Unified Case Management System
This project is under an active NDA with the federal government. Limited details may be shared and discussed.
Highlights
Client
Centers for Medicare and Medicaid Services (CMS)
Synopsis
Enterprise system upgrade: Legacy to Next Generation
Users
1500 individuals from CMS and contractors; scalable to 3500
My Impact
Led research and design for 8 areas of work
About
The Centers for Medicare and Medicaid Services (CMS) provides a unified case management (UCM) system that can support the workload of 3500 users and their efforts to mitigate fraud, waste, and abuse across the Medicare and Medicaid programs. UCM provides users a collaborative space to manage workflow activities, report on workload metrics and administrative actions and law enforcement referrals, and record the outcomes of investigative activities.​
Problem Statement
The Centers for Medicare & Medicaid Services (CMS) seeks to transform its legacy Unified Case Management (UCM) system into a modern, user-friendly interface. The primary objectives are to enhance efficiency, ensure consistency among users across all jurisdictions, and establish a definitive source of truth for Medicare and Medicaid fraud, waste, and abuse audits and investigations. Currently, the UCM system supports approximately 1,500 CMS users dedicated to mitigating Medicare and Medicaid fraud, waste, and abuse. Despite its critical role, the legacy system presents several challenges, including inefficiencies and inconsistencies that hinder effective operations. This modernization effort aims to significantly improve the user experience, streamline investigative processes, and reinforce the integrity of the data used in audits. By doing so, CMS will better serve over 151 million beneficiaries (those covered by Medicare, Medicaid, and CHIP), ensuring the protection of public funds and the interests of United States taxpayers.
Approach
EMPATHIZE & DEFINE
For each of the 8 areas of work I led, I began with mining the project’s initial discovery resources, which included user interviews about job functions and walkthroughs of their processes, defined user roles and mental models, and user journeys. These early resources provided a background to begin understanding roles, pain points, and places the legacy system provided good services. Additional resources to build my baseline understanding included legacy system workflows, user manuals, master requirements documents, and CMS’s Program Integrity Manual (PIM).
With baseline knowledge in hand, it’s time to meet with the users and present my understanding. This is a critical point in the discovery process and it’s imperative to guide the users through the process while allowing them the free range to express their frustrations and joys so I can further refine my understanding. With their help, I can return to Mural and iterate on the workflow for the NexGen solution and begin low fidelity ideation.
IDEATE & ITERATE
Refining the NexGen workflow and moving to low-fi mockups begins the ideation process. These are presented to the users for validation, and with their stamp of approval, I pivot to co-creation sessions moving from low- to mid-fidelity mockups. These sessions can include card sorting exercises and low-fidelity design sandboxes (paper prototyping), to playing Keep, Fix, Nix, and Find with mid-fidelity mockups where we identify opportunities for information architecture improvement, system integrations, and automation.
Using our team’s design system in Sketch, high-fidelity mockups are created and prototyped, allowing for click through presentations of the NexGen workflow in each area of work, and giving the opportunity for light testing and feedback to further refine the design.
TEST
Led a 5-week usability project with 43 individual user sessions for end-to-end workflow testing of each section of work, uncovering valuable insights, and delivering an outcomes presentation to the client.
Outcomes
The portion of the NexGen solution that I worked on as a designer is not live yet, however, our usability testing demonstrated an 89% satisfaction rating… a 42% increase from the legacy system!