McKinsey CMS HealthCare.gov review

. .• . ,: ... ... ;-;,.. . ,;·. .. .. . ,,,.;• ..... •.·>.· ·.· ..... ... . . >.·i<·..:..... : . .;.. . :···, ..;.· • • . .. ' : . ·.·.· . . ·. :··: . ·.· ...... , ,•:·. :.:·, .. : • ... ... .;.,•: ;... •\\·.·· · <·:0 : ,Y· :i .• · , .:,, ; .
________ _....,._
Red Team
Discussion document
·,;; .. :.; :•. : .: . .; /,·;·.' :. ; .·
Confidential and Proprietary- Pre-decisional Information
.. , •..   .· ·:· ...•: ·:·. . ·.·_. ••••• •: • . . :· .•:' .• ' .;.·.. ;:· ,. • . . ;:: .. ;. . .• .•.. . • ... . <:·.·: ·:::   • ',•.'•: ·':, •. . .::·: .·· .·
EC/0001
,,, Red Team overview, objectives, and approach
..
...
:.=

::
•l'.r-.·u"''' ""''" ..." '"'''· •; • '"'• ;;-.•, , .. ....,., ........ "'/'P...,_. .... ,,o'N .. .... ., ... .... .... • • •   <' ' ..,.., __ ,.,.,_. , . • • • • .,.,..., ..... , .,,.,,.. '•'· •,· • •..,, ..., .. •.... ,, ...., o1 ,, "·'•"'•'•'•• '" • ,,.,.,,,-,.,. ,,• ,,,J ,,•, ' . , , , ... ,,_,_,,..,_, ... ,, ...,,,,_.,,;.,I • ,•, • •..- o ....... .,,.._ . • ..,._...,_•.,, . ......,,....,. ''' ••'' .....:
1 The Red Team is:

1 • An independent team charged with "pressure testing" existing traj ectory of the
federal marketplaces
1 • Not a backwards looking effort or audit
• • • --•·-· • ... ·.·.>'n w• ;.• 'v--"·' •·· · ·· . . • v ...•._ •. .,_.,.,,. .. , .. v •. • .·••,••.·•• ._.,._,.,.- ••· • • • • • • ...,_ ... , .. • -·• • • • • • •h'-'
Objectives _A..:..p..:..p_ro_a_c_h _______ ___ _
8 Develop a picture of the Identify consumer paths;
planned consumer experience review and modify vignettes
.. -·· .
over the fi rst year ._,:=-· ·• ;. •
- -· ...
8 Identify risks and threats to that
picture
0 Identify current and possible
additional ri sk mitigation
options
.., ........ .
• t w ..... ."
Define stages of the journey
and risks to each stage
Identify mitigation steps
taken and other options to
consi der
Confidential and Proprietary- Pre-decisionallnfonnation
. ,_... ..... .
1
EC/0002
of the Red Team sources of insight

·:
.::
/


, .'0.'\';\','#01Voo .... U o .. ,.,.ov , , ,,,\.,,. V
.;.;. ..·, ' .···

,,• 'I.V'; • .,, ... H• ................ , .. , ....... . ....,...-.. • • • • ,_..,.,,, • ,,.., ,. '•'·" • .,_,,,.,.,

i • Reviewed 200+ documents and artifacts, including
r operational designs and reports, implementation plans,
;
i workload forecasts, contract-rel ated documents, and
'
management reports and schedules

}
I • Interviewed -40 people across 6 CMS/HHS Offices,
1. Centers, and FFRDC and Federal partner agencies
i Participated in select meetings and working sessions,
i including weekly operations meetings and OI S working
'
i sess1ons
j
• •,.,.. •       • •       • • • • • •   • • • •• ,..,..,., • .,. •'·'•' '"' ...........·... -.• ,.,.,,_. Yo' y• ...,.,...... • ...... ., •••••,•.•-. • '"· .,,.,.., • . ., ... .... , . •.• ., •• ,. •.,.,. , .......... ,,,.,.,,.,.,..., . .•••..••.· ., ..• "' ,, ••,.., ••••..._. . •
Confidential and Proprietary- Pre-decisional Information
·.·· ··; .... ,, ... ,.;
2
EC/0003
..... , .·.: ,., ..· ..
Implementing the health marketplaces is a unique
·.challenge in magnitude and complexity
.-:../ _.....,_____ . ... lt.o ...... - ... ,.._ .. _,_ ... _i .....___ _, __ ...
Buyers and sellers ·
Employers
: . .
j: ::
 
