Innovative Design, Development, and Operations
Contract (IDDOC) Case Study

IDDOC Website


“Happy to see the team has proactively come up with a solution to help users have more information at their fingertips”

– 4i User

An end-to-end, serverless cloud solution that delivers on modernization

The Innovative Design, Development, and Operations Contract (IDDOC) is a two-part system comprising a front-end user interface (UI) and back-end applications for reporting and data exchange. The dual system was designed to offer a user-friendly ecosystem for end users to connect and interact with their data, while creating a secure and efficient way to input, store, and manage the data.

The Challenge

“Hearing the end users say what a huge improvement 4i is, and how intuitive it is overall, just speaks volumes to all of the work the team has done. Great job everyone!"

– 4i Administrator

The Accountable Care Organization legacy UI and back-end operating system (ACO-OS) for the Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation/Center for Medicare (CMMI/CM) required a critical upgrade.

The legacy applications supported a conglomerate of health care organizations offering innovative alternative payment models of care to the Medicare beneficiary populations they served. Unfortunately, the legacy OS struggled to keep up with growing demands for relevant data and proper and continuous data management. CMMI/CM desired a modern and robust environment in which to perform rapid analysis, support data-driven policy decisions, and seamlessly onboard and integrate alternative payment models via a menu of model services.

The Payoff

“Love it! Thank you for listening and putting together this great resource, looking forward to using it.”

– 4i User

IDDOC’s duplicate applications—individually known as 4 Innovation (4i) and Accountable Care Organization – Operational System (ACO-OS)—was developed to meet these needs.

IDDOC’s 4i UI application is a scalable and serverless cloud-based solution, which uses an AWS tool suite of AWS Lambda, Amazon API Gateway, Amazon Simple Queue Service (SQS), Amazon CloudWatch, Amazon CodeBuild, and AWS Secrets Manager, saving 90% AWS environment costs compared to similar applications. Users can now interact with the application with ease using self-service workflow processes. At the other end, IDDOC’s ACO-OS stores and processes Application Performance Monitoring (APM) data for sophisticated plan analysis and reporting. Using an AWS Data Lake solution, supported by AWS Simple Storage Service (S3), AWS Glue, Amazon EMR, Amazon QuickSight, AWS Batch, Amazon Remote Database Service (RDS), and Amazon Athena, the APM Data Hub streamlines data exchange, modernizes data collection processes, and automates data ingestion, pipelines, and validation. Additionally, ACO-OS’s data reliability maintains compliance with the CMS Security Automation Framework (SAF). The new OS achieves 80% savings in AWS environment costs compared to the legacy OS.

IDDOC Dashboard

What we did

What We Did

We deployed 4i in less than 5 months, closely followed by the APM Data Hub just under a year later. Our approach involved building a 100% serverless architecture and pay-per-use infrastructure for 4i, providing a first-of-its-kind, modernized application programing interface (API) integration solution that significantly improves system functionality and workflows and provides a one-stop shop for CMS to onboard and manage health care organizations who offer high-quality services to their patient populations. The solution won the G2X 2020 Most Disruptive Tech Program award for its innovation and business value in transforming digital services delivery in the Federal Government.

A clear impact to the overall bottom line

IDDOC offers the much-needed change in software delivery pace necessary to keep up with the demands of the health care industry. It supports value delivery, above-par work product quality through mature Agile DevSecOps. 4i’s serverless platform reduces environment costs via a scalable, serverless model. Also, by modernizing the ACO-OS legacy system/OS, users experienced immediate results and continue to improve on their experiences with ongoing use of, feedback on, and improvements to the new system. Today, more than 2,400 users rely on IDDOC and can do so with the knowledge that their data is accurate, secure, and accessible.

IDDOC Screen

The Results/Metrics (numbers)


Are we building engaged teams with happy stakeholders?

Onboarding for New Hires

Scaled Agile Partner

Advance Consulting Partner

Business Value

Are we realizing anticipated benefits?


Program Predictability

Speed of Delivery

Are we improving our ability to respond rapidly?


Per Pi


Per Sprint



Are we building quality in the following?


Automation Coverage for DC Participation Management


Automation Coverage for Knowledge Library (in%)


Automation Coverage for Data Hub (in %)



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