Helping CMS Implement Congressionally Mandated Medicare Payment Changes

The Challenge

In April 2015, Congress passed the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), changing the way Medicare pays doctors for services rendered to patients enrolled in the Medicare program. The act implements changes designed to reward health care providers for giving better care, not just more care. These changes will impact a large percentage of Medicare Part B payments, and the Centers for Medicare & Medicaid Services (CMS) seeks to ensure the transition from the current payment program to the new system is simple, clear, and effective.

Project Impact Summary

• Implementation of the Medicare Access and Chip Reauthorization Act of 2015 required a transition of payment programs that would impact a large percentage of Medicare payments to doctors.
• CMS engaged the USDS team to draw on best practices from other large program implementations.
• CMS created an integrated project team that combines policy and operations, and uses agile methodologies and other modern technology practices.
• The development team has employed user research, user need analysis and constant iterative feedback loops with users to ensure transition success.
• On October 14, USDS helped CMS released the Final Rule for implementing MACRA concurrently with a plain language website describing the rule. The website serves two purposes: first, to help clinicians and their partners easily understand how MACRA impacts them and, second, to serve as a single entry point for clinician interaction with the program in the future.
• The MACRA implementation is still on-going and iterative development will continue throughout 2017.

The Solution

MACRA implementation is an important priority at CMS. USDS is helping CMS take an implementation approach that draws best practices learned from implementing other large programs, including HealthCare.gov and the adoption of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) standard. Key priorities include widespread user research and user needs analysis, an integrated project team across CMS responsible for program delivery from policy to operations, a tight iterative feedback loop with users to inform program design and ensure that it is clear and accessible, and incorporation of modern technology best practices.

Success Criteria	Status
Contracts for key elements of MACRA implementation are agile and responsive to evolving program needs.	In progress. CMS has successfully used agile acquisition practices across most of the contracts for the MACRA program.
Project team is integrated and running off of a shared roadmap for execution, including user research, policy, procurement, operations, technology, and analytics.	In progress. CMS has identified a product owner for MACRA implementation. CMS staff and contractors work on an integrated team.
Modern technology development best practices are being used in the creation of program infrastructure.	In progress. USDS assisting CMS staff and contractors to implement best practices in design and engineering.

Milestones

• February 2016: USDS Discovery Sprint/Project Started
• May 2016: Development work started
• October 2016: Final Rule with Comment and website concurrently launched

The Process and Lessons Learned

1. Go where the work is. The USDS team has pushed for extensive collaboration and information sharing between the USDS, CMS, and its contractor teams. The USDS team works alongside CMS staff and contractors on an integrated team at least four days a week in a shared space to facilitate this goal.

2. Engage agency leaders and policymakers in the process. The USDS team works hand-in-hand with CMS leadership on the program. The team is helping to ensure that implementation details, technical trade-offs, and operational complexity are communicated effectively to the whole team, including those writing policy.

3. Identify a product owner. CMS identified a single product owner for the implementation of the law, which has facilitated faster decision making.

4. Provide contracting officers with agile acquisition training. The CMS team was aware of agile acquisition practices, and their ability to implement agile contracts was significantly helped because one CMS contracting officer had already gone through the USDS agile acquisition training program. CMS has successfully utilized agile acquisition practices across most of the contracts for the MACRA program. The head of the division has further requested more training in agile contracting for the entire team.