; .
i !: ·: .
. ' :
!.. .................. ................... .J . i 1
Assistors
• 4 • .- ,;' •
Example influencers and partner agencies ·· : :· : · · ..
. . '
Federally facilitated marketplace · . · .
'Channels:
t•4: ·,;; ... , ..
Website
Call-center
·'

Man'·
Infrastructure:


Data
exchange
Identity
mgmt
Manual
processing
Plan
mgmt
Privacy&
security
Call center
operations
.. '


: :
... ,. :
!
. · Navigators Brokers/ Certified Educating and certifying Launching at scale from
··· agents counselors assistors for enrollment day one in all 50 states
;' .. .. .. .... .. .... .. .., .. .... .. ,, ... , ... .......... Confidential and Proprietary- Pte-decislonallnfonnation
.. ..... . - ·. .
Interacting, ali gning, and
integrating multiple very
large organizations wi t h
potentially different
definitions of success
. · ·.; State
.::·.; ·' .....
managed 1· •
marketplaces j • :
.
State
partnership
marketplaces ! ; ;
. • :;t' State
:-.· ... .....:·x
departments
j of insurance
•
Supporting a complex
and flexible state
marketplace and
partnership model
3
EC/0004
..

.·,I '
of this type ideally have a planning_ , design,
--· implementation process with significant testing and revision
_____ & __ .,. __ __ _...... _ _ , _ ___ . .........
.. ; . "' .. . . ...
·(i

