Exploring Digital Transformation at the Centers for Medicare & Medicaid Services

Andrea Fletcher serves as the Chief Digital Strategy Officer and Director of the Digital Service at the Centers for Medicare & Medicaid Services (CMS). She explains that her office was established to address the need for talent and expertise in a variety of skills to tackle complex problems at the intersection of technology, innovation, and service design and delivery. The CMS digital transformation strategy focuses on improving the user experience and delivering better digital services to its beneficiaries.

Recently, Andrea joined me on The Business of Government Hour to discuss the intricate landscape of digital transformation and delve into the innovative strategies and initiatives driving digital transformation across CMS, offering key insights into the future of healthcare service delivery. Here are some highlights of our conversation.

Accessibility and User-Centric Design

A pivotal aspect of CMS's digital transformation journey is enhancing accessibility and user experience across its digital platforms. Fletcher emphasized the importance of viewing accessibility beyond mere compliance, recognizing that true accessibility entails designing experiences that cater to diverse user needs, including those with visual and cognitive disabilities. Through rigorous user testing and adherence to accessibility standards, such as the US Web Design System, CMS strives to ensure that its digital services are inclusive and user-friendly for all beneficiaries.

Furthermore, Fletcher sheds light on the broader customer experience strategy, extending beyond digital interfaces to encompass all touchpoints with CMS services. From call centers to online interactions, CMS is dedicated to delivering seamless and empathetic service experiences, acknowledging the diverse backgrounds and technological literacy levels of its beneficiaries.

“We exist to pilot and prototype. Before we spend a bunch of money building a thing, we ask: are we building the right thing? We run a lot of discovery and design sprints…We must think about how these beneficiaries experience our services…”

Overcoming Challenges and Embracing Emerging Technologies

Despite progress in digital transformation, CMS faces multifaceted challenges in bridging the digital divide among its beneficiaries. Fletcher debunked stereotypes about the tech-savviness of Medicare beneficiaries, highlighting the wide spectrum of digital literacy among different demographic groups. Moreover, she emphasized the need to reconcile legacy processes designed for a paper-based world with the digital realities of the present, acknowledging the inherent complexities of modernizing entrenched systems.

Looking ahead, Fletcher expressed optimism about the transformative potential of emerging technologies, particularly artificial intelligence (AI), in revolutionizing healthcare delivery. While acknowledging the regulatory constraints and bureaucratic hurdles inherent in government innovation, she underscored the importance of pragmatic, user-centric approaches to technology adoption. Rather than chasing flashy innovations, CMS prioritizes practical solutions that streamline processes and enhance the user experience for beneficiaries.

"I think with AI it is going be a wild 10 years, particularly in the healthcare sector with nurse chat bots etc. How we leverage AI to improve healthcare is going to be fascinating to watch and be a part of."

Harnessing Data for Informed Decision-Making

Central to CMS's digital strategy is the strategic use of data analytics to drive decision-making and improve service delivery. Fletcher highlighted the challenges of navigating data silos and emphasized the importance of asking the right questions to guide data analysis effectively. Despite the inherent complexities of accessing and integrating disparate data sources within a government agency, CMS remains committed to leveraging data insights to inform policy decisions and enhance operational efficiency.

“When I think about analytics and using data, I think about what questions are we asking.  It is not about using some new tools just for the sake of it. It’s about knowing what data we have, what questions we need answered, and whether that data can be used to answer those questions.”

Modernizing Medicare

One significant revelation from the conversation was the evolving landscape of Medicare and Medicaid, especially concerning the expansion of coverage to address dental care needs. Fletcher highlighted how CMS is adapting to meet the changing demands of patient care, notably through updates in the Medicare Physician Fee Schedule. Medicare can pay under Part A and Part B, when dental services are inextricably linked to the clinical success of other Medicare-covered procedures or services. This expansion for example, includes coverage for dental care related to heart valve replacements and kidney transplants. Thus, recognizing the crucial link between dental health and overall health outcomes in such cases.

The endeavor to integrate dental coverage for specific healthcare scenarios into traditional Medicare posed unique challenges, considering the historical segregation of dental insurance from health insurance. As Fletcher explained, the absence of dental coverage in Medicare Parts A and B necessitated the development of new infrastructure to process dental claims—a monumental task not undertaken since the 1960s. This initiative underscores CMS's commitment to modernization, leveraging contemporary technology stacks to revamp outdated systems and workflows.

“Andrea sheds light on CMS's efforts to modernize claim processing, notably with the introduction of the 837 D dental claims form—the first new claim type since the 1960s. This initiative reflects CMS's commitment to embracing modern technology stacks and fostering stakeholder collaboration to improve efficiency and service delivery.”

Embracing Transformative Thinking and Experimentation

CMS embraces transformative thinking and experimentation to push boundaries and drive innovation. Fletcher discussed the significance of piloting and prototyping before full-scale implementation, emphasizing the value of being willing to be wrong and taking calculated risks. By fostering a culture of experimentation, CMS seeks to pilot new solutions, gather real-world feedback, and refine digital services iteratively. The agency employs various tools, including discovery sprints and design sprints, to identify pain points and iterate on solutions effectively.

Adopting agile development methodologies allows CMS to quickly iterate on digital solutions, respond to user feedback, and continuously improve the quality of services. Fletcher discusses how this iterative approach enables the agency to remain flexible and adaptive in a rapidly evolving healthcare landscape.

"I think AI is gonna be a wild 10 years, particularly in the healthcare sector of, you know, nurse chat bots and really how we leverage AI to improve healthcare is going to be fascinating to watch and be a part of."

Building a Skilled Workforce for Digital Innovation

Recruiting and retaining top talent are essential components of CMS's digital strategy. Fletcher highlighted efforts to attract technical talent from diverse backgrounds, including high school interns and seasoned professionals from leading tech companies. By building a diverse team with expertise in engineering, design, and product management, CMS aims to drive innovation and deliver cutting-edge digital solutions. The agency also focuses on workforce development, supporting initiatives to upskill existing staff and cultivate a culture of continuous learning.

“That's why I'm talking with you today, Michael…it’s about getting our message out and recruiting talent. A most significant impact I can have today involves the hiring of specific talent and new skills that we've never had before and perhaps that we didn't even know we needed."

Future Outlook: Driving Innovation in Healthcare

Looking ahead, CMS envisions a future focused on driving innovation and improving healthcare delivery. Fletcher emphasized the agency's role as a leader in healthcare technology, striving to build the best software solutions tailored to the needs of beneficiaries and healthcare providers. By leveraging emerging technologies like artificial intelligence (AI) and prioritizing user-centric design, CMS aims to create a more open and transparent healthcare system. The agency remains committed to advancing digital transformation efforts to enhance the quality and accessibility of healthcare services nationwide.

“I hope our future is about making some waves, doing things differently, and thinking about how we can provide the best healthcare and the best services."

Key Takeaway

Andrea Fletcher's insights offer a compelling glimpse into the ongoing digital transformation journey at CMS, underscored by a commitment to accessibility, user-centric design, and data-driven decision-making. As CMS continues to navigate the evolving landscape of healthcare delivery, its innovative approaches to technology adoption and service design promise to shape the future of healthcare for millions of Americans.