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C2170-010 - IBM Curam V6.0.4 Application Development - BrainDump Information

Vendor Name : IBM
Exam Code : C2170-010
Exam Name : IBM Curam V6.0.4 Application Development
Questions and Answers : 77 Q & A
Updated On : November 15, 2018
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C2170-010 exam Dumps Source : IBM Curam V6.0.4 Application Development

Test Code : C2170-010
Test Name : IBM Curam V6.0.4 Application Development
Vendor Name : IBM
Q&A : 77 Real Questions

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IBM IBM Curam V6.0.4 Application

WorkCoverSA Develops New systems to assist Employers and Injured workers with the aid of IBM and Cúram utility | killexams.com Real Questions and Pass4sure dumps

HERNDON, Va.--(company WIRE)--Cúram application and IBM (NYSE: IBM) announced nowadays the a success implementation of a number of utility solutions for WorkCoverSA to support their company. WorkCover selected IBM global company functions to put in force the Cúram for employees' Compensation solution, a finished and confirmed claims management solution that manages and automates the finished claim lifecycle from injury to influence, as part of a finished modernisation of their IT programs.

WorkCover administers the staff’ Rehabilitation and Compensation Scheme in South Australia on behalf of about 50,000 registered employers and 430,000 personnel. WorkCover collects and manages levies for employers whereas their claims agent control about 20,000 new claims and procedure approximately AUD500 million worth of claims payments each 12 months. After finding their customised legacy software difficult and high priced to retain, it was apparent they vital a new enterprise IT infrastructure that become strong and scalable.

right through the three yr task IBM labored with WorkCover to combine the Cúram for workers’ Compensation answer with IBM Tivoli entry manager for e-enterprise and IBM DB2 regularly occurring Database Workgroup Server, operating on IBM WebSphere software Server. The flexible, solution makes it possible for WorkCover to control claims greater correctly, ensuring superior transparency and consistency in decision making. This improved consistency is driven with the aid of numerous automated calculations and approaches, prior to now performed manually through case managers. in addition, the authority can now respond extra with ease to alterations in law and enterprise priorities with the aid of incorporating them into the Cúram solution, giving it stronger handle over its scheme.

Yvonne Deally, CIO, WorkCover, observed, “Our legacy systems had been more and more customised to the factor they were not efficient to preserve. The Cúram answer applied with the aid of IBM permits our supplier to reply to business or legislative alternate a whole lot greater conveniently, whereas additionally offering better case administration transparency.”

“This has been one of the most wide IBM implementations of Cúram on earth,” referred to Michael Kinnane, Adelaide utility functions leader, IBM global enterprise services. “IBM integrated Cúram with Tivoli entry manager and mixed Cúram and Tivoli with WebSphere and the DB2 server on a windows platform. we are delighted we now have labored with Cúram application to support WorkCover build a brand new platform that reduces the complexity of again-office techniques, enabling the company to boost its focal point on case management and client provider.”

according to Deally, IBM became instrumental in offering the answer. “IBM had both the abilities and proven song listing to manage and carry what become a complex, three-year challenge efficiently, which protected transferring more than 650 million statistics of client related records stretching returned over two decades. We had been exceptionally impressed through dedication displayed by means of the IBM group to WorkCover and to the success of this task.”

“Cúram utility become happy to assist WorkCover facilitate most efficient practices for rehabilitation and return to work and to make sure extra consistent choice making and claims management,” referred to Ernie Connon, president, Cúram utility. "Working with IBM, our Strategic expertise associate, we developed an commercial enterprise solution that enabled more desirable transparency and greater constant determination making, focusing on our superior desires of valuable rehabilitation, compensation and return to work.”

About WorkCoverSA

For extra information on WorkCoverSA, please consult with: http://www.workcover.com

About IBM

For greater guidance on IBM, please discuss with: http://www.ibm.com/au

About Cúram software

Cúram utility is the leading issuer of Social commercial enterprise administration (SEM) utility solutions, delivering foremost-in-category purposes for social corporations globally together with, health and human functions, workforce features, and social safety organizations. the usage of the Cúram company utility Suite groups can immediately reap the merits of customer-centric business approaches and an effects-driven built-in carrier delivery model. The Cúram business utility Suite, underpinned by using the Cúram business Framework, combines the benefits of commercial off-the-shelf (COTS) utility, an enterprise platform and repair-oriented structure with the company and technical flexibility required to allow businesses to implement solutions to fulfill their strategic goals. Cúram software is headquartered in Dublin, eire with workplaces all through North america, Europe, Australia, and India. For extra suggestions, talk over with www.curamsoftware.com.