Ideal large-scale ·program development . , . · · Characteristics of this program .
·::' j
;;: ! $_t.fJ.rt ...... ....... ---------..       l $tc:Jr.t ___.......... . ..  
j Define ! Define .. ..... ,
l policy I i policy I
. \ requirements 1 requirements
:: 1
i .. . .• .....: ..
. , ! Desagn 1 Design . .r Limiieci ..
1 1 l end testing. \
·:: ! .I ! Testing will
,., j Build [ Build I continue to be
: l l j
!. ,.._ I           ........ ,J
; I
l liest ... Gradua', 1 :.: ,_ liest • • •• ·., Launch : ·.
; ! ' (,.//.: ...;.··:!-¥..: >":., ·• i
·' [ launch t . ....... "'l: -- at scale l
' l,..,.,,, .. ,._, .,.,,.. , ................... , .... • .,,,.,,,..,,,..,,v ,._.,,,, ..,_..,., .......... ..... .... _., .... ,_,;,, ... ....... ..... ., ......... ... ..,,, .... . . . .......... - ..... , ........ ! ;, .. _,,..,., . ..... ., ... , .;., ..... .............. , ... ., . ..... -....... ... ....... .,.,• ..- .......................... ,,,,., •••·• .................. . .... .................... , . ........ . .. •••• .... ,.., •.., ... ,;
n Description of ideal situation: Current situation:
• Clear articulation of requirements & success metrics • Evolving requirements
• Minimized dependency on third parties
• Multiple definitions of success
Sequential requirements, design, build, and testing
• Significant dependency on external parties/
• Iteration and revision between phases
• End-to-end integrated operations and IT testing
• Limited initial launch
contractors
• Parallel "stacking" of all phases
• Insufficient time and scope of end-to-end testing
• Launch at full volume
..
.
, ......... ..... ......... _.., ...
CMS has been working to mitigate challenges
resulting from program characteristics
4
Confidential and Proprietary- Pre-decisional Information
EC/0005
Example: Fully automated
:, :' ' o '" •a,oo •• • • • "• • • • • • • • ••• • ••• • •• • • • • • • • • • • • • • ''''''" ,.., "''", "' " ' "" •• • ,,,. •• " •Y • • • ''"' ' ' '" ••"'' ••••••••••,,.,..,,,, '''''''"'' ,,., ••••O· ••.••••••••" •• • •• • • •• ••• • • • • • • •••• "''''' o" "t tl • • I •• •:• ..""' • •••• · '''"'!"'·"" ''"" • •f o • • · •':''U!'f• ., " ' • ' ' • •• '' •• •••,• • •• ' "'' ' ' •• ''' '",.''' """'·' '''' ''" '.'.'." ·: :
Hypothetical consumer profile: Mike
• Mike is married with a two year old son, lives in Maine, and wants to enroll his family in insurance
• He works at an engineering company with 30 employees that does not offer employer sponsored
coverage and his household income is $49,000 (-250% of FPL)
• Mike has worked for the same company for 3 years and his household income has not changed
significantly in that period
Consumer Approximate
experi ence t ime required
.,.,... .,..,.,..,_, ____ ,_....,....,...,........ , .....,...... • • ,_,, • . .--.......... ..., .. .. . ........
.. t·: ... ,. -:o Mike contacts an
;<>I ft. i'·; : agent to enroll
. .... l m coverage; the agent
of. begins an application
online on Mike's behalf
... .......... ... ........ ·; Mike satisfies ID
! verification, residency
; status check, and
1 income verification
30 mins
5 mins
Consumer Approximate
experience t ime required
,,..,._,_,.... ............. , . ......,..,.,._, _,,.... ....., ..•.. . _.,...,_.,.. ..., ..._,. ......... ..... .- ......................
.... . ''"' ' 'i' •
.   ... The broker helps M1ke 30 minutes
:r; , .. t. select a plan and
.fi .: · ·.,.,.- enroll; M1ke makes an
1
.. .;; " r initial payment to issuer
................... -........... .....................................,...._ ..... _ .............. ....
Total elapsed time for
Mike to enroll
<1 day
Real time : Mike receives a letter from Goal: 1 - 2 weeks
1;!11 · ••••••:.· •• ·:.·.·.· .••·· : •••.. .. -. · : ... •.. .. - . • : the insurance company
; indicating his date of initial
..... .... ...... - .......
coverage
Confidential and Proprietary- Pre-decisional lnfonnation
5
EC/0006
:.:.


