Transforming Medicare & Medicaid innovation

Summary

The challenge

More than 135 million people rely on the Centers for Medicare & Medicaid Services (CMS) for their essential healthcare coverage, and CMS programs reach every community, demographic, and healthcare delivery modality in the U.S. Their vast scope gives them a unique vantage point to observe and assess the effectiveness of healthcare nationwide. For CMS, the impact of every small choice is magnified — a tiny inefficiency can lead to trillions of dollars wasted, while a new treatment breakthrough can benefit thousands or tens of thousands of people.

CMS created CMMI to assess healthcare innovations in an effort to improve outcomes and lower costs. Across CMMI, teams conduct thousands of policy experiments, called “models,” applying rigorous research methods to try new techniques for healthcare delivery and evaluate their results. Models that are proven effective can then be rolled out nationwide, benefitting not just CMS program enrollees but all members of the public who access healthcare, including the privately insured.

Participants in CMMI’s model research are diverse, from financial analysts to policy analysts, facility executives, and healthcare providers. To adequately support the policy innovations they’re exploring, CMMI needs to provide model teams with highly efficient and effective internal processes and tools as they conduct their research, analyze their data, and share their findings. The unique needs of each participant group and the speed of innovation at the heart of CMMI’s mission demand sophisticated and adaptable technology solutions, particularly as model teams increasingly look to leverage the power of data analytics. This has spurred unprecedented growth in CMMI’s IT systems, pushing their capabilities to new limits.

To meet this challenge, CMMI is looking to leverage modern digital delivery practices such as service design, human-centered design, lean-agile engineering, and DevSecOps to keep pace with the demands of model teams and their participants. They also want to strengthen the lean approaches and organizational agility that will allow their program as a whole to respond effectively to changing requirements and new discoveries.

The solution

Skylight engaged as a digital transformation lead subcontracting to NewWave under IDOS, part of a plan to implement modern product development practices based in discovery, research, and lightweight iteration throughout CMMI. We followed a structured plan, understanding the current state, providing general practice enablement, demonstrating how human-centered design practices can uncover actionable insights about specific user groups, and implementing new designs to improve usability of critical systems.

We started with a baseline assessment of CMMI IT platforms, scoring each one on its level of maturity across several fields, including use of human-centered design practices, adoption of lean/agile and DevSecOps techniques, and other metrics. We aimed to understand how each platform was built; what technical debt existed; how the platform satisfied user needs; the user’s experience with a platform and what (if any) modern development and deployment practices were employed. We conducted assessments over a period of several weeks by interviewing CMMI stakeholders, IDOS product managers, and development teams, and then synthesized results into actionable reports using a standard rubric. These assessments provided the IDOS team and CMMI a baseline from which to monitor modernization efforts in the future and to understand opportunities for modernization, improvement, and consolidation.

Next, we provided digital transformation coaching support to all IDOS platform teams, targeting areas identified as most in need through the platform assessments. We conducted platform-specific workshops to educate teams and CMMI on modern digital delivery practices and help build practical plans for moving away from waterfall-style development. For example, we worked with the Salesforce Connect team to map out a user research plan that resulted in interviews with multiple medical providers. These interviews helped CMMI better understand user behavior.

Model participation is largely voluntary, so the usability of our systems is important both for retaining users and establishing CMMI’s reputation as an innovator… The Discovery team pierced through five layers of administration/relays; they revealed insights on what users actually want that CMMI had never considered, and had no structural incentive to find out.

IT Advisor, CMMI

We also conducted research with representative users of CMMI’s Enterprise Data Management Program (EDMP) to help CMMI better understand user behavior, engagement level, and how EDMP might help future model teams and participants. We developed interview guides, conducted user interviews, and shared synthesized insights to inform the platform design. These insights helped illustrate the implications of design choices and allowed the IDOS team to better align their designs with user research findings.

Our user research also resulted in new user interface designs for CMMI’s Centralized Data Exchange (CDX), a critical data hub intended to be used across model teams. One team, the Emergency Triage, Treat, and Transport (ET3) model, was able to adopt CDX for its critical work to optimize care provided by medical first responders. The improved CDX allowed ET3 more accurate and timely analysis of data, furthering their mission to improve quality and lower costs by reducing avoidable transports to the emergency department. CMMI’s investment in modern tooling and a human-centered design process makes data-driven decisions possible for ET3 and other model teams.

By investing in practices that put their users’ needs at the center, CMMI can start to answer key questions about the people it serves. And by involving multiple teams across the agency, they can collectively define sustainable research methods and use shared insights to break down organizational silos. Ultimately, a more human-centered CMMI will ensure their experimental models are set up for success, giving everyone in the country an equal opportunity to receive quality, affordable healthcare through sustainable provider practices.

The results

• Provided baseline assessment results that IDOS leaders were able to use to prioritize future improvements
• Initiated modernization plans with multiple teams
• Created user research plans and interview guides, conducted research, and synthesized findings
• Delivered new user interface designs that increased adoption of critical model team support services