Executive Insights and Interviews

CMS modernization, legacy code, and meeting the needs of the user community.

Recently, Mike Farahbakhshian sat down with Jason Cullum in Annapolis to have a pint, and talk about the changes at CMS, modernization efforts, legacy programming languages, and meeting the needs of the user diverse user community.

Jason Cullum is an Associate Partner, CMS Account Manager with IBM. Over the past 11 years, he has worked with various organizations within the Centers for Medicare and Medicaid Services.

Mike Farahbakhshian is an Associate Vice President, Health Care Business Development at By Light Professional IT Services. Responsible for opportunity qualification and long-term capture strategy, he also maintains the pipeline for the company’s vertical, engages veteran partners, and serves as the company’s interface with customer and partners. Jason holds a similar role within IBM.

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Mike F: Tell us a bit about what you’ve seen at CMS, some of the changes, where things may be headed.

Jason C: Within the last several years, the founding of U.S. Digital Service (USDS) brought a lot of new faces and ideas into the fold. There was some concern that the more open technology policy would see some pushback from the establishment but I think from the start there was an awareness that new ideas were a positive development. Agile development and improved focus on the user experience were really behind the initial pushes and few could argue those were things that were not needed. CMS is large agency with many moving parts, so some centers/offices have seen an immediate impact while others are still evolving. Overall, it’s been a positive experience for most.

Mike F: Does that mean more of what is currently paper-based in the claim stream is moving to more modern methods?

Jason C: There is a lot of time and focus on cloud technology and open source tools, but it’s important to understand how to best harness the power of available tools before change is implemented. We have systems like FISS (Fiscal Intermediary Standard System) in Medicare, MCS (Multi-Carrier Claims System) and VMS (ViPS Medicare System) that have been around longer than some of us have been alive. They are so massive and critical to CMS operations, that it is important to be careful and cautious, and to look at incremental change as the path to modernization. And that is happening. There are many CMS and industry folks focused specifically on this topic and we are beginning to see the seeds of change.

Mike F: There is a lot of talk about urgency here as legacy code bases become antiquated. How do we ensure a smooth transition?

Jason C: There has been resistance in training the emerging workforce in legacy languages, such as COBOL, knowing there is limited usage of that technology. If something is used almost entirely in government, such as CMS and SSA, how much focus will there be in training and how many people will see it out? Does the emerging workforce want to come to the government environment as opposed to the “new and exciting” commercial market?

There are initiatives in place in some of the Baltimore schools to train younger people in these legacy languages. Ultimately, there is a distinct advantage to having people knowledgeable in the new and old to help bridge the gap, and to ensure a smooth transition to the next technical solution. Unfortunately, as much of the technology is just not going to be portable, breaking the components down through something such as blockchain may be the answer. At the end of the day, we are talking about systems that have been there 50 years or more. How do you apply innovation to systems that have been there seemingly forever? Ultimately, the companies who can, will be the ones that succeed.

Mike F: One of the big challenges in Federal Health is properly representing the end user. What are your thoughts there?

Jason C: We are starting to see a better understanding of the end user but we are not all the way there, and I am sure that everyone involved will admit that. There are more outreach initiatives but it will be a while before we see real results. As an example, when it comes to technology and generational differences, we have to maintain a focus on ensuring service to those who prefer phone calls and letters, and those who are embracing more modern methods such as apps and telehealth. CMS is putting a lot of focus into this, utilizing technology as a way to augment, rather than replace. They certainly understand that the end goal has to be rooted in the demographic and the base user group, and be a name the Medicare and Medicaid community can trust

What we also have to be mindful of is the large number of Baby Boomers who will age out, to be replaced by the smaller Gen X, and who will in turn be followed by the larger Millennials. The scalability of cloud services that will allow services to ramp up quickly and scale back effectively as needed, will be important considerations. CMS is already adopting AWS and Watson so they are getting ahead of the curve. There are technologies and solutions in play, however, CMS does not have the ability to look too far ahead, as they have the responsibility to respond to legislative changes such as MIPS and MACRA. And there are still outstanding questions about the long term viability of the Marketplace in today’s political environment.

The other thing when it comes to the end user is responding to the diversity community. Understanding the needs of a Medicare beneficiary in South Florida does not mean you understand the needs of someone in South Dakota. Part of ensuring a real understanding of the beneficiary, is making sure that someone doesn’t get left behind, understanding those potential geographic issues, ability to access to care, and even different acceptance of what is termed “quality care”. When we’re talking about the greater good of the entire approximately 60M Medicare base, that diversity must be recognized and resolved in order for the programs to succeed. You also have to take into account the Providers/Physicians, Politicians, Law Enforcement Agencies, ACOs and various contractors of different shapes and sizes who are required to make sure beneficiaries get the best possible healthcare at a reasonable cost to the government.

As we’ve seen in this interview, the landscape at CMS is evolving and changing during these uncertain times. As we’ve seen from this insightful interview with Jason Cullum, it’s good to see that bright, forward thinking minds are here to help future-proof Federal Health IT. If you have more to add to this dialogue, please leave a comment and keep the conversation going! I’m Mike Farahbakhshian, and it’s been my pleasure to engage you all.