Cúram is a registered trademark of Cúram software Ltd. All Cúram items and repair names are logos and property of Cúram utility Ltd. All Rights Reserved. Copyright (C) 2011 Cúram utility Ltd.

For extra information about Cúram application, please discuss with: www.curamsoftware.com


IBM application Blamed for afflicted State health Exchanges | killexams.com Real Questions and Pass4sure dumps

application from IBM has been singled out for technical problems hurting both the Maryland and Minnesota on-line fitness exchanges. officials from each states have blamed IBM’s Cúram, used to examine buyers' eligibility for coverage, for a number of performance concerns, together with dropping client functions.

With the March 31 deadline for open enrollment period speedy coming near, state officials have upped their rhetoric. remaining week, the Maryland fitness Connection stated Cúram and its "serious utility defects." previously, the state blamed a squabble between two basic contractors because the supply for the change’s a large number of bugs.

final month, in a December letter to IBM CEO Virginia Rometty, Minnesota Gov. Mark Dayton distinctive 21 complications MNsure encountered with Cúram, including functions stuck in pending status, as well as inadequate documentation and replica functions.

The continued technical challenges skilled by means of Maryland and Minnesota underscore not most effective the talents weak spot of the application chosen to do the job, however the problem of building a web fitness change, even at a state stage, in a comparatively brief amount of time. Like other state exchanges, MNsure and Maryland health Connection must weave collectively inner most coverage and federal executive methods to examine buyer eligibility for Medicaid and supply correct coverage classes. Add to this the challenge of working with diverse contractors and the time lost resolving contractor conflicts versus fixing alternate bugs--as was the case with Maryland and a number of other state exchanges—and latest difficulties are more comprehensible, albeit of little consolation to patrons.

Responding to Maryland’s claims, IBM spokesman Clint Roswell referred to that the trade is enhancing and that IBM continues to be working with the contractors on the site. “based on our newest statistics on the alternate's efficiency, we are seeing greater than 95% of patrons entering the web page now having a favorable event," Mr. Roswell stated in an e mail to CIO Journal. IBM began providing the software when it acquired Dublin, eire-based mostly Cúram software Ltd. in 2011. Cúram capacity "care and coverage" in Irish.

however an respectable for Maryland health Connection instructed CIO Journal Tuesday that whereas the trade's user adventure has greater, "tremendous issues with the Cúram software and other device accessories nevertheless deserve to be fastened before the web site can characteristic as it should still."

Some Maryland consumers' applications for insurance have been lost or suspended in Cúram, an integral part of the trade it truly is designed to assess consumers’ eligibility for Medicaid and top rate tax credit for personal assurance, observed Joshua M. Sharfstein, Maryland's secretary of health and mental hygiene, and chairman of the change's board, testifying in entrance of the state Senate Finance Committee last Tuesday. He also noted some 834 forms -- utility data the exchanges ship to insurers to comprehensive the utility process -- are generated with error, requiring trade team of workers to manually appropriate them. He also mentioned that changes to Cúram and other applications used for the website would cause whatever thing that had been functioning to stop working. “There are severe challenges that nevertheless remain," Mr. Sharfstein told the committee. "I don’t want to sugar­coat that.”

Cúram is infrequently the reason behind all the trade's ailments. In his testimony, Mr. Sharfstein spoke of the state had to mediate monetary disputes between fundamental contractor Noridian Healthcare solutions LLC and subcontractor EngagePoint LLC, which slowed technical progress in August and September. "throughout this time, there turned into insufficient growth fixing the defects identified all through user checking out," Mr. Sharfstein mentioned. When the site went live on Oct. 1, Noridian servers used to support the exchange crashed, fighting patrons from looking for and enrolling in plans.

Noridian booted EngagePoint from the task on Oct. 25. Neither Noridian nor EngagePoint responded to CIO Journal's requests for comment.

