a mistake by researchers. They missed that goal as 63,002 Marylanders enrolled in private health plans through the exchange.
Concerns about the possibility of continued problems arose even before the board overseeing Maryland's health exchange voted unanimously Tuesday to ask federal officials for their approval — and $40 million to $50 million more in funding — to hire Deloitte Consulting to replicate its work on the exchange in Connecticut.
"In essence, our team is starting over again," said Senate President Thomas V. Mike Miller, a Democrat from Calvert County who has offered blunt assessments of the exchange's shortcomings. He said the Connecticut system's success gives him optimism about improving on Maryland's first attempt to build an exchange. "Obviously, everyone was let down, in terms of the outcome, including the taxpayers."
Experts said successful exchange sites have strong oversight, focus on core needs and employ appropriate, high-quality technology.
Failures in Maryland and other states can be attributed to many factors, said Rick Howard, a research director at Gartner, an information technology research and advisory company. When combined, they "exponentially add risk," he said. He pointed to software engineering skills and technology that were not up to the task, failure to manage the project's scope or accurately assess progress so problems could be fixed early.
Gov. Martin O'Malley and members of his administration say more safeguards are in place now. Whether that is enough to satisfy lawmakers remains to be seen.
O'Malley said Friday that the state is hiring a company to do independent audits of how the Connecticut fix would be implemented. Maryland Health Secretary Dr. Joshua M. Sharfstein, chairman of the state exchange board, said that unlike the first effort, this one will be overseen by the state's top IT professional, Isabel FitzGerald, secretary of the Department of Information Technology.
In testimony before lawmakers last week, FitzGerald said technical changes are necessary to make the Connecticut platform work with Maryland's, but "the only things we are changing are very small, and we're only doing retrofitting."
Connecticut's exchange has been lauded as one of the success stories of health reform, signing up close to 200,000 people. That system worked better because it was simple and well-managed, experts said. Deloitte, which built the technology for Connecticut, has worked on other successful sites around the country, including those in Washington, Rhode Island and Kentucky.
IT companies will try to sell all the latest technologies, and it is up to the state to choose the right products and provide oversight, Schuyler said.