· Example: Manual (high complexity)
• • .......,...,W"""'__,.,_ __ .. • • • • • • • • ......................._.N;,...,._.,.,... __ .... •-.--.--,o., ..... • • • • • • • ___ .,_ __ .l'_• __ .-.-._ ..............
·.1.. Hypothetical consumer profile: Charles .. ,., ,, '·l
::! ...... part-time • . i
·· 1 • He recently left the military and no longer has insurance coverage through TRICARE
• Charles lives .in:Texas and would like to apply for insurance through the marketplace
!
• He has very little income budgeted for health care and wants to be sure he receives the full
amount of subsidy for which he qualiftes
' .... . - ............ w _ ........... ......... c.onsume·r--··· .. ··-··--· ....... N ... >X •• : .......... .......... ..... 'AJ)I>.roxim.ate ............................................... ...... c.ofi&ur:ne·;:-· .................................. ... , .. ; ............ Approxi.mate ....... .
  .. ........... .. ... . time required     ..................... ov.. • . •••     .... .
.. .. .......... • • '*' '''''';.
      Charles completes a paper
... application
·c.w,/ ........ · He receives a letter
.. _ ·! indicating he may qualify for
·· ·,-.: ., .. ·.:: · ··--... l Medicaid; his information is
•   sent to the Texas Medicaid
program
Charles receives
  i notification that upon state
  .. ; review, he does not meet
.. ._. ,v_,_,. ,,..
state-specific Medicaid
requirements, which he
forwards to the FFM
.. · .. · ·;;.... Due to a system lag, he
......
receives notification that he is
ineligible to buy on the FFM
because he appears to have
TRICARE
1
coverage
1 hour
3-4 weeks
3-4 weeks
1 month
·-·.
: He calls the call center to
! challenge the notification
: and is asked to send
documentation that he no
longer has coverage
.. it!V. _-;.;; l The FFM confirms his
1 eligibility and makes a
... :··:· .. ..... ,. .... : final subsidy determination
.... .... .: :; ...... :·:: ... ·:::::.:
Call center operator
helps Charles enroll in a
plan and he makes initial
payment
Total elapsed time for
Charles to enroll
... ' Charles receives a letter
-==--- • from the insurance company
; indicating his date of initial
1 TRICARE real-time checks may not be available on Day 1
·· · coverage
Confidential and Proprietary- Pre-decisional Information
Real time
3-4 weeks
Real time
13-16 weeks
Goat: 1 - 2 weeks
6
EC/0007
:'Complexities of the marketplace its implementation drive four
::: primary experiences for consumers enrolling on FFM
Jo.... V..._,N....,.____ ...,...........,.__   • • .....,.-----,_...___,.,. _ _..,., ______ ...._ ................
Description
Anticipated
time to
. enrollment
Assumed
· .. volume
!'<""""'''" .......
' ------ f ··-·· ---,
I Fully
i automated
.. 1
,
....... ·.' .;
;'' •M <-O.... .... ,, o• OOOoO """'  
• Single
interaction/
instant response
for eligibility,
shop, and enroll
I :
1 Automated w/ 1
i minimal manual !
intervention l
!. ............. ... .... ;.: ..., ... , ................ .., .•.,.· .•....•.
• Automated
enrollment with
manual follow-
up to verify
information
..........
I Manual (low
! complexity)
;
{ . . ...... .......... . . . ...... ... . ... ; ......... . . . .............. !
• 2+ interactions
with
supplemental
document(s)
needed
Manual (high
complexity)
;
\ ............. .................... ...... ., ........•. :
• Complex
manual
processing or
challenges
and appeals
• Same day • Same day • < 30 days • 30+ days
• 15o/o or Jess
• Document submission
required to extend
enrollment > 90 days
• 25% or less
,
. . .. . .. ... . . . .... .. . . ... . .... . .. . . .... .... ...... . .. ........... .. ...... ...... . .... ....... .... .
.
60°/o or more
' . .. . .... . ' . ' .. ... ' ' ... '.... ... . . .. . .... . . ' . .... . .... . .. .. ' ...
Note: Volume assumptions based on CBO estimates with adjustment for FFM share, resulting in 5M enrollees in individual market and 1.2M
.. .enrollees in SHOP. Volume numbers do not include expected Medicaid enrollees or exemptions. See appendix for methodology.
r ' --
r_ ( CI\JIS c -·d ,. I d ft • ta p d . . II 6. ,.
7
' .. N,. Oml en 1a an rroprre ry- re· ec1sJona nrorma 10n
EC/0008
..
:.;
Risk prioritizatio_n approach
...,.,._,....__ __   ___ .,_..,..___     ........ __ .... • • .._.. ... .... ..., ,H,.....     ...... • • • • .._.__._.......,_.......,_...._.Jn
·:: Initial set of risks
generated from:
• -200 artifacts
reviewed
• 40+ interviews
conducted
•
Baseline expectations:
Refine risks in the context of
expectations for planned
consumer experience
A Classify risks: Classify risks as either
V targeting a specific component of the
consumer journey, systemic/cross cutting,
or organizational/governance in nature
40+ targeted
5 systemic
13 most critical
risks
5 organization/
•
Prioritize risks: Identity top risks against the
following criteria:
• Limit ability to offer core marketplace
capabilities
• Significantly reduce consumer participation
or experience
• Absence of key cross-cutting enablers
Confidential and Proprietary- Pre.decisionallnfonnation
8
EC/0009
::.
..
:··
. . .
Most critical risks to marketplace implementation efforts-
: Core marketplace functionality I Experience and participation :
......w..-..- " N_ .. . • • • __ , __ 'OI"l¥"""""'N. .... ..,---..,.--.......,.....,.......,._.........,.._. , _o;M.o.o,j>,N-.o.... __,.-,,,O._.,_,.,.._,,_.., ... ________ _.. ..... ........,._...,..,.;,.,..
: Risk Root cause drivers
.r·--···e .... .. · ·
! !
·,·,, :,: "'' ""; N , Y h' N "' W o ... '" .., \.0 1<. • • • , •, • h" .; .,. or '" •o- ... r _. A .., • • n.., 'I' .. y _, .... '""" .,. "';, ,, " , , .._ '• , ., ... .,..., .......... ,,,...,,....,,..,.. .. ,,,,..,,, .,,;,,o.;H,V¥U '- "''• ' ""''"""'"'•-"'• "'•'- ... ,,,..,...,,,_.,,_ ,,,..,,.. .,.,.. , ,.,. .. ,,,,,,.,.,..
'!,[ G long manual processing times • Potentially undersized contractor eligibility support team
· o f • Potential protest of June 1st contract :·
:g
, c • Higher than expected manual processing volumes
:l ! . ' . ' ' . . ' '
1 8 Failure to resolve post-launch issues rapidly • Compressed testing window and volume uncertainty
''I ..!! l .... .... ............... _ .. ........................ ... ..... ................... ....................... .. ... _ .... .. .... .... an_d intra-agency response teams not yet in place
9 .. . ' .. .. .............. ' .................. .... ...... ' .. ' ...... -- .... ........ ' ' ....... " .. '
··   Q No viable marketplace in large-volume SBM • Large-volume SSM states (i.e., NY, CA) too big t o fai l
1
1
states • High risk of federaiiT/Ops resource overload if pivot
··! 42) , needed
! .... , .. .. ...... .. .. - ... ... .. .... ...... - - ..... ' ' . ..... .. .. .... .. .... - ' . ....... .. " .. " .. " . ' ' .. . .
... _.1
1
8
1
j' G Plans not approved and loaded in selected ...... ......... . . .. .. [)'()j ... -... ............ --· -
• SBM pivots may miss 4/30 data load deadline
J
, __ ..J • Issuers may not design and offer plans
• Data Hub I FEPS are single points of failure
• Limited end-to-end testing prior to launch
:··
....... .. .. ..................................... -....... :---.. .. .. ..
standards results in unexpected tax debt to • Subsidies calculated with less accurate income
; consumer and unrecoverable excess federal • Accepting business risks to meet deadlines
subsidies in 2015
l 't: ' .. .. ... ' ' " . .. .. .......... ' ' ' ' ' ............ - ...... . ' ' ' ' .. . " ............. ' ' .. .. ...... "' ........ . . ' ......... " .... " ...... ' . ' ... " .. .... ............... .. .. " .... .. - .... ' ' ' . ' " .. "" ......... .. ' ............ .
; &: ; e Inaccurate or incomplete financial management systems • Financial management system rel ease in December
! • Limited testing time and resources prior to launch
· ! 5i ; • Due to focus on enrollment, limited focus on financi al
·;j .. ,. """ _. • ' -" • ". " ' - • ·'•' "'" ¥ •·"'- ., . .. " ..... " "'' "¥ • "¥ " •ov ' ·" • ''"" " • .. •· .. " " , ._., • •· • '' ••     •" ""' • • "., •· " •• • • ,.. • '" '"'"" "•· •" • • •, •
':'_j i 0 No call center enrollment channel or long waits • Call center tools linked to enrollment IT systems
• Minimal integration/testing time prior to 10/11aunch
: ((. S • Significant risk of higher call volumes
· ···-... , Confidential and Proprietary- Pre-decisional Information
9
EC/0010
.. . . .-. .
Most critical risks to marketplace implementation efforts-
,. Cross-cutting enablers