Rick Howard, a Gartner Inc. analyst who has been intently following the fitness exchanges, pointed out complaints about Cúram indicate the utility wasn't thoroughly built-in and verified to support the coverage transactions. "one of the most IT options that were deployed just weren't in a position for prime time when it came to the complexity demanded by means of medical insurance marketplaces," Mr. Howard stated.

however he additionally observed Minnesota and Maryland's complications go beyond considerations with particular person software items and contractor litigation. He mentioned the exchanges tackled IT projects that were too complex in an "aggressively" brief implementation window -- most of the states took a few years to outline their challenge requirements -- which supposed untested programs would launch with severe defects. He spoke of he predicts HealthCare.gov and a lot of state exchanges will require persisted intensive remediation, stabilization and enhancement for the subsequent 18 months -- or longer.

Lynne Dunbrack, an IDC analyst who covers fitness care IT, spoke of that 50% of all significant IT projects fail. For the exchanges, the complexity of the work, together with the integration of records between state exchanges and insurers, mixed with tight timelines, amounted to a challenge that has confirmed hard for some states to conquer. "it be in reality not incredible that we’ve considered the considerations on the scale that we now have had throughout all the distinct supplier solutions," Ms. Dunbrack observed.


La. social features company builds on Curam utility | killexams.com Real Questions and Pass4sure dumps

La. social features company builds on Curam utility
  • by John Moore
  • Oct 06, 2006
  • Curam application is featuring the software backbone for the currently launched first phase of a social functions system mission in Louisiana.

    Increment 1 of the state’s A comprehensive enterprise Social functions gadget (ACESS) goals to deliver a standard consumption system spanning most social services classes, according to a spokesman for Curam. The initial section also covers case management for Louisiana’s child insurance plan capabilities.

    Curam is presenting its business-off-the-shelf Social enterprise administration solutions, contracting without delay with the state. The state chosen IBM in 2004 to implement the ACESS, including the Curam utility element. final month Curam and IBM accelerated a strategic alliance to deliver human capabilities, social protection, and body of workers features information expertise options to govt companies. The organizations have been partnering considering 1999.

    within the ACESS gadget, Curam’s application runs on IBM’s z/OS mainframe operating system. also working on the mainframe platform are IBM’s WebSphere utility Server and DB2 database.

    ACESS will provide Louisiana’s social capabilities agency to manage multiple programs including infant Welfare, infant Care, recommendations to Empower individuals, family unit Independence brief assistance application, Kinship Care Subsidy software and food Stamps, among others.

    Future increments of ACESS will let caseworkers control all of an individual’s social and human functions wants in one vicinity, the Curam spokesman said.

    Curam additionally provides its Social business administration application to such state and native government clients as Utah and new york city.




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    Finger-pointing continues on Maryland's health exchange | killexams.com real questions and Pass4sure dumps

    Weeks after officials at the state's health care exchange began blaming IBM software for the worst problems, including lost applications, IBM began pushing back, saying the state shares some of the blame.

    It's the latest salvo in the blame game that has been going on since the exchange launched, and crashed, on Oct. 1. In this case, IBM officials released a statement Wednesday that said the exchange also bears some responsibility for the website, which is still so troubled that officials are considering dumping it.

    IBM was brought in by Noridian Healthcare Solutions, the company that had been in charge of setting up and managing the exchange website until the exchange terminated it last month. IBM's Curam software was supposed to determine eligibility of consumers for subsidies, but officials have said it's responsible for thousands of lost and frozen applications and incorrect subsidy determinations.

    "While the state notified Noridian of its concerns over the management of the project and integration of the elements of the system, it gave that integrator limited direction and exerted a lack of discipline over the development process, including testing," said Mitch Derman, an IBM spokesman.

    "The result was a system that didn't work as required, and Noridian has since been fired," the statement continued. "Since the launch, IBM has worked closely with the state to resolve problems and invested significant resources at no charge to the state."

    Derman also said IBM officials recently met with Gov. Martin O'Malley to "suggest ideas to further improve and finish the system."

