Bringing product thinking to Medicaid's data systems
Summary
The Center for Medicaid and CHIP Services (CMCS) depends on a $100M+ portfolio of data and technology systems to manage programs serving more than 80 million people. The portfolio is known as Medicaid and Children’s Health Insurance Program (CHIP) Business Information Systems (MACBIS). We partnered with CMCS to shift MACBIS from siloed system management to a cohesive, product-driven operating model — introducing modern product, data, and delivery practices across the organization.
The challenge
Medicaid and CHIP together form the largest source of health coverage in the United States, serving more than 80 million people. CMCS oversees these programs at the federal level. Its work depends on timely, reliable data — enrollment figures, claims, financial reports, drug pricing, and program compliance measures that shape policy decisions affecting millions of families.
The systems supporting this work had evolved over many years, each built and maintained independently. The MACBIS portfolio included four major systems: Medicaid and CHIP Program (MACPro), the Transformed Medicaid Statistical Information System (T-MSIS), the Medicaid Drug Programs (MDP) system, and Medicaid and CHIP Financial (MACFin). Despite serving overlapping users and managing similar data, they lacked coordination, shared standards, or a cohesive strategy. Product ownership was fragmented across teams. User experiences were disjointed from one system to the next. Significant technical debt had accumulated, slowing release cycles and limiting the organization’s ability to adapt. Data quality suffered, and sharing data across systems was difficult.
The deeper issue wasn’t any single system’s shortcomings. It was the absence of an integrated operating model — a way to manage the portfolio as a connected whole rather than a collection of independent projects. Without that model, CMCS couldn’t fully use its data to inform policy, improve program design, or make operational decisions at the speed the programs demanded.
The solution
We designed a transformation approach that paired immediate diagnostic work with long-term capability building. Before fixing any one system, we measured all of them against modern standards. Maturity assessments benchmarked each system’s capabilities in product management, agile delivery, and data practices. The assessments gave CMCS leadership a clear picture of where each system stood — and identified the highest-leverage gaps to address first.
The portfolio’s real problem wasn’t any single system — it was the absence of product ownership across them. We introduced a product-based approach to managing systems, shifting teams from siloed projects to outcome ownership. That meant defining product visions and strategies for individual systems, setting objectives and key results (OKRs) tied to organizational goals, and introducing tools like product canvases, agile roadmaps, and product health checks. Teams could now manage their work with greater clarity and accountability.
Mapping the ecosystem surfaced integration opportunities invisible from inside any single system. A service design engagement mapped the full MACBIS ecosystem, revealing how users moved across systems, where handoffs broke down, and where critical gaps existed in the end-to-end experience.
These structural changes were reinforced by a shared foundation for how teams worked. We led the co-creation of a playbook of modern digital and data practices across CMCS. Sustainable transformation meant CMCS teams had to drive it themselves, not depend on us. We worked directly with teams to adopt the new practices rather than handing them a document and walking away. The goal: teams that could keep improving on their own.
The results
- Assessed maturity across the full MACBIS portfolio, benchmarking product, delivery, and data capabilities to establish a prioritized modernization roadmap
- Mapped the MACBIS ecosystem end to end, surfacing integration opportunities and user experience gaps that weren’t visible when systems were managed in isolation
- Established a product-driven operating model across CMCS, replacing siloed project management with outcome-oriented ownership, OKRs, and agile roadmaps
- Co-created a shared playbook of modern digital and data practices, giving teams a common foundation for how systems were designed, built, and managed
- Built internal capacity through coaching and training, equipping CMCS teams to sustain and extend the transformation independently