. ___ .........._....._.___ .,..____ ........... ......_ ..,... _______ ....._,_ ____ . __ __
...: Ri sk Root cause drivers
,, . ..... ... .. ............................... ..... -.......................... ...... ..   .. .. .. .. ......... .
needed for implementation effort • No clear roles, responsibilities and processes for
making change
• No single empowered decision-making authority
• Lack of a "shared definition of success"
. ..... .. .... ....... ............. .. .... .. ... ......... ...... .. .... .. . .. . .. .... .. ...... .... ............................ ... .. -.. . .. . . _ .......... -.... - . · ····-····· .. ... ........ ......... .. ........ ........ .... ...... ........ ... .
8 Indecision about Version 1.0 requirements in select areas
',
• Less than 180 calendar days - design still presumed to
be open
• Drives development churn and compressed timelines
• Materially higher risk of system instability
.•. .. .. .. .. ...... .... .. ........ .. .... .. ...... -.. ..   .. . . . . .. .. .. ... .,
interdependencies • No end-to-end business process view across agencies .,,
8 No critical path transparency (inter- and intra-
agency)
C9 Budget uncertainty and timing prevents execution
of plan
.. ., . .... .
or fully within agency
• Difficult to identify/address critical integration gaps
• Lack of transparency and alignment on critical issues
• Critical path drives coordination of end-to-end efforts
• Lack of visibility into critical milestones across agencies ..
• Staff still engaged in program design
• Many functions are contractor dependent
• Core contracts not awarded due to budget
• Hampers ability to hire/resource critical path activities
.@ .. ..
.' C IVIS
...... ··- and Proprietary- Pre-decisional Information
10
EC/0011
Options that could be_ implemented to help mit igate key risks
::: ( 1' ) Align on initial release
· ·· and transition to

