Henry Chao is currently the Chief Strategy Officer at Sparksoft. He is also a former CMS lead who spent more than a decade with the Agency as Deputy CIO and Deputy Director, Office of Information Services; as the CTO; the Deputy Group Director, Information Systems Design and Development Group, Office of Information Svcs; and as the Systems Implementation manager, Medicare Advantage and Part D, Office of Information Services. He is also the author of a new book, ‘Success or Failure? The Untold Story of Healthcare.gov.’

FedHealthIT spoke with Chao about why he wrote the book, who it speaks to, and the bigger message.

Why did You Write the Book?

In a LinkedIn post, Chao writes, “One of the reasons I wrote the book is to offer my experiences and hopefully provide insights that have not been shared. Maybe in some small way getting people to hear the untold story will open their hearts and minds to accept that there are facts, truths, and information that still need to be known. The other reason I wrote the book is to satisfy a personal challenge and commitment to document what really transpired. My experience felt incomplete without getting some narrative written down.”

He also told FedHealthIT that he wanted to provide insight and an alternative look at ways large, complex national projects, in particular at CMS, are conducted. “I spent 10 years focused on Medicaid and seven years on Medicare Part D implementation. There isn’t often the chance to progress into the next big project with time spent focused on lessons learned.”

Chao says there are complexities within Government that are not discussed including taking on the existing complexities of established, institutionalized processes that don’t work well for something new you are trying to accomplish. This entails some level of risk-taking and challenging the established ways of doing things. “I’m not advocating blind risk-taking or reckless disregard to potential consequences but rather, a form of cautious risk-taking that recognizes the context in which you have to operate and where in that context could you actually make incremental, meaningful changes that helps with your objectives.”

Chao says that nearly every leadership course he has taken while in the Government discussed themes such as “fail early and often” but, as with any difficult situation you might find yourself in working on, facing potential failure, real or perceived, is something no one will receive absolution in advance for. “In any large, complex project in the Government some part of the project will stumble and have adverse effects. Your job as a leader is to always anticipate and to quickly assess and determine options, accept that not all options are necessarily going to be good options, and continue to execute in order to make forward progress.”

In any large-scale project involving some form of change or transformation such as with Insurance Marketplaces under the Affordable Care Act (ACA), he says, you don’t have the luxury of working with a clean sheet of paper and not have to factor in the existing programs, business processes, operations, systems, and data that already exist. The result, as with HealthCare.gov, may be a new program or new way of doing things but we don’t consider the massive amounts of business process reengineering and numerous systems, data, and process integrations that had to be accomplished before that online experience could be realized.”

Working on something totally new will always cause some level of disruption and need to confront existing technical debt with what already exists, he says.”

He notes other pressures such as inflexible deadlines established by decree and/or legislation. “Delays and problems with rollout of any system is never completely rooted in technology issues. The more enlightened approach would be to holistically examine what it takes to go from legislation to policy to requirements to implementation and operations, including factoring in other critical factors such as budgets, contracting, and implications of any new security and privacy requirements. Unfortunately, a more holistic approach to examining major rollouts is not discussed as often as it should. What tends to happen is that a disproportionate amount of attention and discussion is focused on technology issues, which has its fair share of challenges but isn’t the root cause of all the challenges.”

Who is This Book For?

Chao says he hopes his book will be of interest to a range of readers from Healthcare, Government and industry in general, really for anyone building anything. “When you’re working in the storm of a project, it can be hard to maintain the proper perspective, to understand the balance between the myriad of priorities that drives the need for something new, accounting for the necessary integrations with what already exists, meeting global and unique security and privacy requirements, and the frenetic pace of constantly changing minimum viable product (MVP).”

What are Some of the Takeaways?

“I hope to give people a healthy appreciation for working in the public sector, for the impossible deadlines that are imposed.”

He says he wants people to understand they have to season some of the news they read with an understanding that those in the heat of it are working against budget and timeline challenges while still trying not to sacrifice accuracy for speed.

“I want people to understand that when you are committed and there are no good options, you still have to find ways to make things happen. I hope through this book to provide deeper understanding and to change the hearts and minds of some people who may view the whole process more simplistically than it should, meaning it’s readily acceptable and perhaps even more interesting when there’s news of a technical failure, rather than a failure of the policy or process, which success or failure is equally dependent upon.”

Is There Anything People Would be Surprised to Know About You?

Prior to my 21 years at CMS,I spent a decade in the Navy as an Aviation Electronics Technician.

Henry Chao’s book is currently available on Amazon. He will be taking part in an upcoming CMS Focused Master Class (BLT) Training Seminar and Workshop led by former CMS leaders who are experts in their respective areas. More about the event is available here.

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