Systems failure

At last week's Board of Public Works meeting, Comptroller Peter Franchot asked a series of pointed questions about the process by which the state selected the vendors who built Maryland's flawed health insurance exchange website. In particular, he suggested that the state was ill served by legislation that exempted the health exchange's procurement from review by the Board of Public Works. "There's a damn good reason this board has stood the test of time since the Constitutional Convention of 1864," he said.

It's a fair question but an unanswerable one. Maryland exempted the exchange from the normal procedures ostensibly because of the tight timelines the federal government established for the creation of state-based exchanges but also, we suspect, because of Gov. Martin O'Malley's desire for Maryland to be seen as a leader in the adoption of the Affordable Care Act. In retrospect, that urgency appears misplaced. Some of the states with the most successful exchanges — Kentucky, for example — started much later than Maryland did. As a result, they had simpler but more functional systems that were developed after the federal regulatory framework was better established. Moreover, it's not as if the state did no due diligence before signing contracts. It did conduct a procurement process, but a streamlined one that did not include approval by the Board of Public Works. Whether the normal process could possibly have detected the flaws that are now so painfully apparent is impossible to say, and Mr. Franchot admitted as much.

But his questions do place some needed attention on the contractors who over-promised and badly under-delivered, particularly the Curam subsidiary of IBM that produced the software that forms the website's backbone. Marketed as an off-the-shelf solution that would require minimal customization to meet any state's needs, it has proven badly ill suited to the task, both here and in Minnesota, which also employed the same software.

Curam, which was purchased by IBM in December of 2011, was a well-known platform for managing social services programs that had been used by scores of governments world-wide. In its bid materials, the company promised it would "allow Maryland to safely and confidently address the challenges of health care reform, meet aggressive timelines, and maximize funding opportunities" because of its umatched technical and regulatory expertise and the functionality of its software.

The reality has been quite different. In testimony before the legislature's health exchange oversight committee, state Information Technology Secretary Isabel FitzGerald and Health Secretary Dr. Joshua Sharfstein reported that Curam was "much less mature out of the box" than the company had promised and that the product is "still not fully functional or completely delivered." They said the number of defects with the product continues to grow — it's still over 200, despite months of fixes. Applications are lost or improperly processed, and the structure of the Curam database is incomprehensible and appears not to meet basic industry standards. The result is not only significant customer frustration but also significant additional expenditures by the state to produce manual work-arounds and to field far more customer service calls than expected.

Minnesota experienced many of the same problems, and in December, Gov. Mark Dayton sent a scathing letter to IBM CEO Virginia M. Rometty outlining 21 issues and demanding that the company immediately deploy whatever resources were necessary to fix them without cost to the state. According to the Minneapolis Star-Tribune, IBM promised to send dozens of workers and spend up to 4,000 man-hours at no cost to the state to fix the problems. A spokesman for the state's exchange said the "tech surge" wasn't all it was cracked up to be, and MNsure, as their exchange is known, still requires extensive manual work-arounds. He said the Curam error rate there has improved, but the system is still  not what Minnesota signed on for.

A spokesman said Governor O'Malley didn't write a letter to the CEO, but he has been directly engaged in discussions with senior IBM officials, and the company has devoted additional resources to fixing the problem here. But it still isn't fixed.

Say what one will about the procurement process, it is not as if the state bought software from a fly-by-night company. Curam had a long track record in the field, and it is backed by IBM, a pillar of corporate America. Neither has lived up to its promises. We don't excuse state officials for their roles in overseeing the exchange's development, but we believe IBM and Curam also need to be held to account for their failings. Ms. FitzGerald and Dr. Sharfstein have done so, but it might have more punch coming from the governor, loudly and in public.

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