:·:
solving for stability
Take tactical actions in
targeted areas
• Prioritize and lock down scope for "version 1.0"
• Conduct fully integrated end-to-end test of version 1.0
• Continue to enhance plan to develop an "operations command
center" and response team
• Determine readiness of SBM implementations
• Mitigate risks related to Call Center and El igibility support contracts
• Define broker/agent and issuer direct enroll ment model
• Manage demand through targeted outreach
• Accelerate decision-making on using IRS tax data for verification of
income
,, •••• •• •• ,, , , , , , , o4 " o , " ,, ,, ,, ,, ,, •• , , 0 , •• ,, ,4 .. , , ,, ,, ,, •• , , •• •• ,, , . ,, , ,, 0 , o "",. , , o•C · ,, ,, ,, , , • • , , , • •• • •• , , ,, , . ,, , , •• I • , 1o , o o , , , , •· • • " •• , , •• ,, ",, o o " o o•" •• • • • • •• - " " •• • • • • • • •• • ' .. • • • • •• ' ' .., " ' ' ' ' ' ' ' '' ' ' •· •••• ' ' '" '''
(i Streamline decision
  making process and
manage critical path
.... . . ..,

, .
. . .......
":
. •'•'· ·
"·
• Name a single implementation leader (COO/DCOO) and implement
associated governance process to:
Manage critical path
Create transparency on critical issues
• Finalize budget and release funds
Confidential and Proprietary- Pre-decisional Information
11
EC/0012
areas where requirements need to be defined and "locked
down" by April 30 . .
Decision Description
'"· "'' ""'" ' ... , . ..... '"' .... ., . .,. ..... , , "' . . .. ....... ... ..... , ..... .. ·· ......... ...-.... ... ' ........... ...... .......... .... ' ..... .... . ..... .. .............. ..... ........ ' ..
;·
10 proofing (IRS)1
Household consent
(IR5)
1
Marketplace
operating models
Issuer direct
enrollment
Agent I broker
enrollment
• Requiring AGI as a shared secret will likely increase the amount of time
needed to complete an application for enrollment but will provide IRS
with more confidence in a user's identity when returning federal tax
information
• Current taxpayer privacy rules require identity verification for each tax
return that is retrieved to construct the household income and family size
• Determine how each marketplace operating model should function (i.e.,
SSM and different fl avors of partnership models, e.g., Utah) with specific
description of business rules for each marketplace variation
• Define entire end-to-end business flow (registration, authentication,
handoffs of information, types of data, SLAs) by which issuers will
direct enroll consumers into plans and
• Define process by which agents and brokers can enroll consumers
• AgenUbroker training and certification (for safeguarding Federal Tax
Information) need to be developed and implemented
Financial • All financials system management processes and calculations need to be
management defined including: APTC and CSR aggregations across exchanges,
internal accounting systems, monthly receipt and reconciliation of
enrollment reports, collection of marketplace fees, and payment of APTC
f; § 1 10 proofing and to be finalized by April 12
·           Confidential and Proprietary- Pre-decisional Information
··. · ' ··. . . ···: ..... .. ·. ' • ... ,·,• . ·.. .. . ... . . . . . ·,·,•
12
EC/0013

