Transforming how Medicaid and CHIP data are leveraged

Summary

The challenge

CMCS plays an essential role in supporting the nation’s public healthcare system: It’s responsible for developing policies and managing operations for the Medicaid and CHIP programs. Together, these programs provide more than 80M disadvantaged individuals (such as children of low-income families) with greater access to healthcare.

CMCS’ ability to deliver timely, reliable, and comprehensive Medicaid and CHIP data using technology and analytical solutions is critical to the success of its mission. To that end, CMCS depends on a $100M+ portfolio of systems called Medicaid and CHIP Business Information Systems (MACBIS). Collectively, these systems provide the infrastructure necessary for defining, collecting, and analyzing data related to Medicaid and CHIP, including claims, finances, and program compliance. MACBIS serves the needs of thousands of users and stakeholders inside and outside of government, from all 50 states to Congress. Integrated, high-quality systems are essential for delivering data and analytical solutions to these populations.

However, MACBIS systems have historically operated in silos, even though many serve the same end users and manage similar data. In addition, these systems were predominately being built and maintained using traditional software delivery and data management practices. As a result, MACBIS has suffered from:

• Lack of a cohesive product strategy
• Suboptimal, disjointed user experience journeys
• Low-quality engineering, including large amounts of technical debt
• Long release cycles
• Poor data quality
• Missed opportunities to integrate and share data

Recognizing the opportunity for improvement, CMCS sought out a partner who could help them unlock the value of their datasets through the adoption of modern digital delivery and data management practices.

The solution

To support the transformation of how CMCS manages and delivers its portfolio of MACBIS systems, our team, as a subcontractor to NewWave:

• Facilitated the co-creation and socialization of a playbook, similar to the U.S. Digital Services Playbook, that articulates a set of principles for thinking and working in more modern ways
• Designed and conducted maturity assessments to gauge the organization’s current level of proficiency with modern digital and data practices, and developed a set of prioritized recommendations for improvement
• Helped shift the organization toward a product-based approach to managing its portfolio of MACBIS systems, including the introduction of outcome-oriented delivery practices, OKRs (objectives and key results), product canvases, agile product roadmaps, and product health checks
• Conducted a service design engagement to map out the entire MACBIS ecosystem, which resulted in a service blueprint that highlighted how users interact with every system and revealed opportunities to address high-priority user needs across multiple program areas
• Provided various forms of coaching, training, and capacity building at multiple levels of the organization to accelerate the adoption of modern digital and data practices

Through our support, we helped jumpstart CMCS’ adoption of modern digital and data practices. By doing so, the MACBIS program is now better positioned to leverage data in a way that ultimately improves healthcare outcomes for the millions of people who rely on the Medicaid and CHIP programs.

The results

• Helped jumpstart large-scale digital and data transformation across the MACBIS program ecosystem
• Introduced a product-based, outcome-oriented approach to managing the portfolio of MACBIS systems, making CMCS a leader in this area within all of CMS
• Created a service design blueprint highlighting strategic product opportunities for improving end-to-end user experience journeys