The unexpected risks are, naturally, unpredictable and potentially more worrisome, Frizzera notes.
There will be a marathon of testing and fine-tuning during the next few days as developers and stakeholders work out the known kinks.
"It's completing the final rounds of testing, it's preparing our production environments, it's thinking about day-one readiness from an operations perspective. Lots and lots of late nights and weekends as people get ready for go-live," says Patrick Howard, who leads Deloitte Consulting's public sector state health care practice.
Part of the crunch is due to tight timing.
The healthcare exchanges are the cornerstone of the Affordable Care Act, President Obama's health insurance reform legislation enacted in March 2010. Since the passage of the law, government agencies, contractors and private insurers have been working on the design of the insurance exchanges. But implementation has only begun in earnest within the last 12-18 months.
"It's a relatively short implementation time for such a big project," says Frizzera, who was responsible for executing the design and implementation plan for ACA while she was at CMS (she left the agency in 2010).
"I think everybody would have liked to have more time," says Deloitte's Howard. "More time is always a good thing. That being said, the majority of systems I've been exposed to are very, very stable and ready for day one."
Deloitte was hired to build healthcare exchanges in Washington, Kentucky, Rhode Island and Connecticut -- four of the 16 states that opted to build and run their own exchanges. Seven states are partnering with the federal government in a state-federal joint effort, and 27 relying on the federal government to operate their exchanges.
Leading up to the launch, "there has been rigorous testing of these exchanges, starting as early as May in many states," Howard says. "We're talking about thousands and thousands of scenarios."
"The states are very prepared," Howard says, "but with all that said, if you tested for two years, you're still going to find things in real life that you just didn't catch, that you never expected to happen."
As in any typical tech-support scenario, "day one will be all-hands-on-deck, people will be watching carefully what's happening, there'll be operations rooms for every one of our clients," Howard says. If something unexpected happens, people will figure out what needs to be done to fix the problems.
Adding to the complexity of the marketplace launches are the transactions themselves -- shopping for health insurance is no ordinary ecommerce transaction.
"It's different from a typical shopping-cart experience when you add in the complexity of financial eligibility, determination of tax credits and Medicaid," Howard says. "That adds quite a bit that you wouldn't see in a normal shopping experience."
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