Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services (CMS) is the agency in the Department of Health and Human Services responsible for providing health coverage for seniors and people with disabilities, for limited-income individuals and families, and for children-totaling almost 100 million beneficiaries. The agency's core mission was established more than four decades ago with a mandate to focus on the prompt payment of claims, which now total more than 1.2 billion annually. With CMS's mission expanding from its original focus on prompt claims payment come new requirements for the agency's information technology (IT) systems. Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services reviews CMS plans for its IT capabilities in light of these challenges and to make recommendations to CMS on how its business processes, practices, and information systems can best be developed to meet today's and tomorrow's demands. The report's recommendations and conclusions offered cluster around the following themes: (1) the need for a comprehensive strategic technology plan; (2) the application of an appropriate metamethodology to guide an iterative, incremental, and phased transition of business and information systems; (3) the criticality of IT to high-level strategic planning and its implications for CMS's internal organization and culture; and (4) the increasing importance of data and analytical efforts to stakeholders inside and outside CMS. Given the complexity of CMS's IT systems, there will be no simple solution. Although external contractors and advisory organizations will play important roles, CMS needs to assert well-informed technical and strategic leadership. The report argues that the only way for CMS to succeed in these efforts is for the agency, with its stakeholders and Congress, to recognize resolutely that action must be taken, to begin the needed cultural and organizational transformations, and to develop the appropriate internal expertise to lead the initiative with a comprehensive, incremental, iterative, and integrated approach that effectively and strategically integrates business requirements and IT capabilities. Table of Contents Front Matter Summary and Recommendations 1 Essential Considerations and Background 2 Toward a Comprehensive Strategic Technology Plan 3 A Meta-Methodology for the Modernization and Transformation of Business and Information Ecosystems 4 Achieving Cultural and Organizational Transformation 5 Anticipating a Data-Centric Future Appendixes Appendix A: Statement of Task Appendix B: Briefers to the Committee Appendix C: Biosketches of Committee Members and Staff Appendix D: Sources and Uses of Data Within the Centers for Medicare and Medicaid Services Appendix E: A Two-Phase Approach to Modernization and Transformation of Business and Information Ecosystems Appendix F: Glossary Appendix G: Acronyms