    But it's not clear the state plans to keep the site going much longer after open enrollment ends March 31. On Wednesday, Dr. Joshua M. Sharfstein, chairman of the exchange board and state health secretary, repeated earlier comments that exchange officials are reviewing options that include adopting another state's functioning technology, such as Connecticut's, or moving to the federal exchange website or fixing Maryland's own site. He said an announcement would come in weeks.

    In the meantime, Sharstein said the IBM software still contains many defects and the company remained on board because its workers were needed to help fix its own product, and, as a subcontractor, is still being paid for some of its work.

    IBM now answers to Columbia-based Optum/QSSI, which was hired in December to help fix the site and took over management when the exchange cut ties with Noridian.

    "We have such serious challenges that there obviously is plenty of blame to go around, but we've been very disappointed by the core software product and that product continues to be defective," Sharfstein said. IBM "does not appear to be denying that."

    Noridian, which did not respond to a request for comment, has laid at least some blame on constant changes sought by the exchange.

    meredith.cohn@baltsun.com


    Minnesota Governor Blasts IBM For State Health Exchange Troubles | killexams.com real questions and Pass4sure dumps

    Minnesota Governor Mark Dayton blamed IBM for software problems that have stalled thousands of insurance purchases on the state's online health exchange. The exchange, MNsure, said it is bringing in UnitedHealth Group-owned contractor Optum to review operations. But MNsure may have to accept some of the blame after taking systems integration duties from the site's general contractor just eight months before launch.

    "Your product has not delivered promised functionality and has seriously hindered Minnesotans' abilities to purchase, health insurance or apply for public health care programs through MNsure," Gov. Dayton wrote in a Dec. 12 letter addressed to IBM CEO Virginia Rometty.

    The episode marks the latest example of a state exchange calling out a key contractor for a poorly or non-functioning online state health exchange created in the wake of the Affordable Care Act. Oregon and Massachusetts in December called out their top contractors, Oracle Corp. and CGI Group Inc., respectively, as being key culprits behind their struggling health exchanges.

    Gov. Dayton's letter, released to the public on Friday, addressed IBM's Curam software, which was supposed to determine consumers' eligibility for Medicaid and premium tax credits for private insurance. Instead, problems have left some applications in "pending" status. Inadequate documentation and duplicate applications have added to the challenges, forcing MNsure staff to spend thousands of hours trying to fix the system, he said. MNsure paid IBM nearly $4 million for Curam software, as well as services and support.

    IBM spokesperson Mary Welder said the company is working "aggressively" to improve MNsure. Matt Swenson, a spokesperson for Gov. Dayton, said that IBM last month sent more than 80 workers -- at no extra cost to the state -- to MNsure headquarters in St. Paul.

    MNsure may have to assume some blame for its current predicament. Since February 2013 the state exchange has served as its own general contractor after pushing the original contractor, Maximus, to a secondary role., according to documents provided by an MNsure spokesperson. Maximus selected IBM and other software providers before designing the exchange. Taking on the general contractor role, which includes managing the integration of various private insurance and government systems, is a tough task; the Centers for Medicare and Medicaid was heavily criticized for electing to run the development and integrate HealthCare.gov. The site was plagued with a number of technical problems for months after its October 1 launch.

    Michael Krigsman, CEO of IT consultancy Asuret Inc., who reviewed Gov. Dayton's letter at CIO Journal's request, said it wasn't clear whether MNsure's problems lie with IBM's software, or the way it was integrated. "The fault could be with the system integrator," said Mr. Krigsman.

    The exchange has asked Optum, the parent company of QSSI, which is currently managing HealthCare.gov and Maryland Health Connector, to conduct an "end-to-end" review of the website and suggest fixes, said MNsure spokesperson Jenni Bowring-McDonough. She said Optum will assess the functionality of MNsure's software, the site's call center operations, as well how the agency works with its contractors. Optum will also provide a cost estimate for fixing the site by next week, after which MNsure could hire Optum to make some of the repairs.

    Meanwhile, Minnesota is conducting its own assessment. On Tuesday, Jim Nobles, the state's legislative auditor, began scrutinizing other vendors involved with building MNsure. Mr. Nobles did not respond to a request for comment Wednesday.

