To meet increasingly complex daily operations, agency high-profile initiatives and facilitate mandated data collection and reporting activities, CMS needed to migrate the existing applications that support Medicare Advantage (MA) and Prescription Drug (Part D) programs to cloud. These programs are vital system support for the ongoing operations of the MA and Part D plan enrollment and plan compliance business functions as well as the agency’s strategic planning and program analysis activities.
Especially critical to this Lift & Shift migration project was ensuring data exchange with a wide array of internal agency partners, and MA plans, Prescription Drug Plan (PDP) plans, cost-based plans, Program for All-Inclusive Care (PACE) plans, demonstration organizations and affiliated industry groups was not interrupted. The project needed to keep the needs of the broad user base of more than 12,500 users includes internal agency staff, private health and drug plans, pharmaceutical manufacturers, States, consultants and third-party vendors, external Federal agencies, and contractors at the forefront of modernization activity.
In the 1970s, less than a decade after the beginning of fee for service (FFS) Medicare, beneficiaries gained the option to receive their Medicare benefits through demonstration programs for managed, capitated health plans, primarily HMOs. The Balanced Budget Act of 1997 formalized Medicare Part C. By 1999, there were 6.8 million enrollees -18% of total Medicare enrollees.
Medicare Part C enrollment remained steady at 6.8 million until the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The Medicare Part D prescription drug benefit was authorized by Congress as part of this act. CMS leverages HPMS to support Prescription drug coverage for stand-alone PDPs (Prescription Drug Plans) and as part of MA-PDs (Medicare Advantage Prescription Drug Plans).
The MA program has grown in size and scope now supporting nearly 3,000 plans and 19 million enrollees and now comprises 33% of all Medicare enrollees. Stand-alone PDP enrollment is more than 25 million with at least 1 plan in every state. CMS decides to modernize the HPMS to support increased enrollment and management requirements awarding the contract to Softrams in May 2018.
Softrams has migrated the HPMS system to cloud and is working on incrementally modernizing HPMS to better support MA and PD plans, CMS staff, and program stakeholders through modern technology solutions combined with Agile delivery. Medicare Advantage enrollment is projected to increase to an all-time high of 22.6 million in 2019, an 11.5 percent increase compared to 2018.
Softrams built out and validated a cloud environment for this mission critical system that enables existing modules and data structures to seamlessly execute alongside modernized and new modules and data structures. This provides uninterrupted service for the agency and HPMS-approved plans that enroll 25 to 30 million Medicare beneficiaries annually. Softrams supports the ongoing operations of the MA and Part D plan enrollment and plan compliance business functions working collaboratively with CMS staff to modernize application data structures and existing C#, .NET applications developed over the past 15 years in the AWS cloud. Softrams ongoing work includes O&M to meet business needs and providing development/enhancements for Medicare Plan Finder (MPF) data and Fraud, Waste and Abuse (FWA) activity.
Using Agile development processes, we worked with CMS and peer contractors to build out cloud environments using open-source and agency-provided software that supports extensive inbound and outbound data exchange capability in the existing applications and future growth needs. Softrams built out the AWS environments using Terraform/Ansible using Infrastructure as a Code (IaaC) and overcame significant challenges to rapidly build, test and deploy legacy ASP and .NET modules. Softrams DevSecOps seamlessly migrated multiple terabytes of data from the legacy Oracle RAC cluster to the Oracle RDS environment without significant business interruption. We migrated the code repository from TFS to GitHuB (the first time this migration approach was used at CMS) and built out CI/CD pipelines for the HPMS application. With our Infrastructure as Code and the CI/CD pipelines, we empowered CMS with tools to build the entire HPMS environment within one hour.
As the system of record for contract, plan, and bid data, the application is responsible for the data that serves as the backbone for the MA and Part D programs. Downstream systems depend on this data to carry out mission critical agency operations such as beneficiary enrollment, plan payment, appeals processing, payment reconciliation, and premium withholding. Softrams’ data administration services include supporting data migrated from the legacy environment (AWS Oracle RDS) as well as new databases built in the cloud for the FWA and MPF data, Extract, Transform, Load (ETL) processes, SAS procedures and reports, and application integrations.
As part of Phase 1, we migrated and validated legacy data in the new AWS environment, migrated applications and transitioned O&M activity for the MA and Part D plan enrollment and compliance processes: application submission, automated network adequacy review, formulary submission, bid and benefit package submissions, Part D drug pricing submission, marketing material reviews, plan audits and compliance, performance monitoring, complaints tracking, risk adjustment overpayment and data validation, fraud, waste, and abuse tracking, financial reporting, financial and plan bid audits, plan surveys, and data support for the Medicare & You handbook and the www.medicare.gov website. This provided a functional product that received CMS approval to support cloud processing in October 2018 – six months after contract award.
Softrams used modern DevSecOps best practices for Continuous Integration, Continuous Deployment and Configuration Management to rapidly develop and build out the AWS environments within 6 months of contract award. We delivered Phase 1, devoted to transition and application software and data migration on time. Our integrated agile teams work closely with our customers to enhance operations through additional services to support MA and PD, CMS administrative tasks, and annual updates that are designed to offer additional flexibilities and efficiencies to plan sponsors that supports quality care for program enrollees.
Softrams process modernization work, where we have completed Lift and Shift activities to move the current data, modules, and system components into the cloud, continues to support the CMS mission through ongoing O&M to optimize data structures, modules and systems components and development of new applications that support additional plan choices for Medicare Advantage and Part D enrollees.
Processes to monitor and optimize system performance on a continuous basis.
A flexible data architecture to accommodate future program requirements and growth.
Compliance with all CMS and other Federal requirements.