Comprehensive Business Process Overhaul at CMS

Citizant partnered with the Centers for Medicare & Medicaid Services (CMS) to provide comprehensive Enterprise Architecture (EA) and Business Process Reengineering (BPR) services.  Our efforts supported IT investment decision-making, health policy implementation, and segment architecture development to align with the agency’s mission in ensuring effective, up-to-date health care coverage and promoting quality care for beneficiaries.

During 3 years of support, the Citizant team, which consisted of a Project Manager, Enterprise Architect and up to six BPR specialists, completed more than 400 business process models (current and target) supporting 50 projects, including the American Recovery and Reinvestment Act (ARRA) and Health Information Technology for Economic and Clinical Health (HITECH) Act. The team collaborated with more than 400 business owners, subject matter experts (SMEs), and policy makers from all organizations under every line of business (Medicare, Medicaid and Medicare Advantage) within CMS.

Leveraging EA to Guide Process Redesign

CMS faced challenges similar to those faced by many federal agencies and program offices -- e.g., stove-piped systems, outdated technology, and duplicative and redundant data entry. In support of CMS’s Customer Service line of business, Citizant was tasked to:

  1. Develop a business- and performance-based target segment architecture resulting in efficiencies and improvements to customer service agency-wide.
  2. Establish a common information architecture used by CMS and contractor staff that provides customer support services to citizens.
  3. Obtain executive sponsorship to transition beneficiary customer service to the target architecture.

Citizant’s approach included conducting interviews and fact finding sessions with more than 45 stakeholders spanning 18 components that provide beneficiary customer service. In addition, detailed focus groups were centered on four organizations that provide significant customer service to the member community.

The team developed and documented the As-Is business process models, systems and information exchanges. Citizant produced documentation to capture business and security risks, performance measures and statistics.

Citizant’s analysis of performance gaps identified opportunities for customer service and operational improvements such as:

  • Minimizing the 15 distinct entry points into customer service for beneficiaries.
  • Consolidating more than 90 duplicative systems and tools used to support Customer Service functions.
  • Improving real-time access to reliable data and reducing point-to-point connections and data replication.
  • Integrating business functions and information to provide a comprehensive “beneficiary episode”.
  • Transitioning to a service-based model for IT portfolio analysis, thereby more effectively leveraging existing customer service investments.

Proof of Delivery

The customer said this about our team:

"...the only contractor in my experience at CMS to provide flexible, responsive service while always looking for opportunities to do more and deliver extraordinary value."