By Barry Rascovar
August 11, 2014 — For a 44-year-old, Josh Sharfstein has accomplished much: Baltimore City health commissioner, Maryland health secretary and chief deputy commissioner at the Federal Drug Administration.
Yet when Sharfstein leaves his state post at year’s end, his many achievements will be eclipsed by one giant failure: Maryland’s terribly botched health insurance exchange rollout.
This glitch-plagued rollout — the costliest debacle in Maryland state history — was a monumental disaster that should have been foreseen.
There were plenty of warning signs in the year leading up to the Oct. 1, 2013 enrollment opening. The exchange’s computer software immediately crashed — and remained dysfunctional for months.
To his credit, Sharfstein shouldered the public blame for this immense fiasco. The other chief culprits, Gov. Martin O’Malley and Lt. Gov. Anthony Brown, deflected criticism to protect their political futures.
Even worse, they connived with legislative leaders to cover up the true story by avoiding an in-depth accounting of what went wrong until mid-2015. This intentional lack of transparency and accountability will remain an indelible blot on the O’Malley-Brown administration. It will haunt both of them in the years ahead.
Sharfstein took the fall at legislative hearings. He was the only one connected with this ill-fated project to apologize and take responsibility for a truly screwed-up rollout.
It is ironic this happened on Sharfstein’s watch because he’s known as a hands-on micro-manager who drives underlings crazy with his detail-oriented obsessions.
Loss of Control
This time, though, Sharfstein ran afoul of a bone-headed decision by O’Malley and Brown to set up the new Maryland health exchange as a separate, independent agency — instead of wrapping it neatly into Sharfstein’s health department.
That twist meant huge additional expenses — a separate set of backroom jobs had to be created and filled that could easily have been tacked onto existing services within the health department.
The biggest problem in giving the exchange its independence was loss of control.
Sharfstein never gained direct authority over the health exchange because O’Malley set up the new agency outside the health secretary’s purview.
Yes, he co-chaired the oversight board with Brown, but that group served as a rubber-stamp for whatever Rebecca Pearce, the insurance executive hired to run the exchange, suggested. The panel didn’t challenge her assessments — a serious mistake.
Even worse, there were no traditional checks and balances to make sure the pivotal choice of technology contractors didn’t veer off-course (sadly, it did).
Nor were the health department’s seasoned computer experts in position to monitor the exchange’s faltering software development.
The department was left on the outside with no authority to intercede or blow the whistle on the prime contractor’s inept performance and failure to meet deadlines.
Righting the Ship
Sharfstein, a pediatrician whose entire career has been in government and public health, was ill-prepared to act as overseer of a highly complex information-technology project.
But as an experienced manager, and with a wealth of IT expertise available in his department, he probably could have avoided the computer crash that proved so costly.
To his credit, Sharfstein accepted responsibility for the disaster. He worked tirelessly to find a work-around and a fix (the first succeeded, the second didn’t). Now the old exchange system is being junked and a new one that is functioning well in Connecticut is being superimposed — at an enormous cost.
The health secretary will stay on to see if this latest stab at building a health insurance exchange works. He wants to walk away without leaving a health exchange headache on his successor’s desk.
That determination says a lot about Sharfstein’s commitment to righting the ship.
He can take pride in the fact that despite horrendous obstacles, over 400,000 people (mostly Medicaid recipients) signed up for health insurance through the exchange. If the Connecticut software system works in Maryland, that number should grow in Year Two.
Moving to Hopkins
We haven’t heard the last of Josh Sharfstein.
He’ll take up residency at Johns’ Hopkins’ Bloomberg School of Public Health as an associate dean with a full workload, but the urge to serve the public could lure him back, especially during a Hillary Clinton presidency.
If that’s the case, he’ll still have to explain what went wrong that led to Maryland’s costly health exchange snafu. It’s a scarlet letter he will wear, whether deserved or not.
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