Client:

The Centers for Medicare & Medicaid Services (CMS)

Industry:

Healthcare

Services:

Integrated Health Optimization

Digital Modernization

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Key Figures:
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• >80% reduction in weekly file processing time
• ‍>70% reduction in daily file processing time
• ‍99.99% Application reliability
• ‍>90% Infrastructure cost savings for 4i

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Summary:

The Innovative Design, Development, and Operations Contract (IDDOC) is a two-part system encompassing data submitted by healthcare providers into the front-end 4Innovation (4i) platform and processed by the Accountable Care Organization Operation System (ACO-OS) where data is stored.

This 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

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‍Challenge: Redesigning Legacy Systems to Meet Growing Demand

The legacy applications supported a conglomerate of health care organizations offering innovative alternative payment models (APMs) of care to the Medicare beneficiary populations they served. Unfortunately, the legacy applications struggled to keep up with growing demands for accurate and continuous data management. The CMS Innovation Center (CMMI) and 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.

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Solution: Dual Applications for Data Submission, Processing, and Storage

Softrams proposed to develop and launch a new user-facing 4i platform and modernize the legacy ACO-OS system to meet these needs. 4i is a scalable and serverless cloud-based solution for healthcare providers to submit data, while ACO-OS was developed to store and process Application Performance Monitoring (APM) data for sophisticated plan analysis and reporting. We deployed 4i in less than 5 months, closely followed by the APM Data Hub just under a year later. This effort was extremely complex, requiring modernization activities to be done without impacting ongoing operations and necessitating a phased approach. The last phase was completed in November 2023.

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Outcome: Meeting Demand and Improving User Experience

The complete IDDOC solution offers the much-needed acceleration of software delivery necessary to keep up with the demands of the health care industry.

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• Modern data storage with use of a data lake environment
  
  • Our team employed a data lake environment to modernize the legacy ACO-OS system to improve deployment timelines, workflow management, and data storage and retrieval.

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• Automated data processing with Provider Enrollment, Chain, and Ownership System (PECOS)
  
  • We accomplished full automation of data processing, removing the need for manual intervention from users. Our PECOS integration has drastically improved weekly and daily data processing times by more than 70%.

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• Modernization with Agile DevSecOps and serverless architecture
  
  • ACO-OS supports value delivery, above-par work product quality through mature Agile DevSecOps. 4i’s serverless platform reduces environment costs via a scalable, serverless model.

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• >6K active participants
• ‍$8K saved per month in operating costs
• ‍25K API requests serviced per day
• ‍80% Infrastructure cost savings for ACO-OS

AWS Services Used:

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• Serverless cloud-based interface
  
  • AWS Lamdba, Amazon API Gateway, Amazon Simple Queue Service (SQS), Amazon CloudWatch, Amazon CodeBuild, and AWS Secrets Manager are used to stand up 4i’s scalable and serverless cloud-based interface.

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• Modernize data collection processes
  
  • AWS Simple Storage Service (S3), AWS Glue, Amazon EMR, Amazon QuickSight, AWS Batch, Amazon Remote Database Service (RDS), and Amazon Athena support ACO-OS’s AWS data lake solution to streamline data exchange, modernize data collection processes, and automate data ingestion, pipelines, and validation.