    A significant revamp of the exchange is unlikely. Replacing software designed to meet Minnesota's state requirements for a health exchange and integrate with multiple government database is no easy task, said Mr. Krigsman. "Do you keep your existing investment, or start over?" Mr. Krigsman said. "There's never enough time to get it right, but there is always enough time to fix it."

    During a MNsure board meeting Wednesday, MNsure interim CEO Scott Leitz said that nearly 72,000 people have enrolled through the exchange since Saturday.  He said MNsure is hiring more call center operators and processing more paper applications to allow as many consumers as possible to get coverage through the end of the March 31 open enrollment period. But he said that despite the extra help MNsure won't have the "ideal system" by March.


    Analysis: Health Exchange Mess Part I: Failures in leadership | killexams.com real questions and Pass4sure dumps

    In a two-part series Thursday and Friday, retired auditor Charles Hayward (full bio below) delves into the problems that led to a disastrous launch of the Maryland Health Benefit Exchange in fall 2013. Among the chief failings of state leadership: not addressing serious red flags when there may have been enough time to fix the root causes; not appreciating the monumental tasks assigned to limited resources; and not selecting one IT expert to take leadership on the website’s development. He writes that by September 2013, project control was lost, a perfect storm had materialized, and officials crossed their fingers, hoping for a miracle at launch. As the smoke clears, taxpayers will underwrite hundreds of millions wasted.

    By Charlie Hayward

    CharlieHayward@MarylandReporter.com

    Whenever ineffective planning, poor judgment and lousy communication intersect with really bad technology in a large-scale, high profile, IT development project, a “perfect storm” of catastrophic failure is the predictable result.

    Studies of IT software-development failures show the deadliest of all risks for large software projects is the “big bang” release—like the one the state of Maryland chose to implement in 2011 via its Health Benefits Exchange when it finalized plans to launch, all at once, a versatile, multi-purpose Health Information Exchange website.

    In the first of a two-part assessment, we will examine the roles and responsibilities of the principal parties, and take an objective look at what was happening inside the exchange. Next, a brief commentary on the administration’s overwhelming desire to enroll as many people as possible and the costs of doing so. Last, we will list some of the key winners and losers and consider the effect on the state’s reputation from the first year of Obamacare implementation.

    Distinctive Responsibilities—The State, the Exchange, and its Contractors

    To objectively understand failure when multiple parties are involved, it is vital to appreciate the distinctive roles and responsibilities of the three principal entities: the state, its newly created exchange, and the contractor, Noridian Healthcare Solutions.

    The administration of Gov. Martin O’Malley alleges contractors are to blame. That is correct, but those allegations are misleading by omission, and they suggest a lack of introspection regarding the root causes of the problems.

    Contractors’ deficient work is easy to visualize—they were project and programming experts who wrote the computer code and provided the “commercial off-the-shelf” (COTS) application from IBM/Curam—both of which failed in spectacular fashion. In contrast, the state’s overarching role and responsibilities were less visible (and more intangible) elements of success; much harder to grasp, yet vital to a successful launch.

    Sandwiched in between the state and its contractor, was the exchange. The exchange took direction from the state (via Department of Health and Mental Hygiene) and managed contractors it hired. The exchange was a small entity staffed at first (Fall/Winter 2011) with a handful or so of bright people trying to ramp up to about 50 employees in a hurry.

    Pearce highly qualified

    Its first hire was Rebecca Pearce, who was highly qualified to lead the exchange although she was not an IT expert. Her role was to breathe life into a new organization and, in doing so, she would be buffeted during the startup period (2012 -2013) by immense changes, as would any complex entity. The exchange was constantly in hiring mode. It was setting up internal operations departments, such as HR, IT, accounting, budgeting, marketing, customer outreach. It was setting up internal controls within those departments.

    It was singularly responsible for negotiating “Memorandums of Understanding” with six to eight different state entities who would become its business partners. It was establishing ground rules with three federal regulators, each of which was susceptible to releasing hundreds of new requirements at any time. It needed to set policy supporting Obamacare implementation.

    Exchange staff met regularly with officials in the state legislature to assist them with writing three major laws; one each in successive years. It needed to establish procurement and other administrative policy. In addition to its state business partners, it was working with a half dozen other business partners whose operations spanned the entire state in order to plan Obamacare implementation and establish networking and collaboration arrangements.

