Managed Care Review
Modernizing the submission and review process for Medicaid funding
The Centers for Medicare and Medicaid Services (CMS) is a federal government agency that serves more than 100 million people through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace.
States across the country submit their Medicaid plans to CMS several times throughout the year. The current process for submitting, reviewing, and approving managed care contracts and rates is a manual and time-consuming process. In FY2017, CMS reported that contract and rate reviews were taking an average of 254 days and has been described as a “black box” by states.
CMS partnered with Truss to research and develop a modernized process for the submission and review of Medicaid managed care plans. Truss and CMS created Managed Care Review (MC-Review), an application that captures state submissions and facilitates CMS reviews in a centralized platform. We launched to 6 states and cut the submission process down by 75% and the review process down by 50%.
As a senior UX designer at Truss I led the design direction for MC-Review. This included planning and facilitating research sessions, developing design concepts/prototypes, and managing stakeholder and user relationships. As design lead, my role also included mentoring and setting direction for other designers on the team.
The project began with a 6 month discovery and framing process. During this time, myself, two other designers, a product manager, and an engineering lead engrossed ourselves in the managed care process. We met with multiple stakeholder groups within CMS and dozens of state employees across the country to conduct contextual interviews, storyboarding exercises and design studios. These activities gave us a first hand account of how the submission and review process currently worked and allowed us to uncover pain points and challenges for us to focus our efforts.
Through our research we arrived at the conclusion that in order to streamline and improve the full managed care review process we needed to start with capturing well organized submissions from states. The current submission process was being done via email with little standardization from one state to the next. This led us to begin design and development of a submission form for states to send all of their managed care related documentation and background information to CMS.
In order to better organize submission data and documents we broke the form down into a multi-step process. This helps state users understand the progression of the form and reduce uncertainty as they complete each screen.
One of the larger issues with the current submission process was the reliance on email attachments. File size limitation meant that states had to submit multiple emails in order to send all their documents to CMS. By designing a reliable multi-file upload process we eliminated a significant amount of time in the submission process.
As important as it is for states to easily submit their information it’s equally as important to provide a well organized output of the information to CMS. We designed the submission summary page for easy review and retrieval of documentation by each CMS division. By organizing the output into sections based on key parts of the submission it allows CMS to quickly scan and intake a submission into their review process.
Once we had our first iteration of the submission form developed we wanted to do a more thorough usability test of the process with real submission data. In order to lower the risk of releasing an additional new system into an already complex process we developed a testing plan we called “Parallel path” testing. In these parallel path test we asked states to use MC-Review to submit a real submission while at the same time sending it through the traditional email process. This allowed us to compare and contrast the time and effort between the old and new process. Additionally, it allowed CMS to use their existing process while we ran usability tests using real data. We conducted 9 parallel path tests with states over the course of 4 months. The new submission process reduced the state submission time by 75% and reduced the CMS intake process by 1.5 hours.
Given the significant improvements to the process and our drive to get working software into the hands of users as quickly as possible we began a pilot program in the summer of 2022. The pilot program allowed selected states to make official submissions to CMS via MC-Review. The team has fully onboarded 3 states to the new process with more coming in the fall and winter of 2022.