..
.•
::·.
• ,
:· ·. ·.· .. .. :• ..; .. •:·. ......... .; .·... · .
. :(3.--1 An implementation leadership team and a consumer
'· ...... .--- outreach team could drive implementation progress
. ··:. · .··.:···
:: :· ·.·
; : '.;'::;:.;·
: ,: .; . .·:· ..::? ' :
•• · ·• ·aesponsibil-
,: ' itiW.$·?? '': ::<· : ··<>
.. ..: .. :.::. ;>>: ·.;: . ...;. •
::•: .. ; , : · ·.·.• ·.;.·.·.· .·
··;:···::
·:,·=-:-=.
• Expedite decisions on critical path and Version 1.0
- If consensus cannot be reached, the leader will
decide or escalate
• Regulate issues affecting IT and Ops build
Reduce number of governance bodies to one
All decisions impacting bui.ld must flow through
this team
• Report directly to the Administrator and Secretary
• Brief White House on implementation progress
• Requests f rom policy staff must flow through the
policy liaison
• Track project status
from all stakeholders
• Create an integrated
managerial vi ew
across key
milestones
• Surface ri sks to
facil itate resolution
• Provide analytic
capability to support
rapid decision-making
Policy
coordination
• Coordinate with the
implementation
leadership team
• Drive consumer
outreach
• Coordinate
outreach efforts
across CMS, HHS,
the White House
and partner
organizations
•• ,, " .. . ...... .... . . . ... , ..... -· • •• ' • . • •,. . .. . . •• •• •• • • •• •" ... .. " .. . . .... .... ..... . . " • " .. . .............. , .. .. . .. . . .... . . . . ........ . . ... " ••••• , •••• • > ,, .. • • ••••• • • • . . .. . . .. - · . ... ,. •••• •. < < •
:.'<. ·'; >.:. • 1 representative each (CMS Administrator to select): • 3-4 dedicated FTEs • Sr. Advisor to the
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OIS - Regional offices
SSA - CCIIO
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13
IRS Confidential and Proprietary- Pre-decisionallnformation • Others TBD
. , .. .. . ..... .-.· . ....... ··.·:.·:::··.··
EC/0014
·.'
.. CMS needs specific from HHS and the White House to
successfully operationalize the marketplaces
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Critical action
1. Agree to lock down open requirements by 4/30
1
and
shift all other new requirements or changes to
existing requi rements into version 2.0
2. Implement new governance process to support
effective operational execution
3. Determine desired demand strategy
4. Align on shared metrics for success
5. Lock down all funding sources for year 1 operations
Distribute funds as early as possible to match
contracti ng schedule
Deadline
• Mon, 4/8
• Fri, 4/12
• Fri , 4/12
• Fri , 4/12
• Men, 4/15
• Ongoing
! 6. Communicate pivot plan to SBM states • Mon, 4/21
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· <(.(;.""S 1 10 proofing and household consent need to be finalized with IRS by Aprtl12
14
•• ·-·, . ..... ····M· Confidential and Proprietary- Pre-decisional Information
EC/0015
;.