    For instance, the exchange was working with grassroots entities (mostly nonprofits) who would ultimately assist with program outreach to potential enrollees. It was working with the state’s pre-existing network of insurance brokers about their roles in selling products. It was involved with helping to implement which insurers would become qualified to sell products on the exchange.

    Judging from the evidence, the exchange and its small staff did a remarkable job, except with respect to the website platform.

     Meanwhile, the state’s big-bang vision posed a major risk of a big-bang-boom outcome, assuming the best contract management practices and system-development principles had been followed. The state wanted to lead all others in Obamacare implementation, so it conceived of a website with all the bells and whistles; its leaders were seemingly oblivious regarding the latent risks attendant to its vision. Ultimately, the exchange never implemented the best contract management practices and system-development principles that would have given the project any chance of success.

     As the facts surrounding the website platform’s failure emerge, we will see a domino effect of separate (and successive) failures: State of Maryland ? Exchange ? Noridian. Gov. Martin O’Malley administration’s failures ultimately led to organizational and management breakdowns within the exchange. Ultimately, the state’s and exchange’s failures did not cause contractor failures, but they created the atmosphere which precluded the exchange from identifying the gravity of Noridian’s problems in a timely manner, and taking immediate and decisive action to ameliorate the root causes of the early warnings. Hence, the “perfect storm.”

     State of Maryland

    The O’Malley/Brown administration, including Secretary Joshua Sharfstein, M.D., should have known that the exchange’s workload was too much for its nascent staff to manage, and they should have taken decisive action after major red flags in November 2012 of impending failure. Specifically, these leaders:

  •  Failed to appreciate the drain on the exchange’s limited resources from the level of effort needed for exchange startup activities during 2012 – 2013, and the distractions these activities would create relative to the concurrent website platform build. See this chart showing milestones for the exchange’s myriad startup responsibilities. Sharfstein was aware that startup activities were, in fact, undergoing significant “mission creep” during these years—not captured in the chart’s static milestones.
  • Misjudged the risk in the website build. Either they did not fully identify specific risks common to big bang releases, or they performed risk assessments that were ineffective.
  •  Did not assure the exchange was supported by sufficient, qualified IT resources during the website platform build to properly manage and control that work.
  • The Exchange

    The exchange did not have a single individual assigned to manage Noridian’s work who was proficient with large-scale IT development projects who had ultimate authority and complete responsibility. The U.S. Government Accountability Office has been recommending this approach in countless reports over the last 15 years. (As an aside, the exchange will utilize this approach during the build using technology from Deloitte Consulting, which provided successful technology in Connecticut. Isabel Fitzgerald, the state’s chief IT expert, will manage. The role of Fitzgerald in the Deloitte build stands in stark contrast to the organization model existing during the failed Noridian build.)

    The exchange’s project management resources were spread among many contractors who were being managed by a diffuse control structure. Thus: roles, responsibilities and lines of authority became hopelessly blurred. And so it was no surprise that as the Noridian build evolved, communication broke down, critical-path schedules weren’t used, contractors set their own priorities and performed work in good faith but outside their contracts’ specifications.

    Endless meetings ultimately turned counterproductive, as the challenge of working with multiple contractors led to tradeoffs between resolving contractor conflicts versus fixing exchange bugs. Deadlines passed without remediation. Sheer chaos was pervasive in the last few weeks before website launch.

    The exchange’s key managers did not know what functionality the site would have as of the launch date, because time expired before platform testing was finished. Incredibly, they would rely on launch “glitches” to pinpoint the true state of functionality. They’d crossed their fingers and flipped the switch, hoping for a miracle.

    These conditions are apparent from BerryDunn (quality assurance contractor) monthly reports issued during the website platform build. They are the logical result of the O’Malley administration’s leadership errors described above.

     Contractors

    Problems between Noridian and its subcontractor EngagePoint, Inc. are well known. So too are the major dysfunctions within the IBM/Curam toolsets, business processes, and interfaces at the core of Maryland’s website platform. Noridian claims its problems were partly attributable to changes in federal requirements, particularly Jan. 17, 2013 release by the Centers for Medicare and Medicaid (CMS) of 70 business functions that the website was required to achieve.

