By Julie Boughn

When you are on the “inside”, you think you know how things work on the “outside” – and you sort of do, but you really, really don’t.

Before I talk about those surprises, lessons learned, and lists of things I would like to do differently, let me give you just a little background. I spent nearly 29 years on the “inside”, almost evenly split between Social Security Administration and the Centers for Medicare & Medicaid Services. (Two agencies could not possibly have more different cultures!) For nearly all of that time, I was doing information technology (IT), procurement of IT or both, all in support of government health programs. Since 2014, I have been on the outside, supporting government health programs as a vendor and/or a consultant.

“What has surprised you the most?” is a question I get very often. Three things really come to mind:

  1. The degree to which bid decisions are made on the basis of perceived risk of the contract.
  2. How conversations about work share,as opposed to solution, dominate partnering discussions.
  3. RFPs are nearly universally terrible, business problem that the Government is seeking to solve.

“What would you go back and do differently?” is another frequent question. I will write about that at a future time more fulsomely, but the list definitely includes things to address my surprises.

Outsourcing risk?

As a government buyer, I thought myself very clever in including things like directed penalties, liquidated damages, and specific evaluation factors in contracting actions. Now I understand better the impact of the Government’s effort to outsource risk in these ways. Smaller firms obviously have a harder time taking on significant financial risk, and I have seen more than one decision not to pursue an opportunity, not because a solution was not available, but simply because the risk was thought to be too great. This is not just an issue for small firms either, as supposedly “deep-pocketed” large vendors will often walk away from deals for the same reason: too much risk.

Government buyers should always understand who they are chasing away from their problems and give a great deal of consideration to when and how much risk to outsource.
In one recent example from a government health program, the agency’s RFP asked for implementation of a system to collect and calculate clinical quality measures using standards that don’t quite exist yet and on a timeline that was incredibly aggressive. Add in the directed penalties (and the less than 3-week turnaround time for proposals), and the agency practically guaranteed that qualified vendors would be watching from the sidelines. Government buyers should always understand who they are chasing away from their problems and give a great deal of consideration to when and how much risk to outsource.

Partnering to deliver a better solution?

As a government official, I had more conversations with my contracted vendors along the lines of “I’m really disappointed that you don’t seem prepared to actually deliver on what your proposal said you would do.” I never want to be on the vendor side of that conversation! So I always, always want to talk about solution and delivery when we consider proposing and partnering. Exactly what are we planning to bring to the government? How will the operation work? What systems and business processes will we put in place? How will we meet the time lines the government is asking for?
Yet so many discussions seem to center around which team partner gets what share of the ultimate work, not on the solution the team will bring. And that work share extends to sharing the risk as well. As a government buyer, I might do more to influence partnering decisions either by explaining the resulting business operation more explicitly, or perhaps by making the pieces of work in the solution more explicit.

We really are in this together

The one thing I always assumed as a government buyer I have learned is universally true. Vendors, specifically the people that work for and with vendors, absolutely care about the programs they are serving and would like nothing more than to deliver an awesome solution to the government. That is a foundation from which to build more opportunities to work together to make the programs work for the populations they serve. Medicaid, Medicare, Marketplaces, Veteran’s Health, Military Health, etc…they are all so important. The more smart minds pulling together to make them work, the better.

Tell me, those of you who have worked both sides of Government Health IT procurement, what has surprised you the most? Connect with me on LinkedIn.



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