State of Minnesota

The following entry is a record in the “Catalogue of Catastrophe” – a list of failed or troubled projects from around the world.


State of Minnesota – USA
Project type : e-Commerce marketplace
Project name : The Affordable Care Act – MNsure
Date : Jan 2014  Cost : In the region of $150M USD

Synopsis :
In Oct 2013, President Obama’s Healthcare.gov website caused a stir by becoming the year’s biggest troubled IT project story.  What got less attention was the fact that some of the US States had elected not to use the federal Healthcare.gov website to implement the Affordable Care Act (ACA) and had instead decided to develop their own. While some of those projects were successful, reports are now emerging of how the system developed for the State of Minnesota encountered its own set of problems.

While the Federal government chose to develop a bespoke health care market place system, Minnesota selected a package system offered by technology giant IBM (International Business Machines).  The “Cúram Solution for Healthcare Reform” is a package specifically designed to help states implement the ACA requirements without the need to develop their own system from scratch. It is an appealing option. Starting with a packaged solution can dramatically reduce risks as the development effort and presumably testing will already have been completed. Also buying an off the shelf product helps share costs with other customers, thereby offering the hope of reduce costs as well.

Based on the Cúram product the “MNsure system” was intended to bring the state of Minnesota into compliance with the federal government’s ACA requirements and ensure that residents of Minnesota had access to the health care insurance products they were entitled to. As with many large IT enabled projects a number of contractors were involved. According to reports, Maximus from Reston, Virginia was the prime contractor while IBM provided the Cúram base system that determined whether applicants are eligible for public programs (e.g. federal tax credits to help offset the cost of of the private insurance available in the marketplace). Other organizations then provided other components such as the e-commerce shopping components and billing. EngagePoint of Fort Lauderdale, then acted as the system integrator, validating end-to-end functions.

Unfortunately, as happened to the federal government’s Healthcare.gov system, things did not go as smoothly as hoped. Following the Oct 2013 launch, system problems and glitches prevented Minnesotan’s completing their transactions. The problems continued into Dec 2013 and in a sign of increasing frustrations Minnesota’s governor Mark Dayton sent a “robust” letter direct to the IBM CEO requesting immediate action. That letter has now been made public and reveals details of the types of problems the Minnesota government was facing operating the system. The Cúram product is the focus of the letter, which alleges among other things that “the Curam product did not properly perform eligibility determinations or verify individuals’ application information, as required under federal law. The fact that this functionality was not working was known to Curam staff, but was not communicated to MNsure”. The letter then includes a 3 page long list of defects originating in the MSsure system that need urgent attention.

To IBM’s credit it appears they did respond swiftly to the Governor’s letter and did send an army of specialists to address the problems. However as with many such problems once they are in a system it can be a tough job to get them out. Reports from the Star Tribune in Minnesota indicate that problems with MNsure are continuing into January 2014.

Related story :

  1. Cover Oregon
  2. Healthcare.gov

Note: There are also reports of problems with the healthcare exchanges in Maryland and Hawaii (Maryland problems, Hawaii problems). If anyone out there has time to investigate feel free to share any lessons learned that might come out of those projects.

Contributing factors as reported in the press:
Initial enquiries by the Minnesota state government are now being conducted, however the Governor’s letter implies problems with: Requirements management, quality management and communications. Failure to appreciate the complexity of integrating a new system with existing systems. As an outside observer, I also wonder if Minnesota underestimated the risk. While Cúram may be an off-the-shelf product, given that the ACA requirements only came into effect in Oct 2013, it was an unproven product at the time that it was selected. There is a big difference between off-the-shelf unproven and off-the-shelf proven. It appears the implications of that gap may not have been fully appreciated.

Reference links :

  1. The letter to IBM’s Chairman, President and CEO
  2. Cúram Solution for Healthcare Reform
  3. MNsure’s website contractors draw 11th-hour flak
  4. Dayton slams IBM for failures with MNsure website
  5. The MNsure system website