    But Noridian should never have bid the work without fully appreciating the major risks inherent in Obamacare implementation, particularly HHS’ episodic, last-minute changes flowing down into Maryland’s website specifications. Other states faced the same changing specifications and their contractors succeeded.

    Noridian owned these problems because it bid the work and signed the contract expressly requiring it to bear a high degree of performance risk. As such, Noridian was responsible for fixing its problems. Absent Noridian’s fixes, the state was responsible to replace Noridian and execute contingency plans or risk catastrophic failure. By the time these options were clear, the exchange was trapped like a deer in the headlights; it had no contingency plan. It was too late to do anything.

    Success—At what cost?

    By most measures, the O’Malley administration succeeded in its goal of maximizing enrollment, having comfortably exceeded its downsized goal of 260,000 sign-ups. In the process of enrolling somewhere near 300,000, Gov. O’Malley, Lt. Gov. Brown, Dr. Sharfstein (Department of Mental Health and Hygiene head) and key people in the exchange arguably suffered from a severe case of tunnel vision.

    In the aftermath of O’Malley’s decision to scrap the website platform and award $70 million or so of no-bid contracts to Optum/QSSI and Deloitte Consulting, the state legislature and taxpayers are asking about accountability for—let’s call it $300 million of sunk costs, and counting. Who is to blame and what will be their fate? Will there be restitution?

     Winners and losers—and reputational costs

    The newly insured are winners, particularly those covered by Medicaid’s expansion. About 96,000 people covered under the legacy Medicaid program were automatically enrolled in expanded care (i.e., non-emergency hospitalization) that was unavailable under the old Medicaid program’s primary-care benefits.

    And a new cohort of Medicaid beneficiaries — the exchange doesn’t have final numbers, because the website failure caused many applicants for Medicaid expansion to be put in a queue, pending results of case-by-case eligibility determination at a later time. So the enrollee count seems to be somewhere between 132,000 and 150,000.

    Still another cohort of winners (63,000 as of April 4) has purchased subsidized insurance under private plans sold in the exchange. Many will learn, however, that subsidized premiums are affordable but the health care itself is not—once the bills for deductibles and co-pays come due.

    The clear winners also include many high-priced “white shoe” consultants who were able to capitalize on the exchange’s failure to implement and operate the software infrastructure it contracted to build. Possibly the biggest winner may be crowned in years to come: the tort lawyers.

    The losers include people who formerly were insured for lesser coverage, but were required under threat of penalty to buy more expensive coverage, exceeding their needs. And then there are the people who simply decide against any of Obamacare’s options because they have better ways to spend their money. They will be required to pay the “penalty-tax.”

    Probably the biggest losers are thousands of helpless taxpayers who paid for the dysfunctional site and the many cascading effects (described in the second installment) associated with its failure. Those taxpayers then paid to keep the website open long enough to limp through the first year’s enrollment.

    Then they will now pay Deloitte and others millions to (1) plug another state’s solution into Maryland’s milieu, and (2) reconstruct a single database of record—from information that is now spread over mountains of paperwork from manual workarounds or are unsalvageable or hopelessly irretrievable from Curam.

    Obamacare so profoundly changed the insurance landscape that government entities have commandeered the role of selling insurance products formerly held by the private sector. A private company has a good reputation when it consistently meets or exceeds the expectations of its customers. A bad reputation results when the organization’s words or deeds fall short of customer expectations.

    How would people view the credibility of state leaders if they were private-company executives engaging in the kind of tunnel vision, poor planning, mismanagement and spin, described above?

    Charles Hayward spent more than 30 yers performing Government Accountability Office full-scope “yellowbook” audits and served as a partner in two accounting firms. He retired in Nov. 2007 from Cotton & Company LLP, where he was a partner and principal financial auditor of the firm’s audit practice group. He led audits of many federal agencies, including the U.S.Department of Justice, Department of Commerce, Government Accountability Office and the Small Business Administration. He earned a bachelor’s degree with honors in Business Administration from Bowie State College, and attained every auditing-related certification, including CPA, CISA, CFE and CGFM. Since retiring, he has worked on a few consulting assignments and been a contributing writer for MarylandReporter.com, specializing in audit coverage.



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