Project Failure Case Study; Maine's Medicaid System

Talk about a project disaster. As reported in an excellent article in CIO Magazine, the Maine Medicaid Claims System project is a case study of a project gone awry.

The project was undertaken to switch from their legacy systems to a new web-based system to process Medicaid claims and facilitate HIPAA compliance (Health Insurance Portability and Accountability Act of 1996). As a result of the failed project, Maine is now the only state in the union not in compliance with HIPAA.

System problems led to many claims ending up in limbo, leading to hundreds of calls from health care practitioners, nearly 300,000 patients being turned away, several dentists and therapists going out of business, and destroying Maine’s finances and credit rating.

So what went wrong?

Mistakes included the following:

• Deciding to develop an entire system from scratch using unproven technology, while other states built a front-end onto their legacy systems
• Caving to pressure from management to meet tight deadlines with inadequate resources instead of pushing for a realistic plan to begin with
• Failing to notice why other bidders either didn’t bid or came in way higher (a sign that the schedule was unrealistic)
• Hiring a vendor with no experience in developing Medicaid claims systems because they were the lowest bidder
• Not having a Medicaid expert on the team, leading to errors in judgment
• Underestimating the time needed to meet with subject matter experts
• Competing with another major initiative (a department merger) for executives’ attention and resources
• Skipping project management basics (including piloting, adequate end-to-end testing, staff and user training, etc.) due to looming deadline pressures
• Failing to stop, regroup, and analyze the risks
• Taking a “big bang” approach to cutover with no contingency or backup should something go wrong

Management’s response, of course, was to switch program managers, and issue stronger demands to have a smooth system, but none of the changes or demands made much of a difference. Consultants were brought in to prioritize the many problems, but still, the complexities proved too much. It wasn’t until a Medicaid expert was brought in that things began to gel.

Like many project failures, it’s easy to point to the project management (and certainly there are many shortcomings there in this case), but the organization must share the blame as well if it insists on unrealistic deadlines and leads by fear (fear of shareholders, fear of competition, fear of management, etc.). None of these variables can make an unrealistic schedule more realistic.

It's really very simple. Either adequate resources must be committed, the expectations lowered, or a more piecemeal approach taken (or all three, if applicable). In any case, the schedule must be realistic and risks need to be managed.

Here's the full article. It's well worth reading, as are the reader comments.

Maine's Medicaid Mistakes - Editorial - CIO