Summary

The Data Modernization component of Medicare Payment System Modernization will allow users to access healthcare claims, beneficiary, and insurance data in real-time with fewer glitches.

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MPSM DMod: Building Data a Forever Home

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Modernizing data is like building a home; you want to start with a strong foundation that can be maintained to support a lifetime of memories.  

Data Modernization (DMod) serves a similar foundational capacity within Medicare Payment System Modernization (MPSM) – it enhances our ability to innovate by building a long-lasting infrastructure that will make CMS data easier to access and use. 

Medicare Payment System Modernization (MPSM) is a project started by the Application Management Group (AMG) with the goal of improving the maintainability, adaptability, and responsiveness of Medicare Fee for Service (FFS) systems. This effort encompasses the modernization of data, processes, and systems in order to enable CMS to meet its business and program needs. 

The MPSM project is in the process of transferring data from these long-standing legacy systems to modern, cloud-based databases housed on Amazon Web Services (AWS): 

Currently, many CMS systems and applications are not easy to access because they are frequently housed in a COBOL mainframe. COBOL was the best option decades ago. Unfortunately, a shortage of COBOL-fluent programmers and a lack of modern software tooling make these applications costly to maintain. 

“COBOL systems are complex to change and verify,” says MPSM Technical Lead Samuel Wiley. “CMS is looking to iterate on alternative payment models and focus on value-based care and other ways of ensuring the best possible outcomes for our beneficiaries. The more dissimilar these models are to Fee-for-Service, the more difficult and costly they are to implement in our current systems.”  

Existing systems also require CMS employees to review multiple screens to gather beneficiary and claim information.

“Claim information is presented on a green screen interface that is not user-friendly because this information is fragmented across multiple screens, says Divyangkumar Joshi, MPSM Product Manager. “In addition, this legacy data is not available 24/7 due to mainframe batch cycle processing.”

DMod has selected IBM InfoSphere, a leading data replication platform, to help CMS stream and translate data from the mainframe to the cloud. InfoSphere is being used in combination with Apache Kafka to publish and subscribe to data streams that store and process data in real-time. 

There have been some struggles with the data replication process, particularly around scaling up to the size and complexity of CMS’s data. DMod has been working closely with IBM to update and stabilize InfoSphere and has made significant strides over the past year.  

Moving legacy data to a cloud-based platform saves time, reduces the complex processes for gathering information, and allows CMS employees, healthcare professionals, and Medicare beneficiaries to view and obtain information quickly. 

As MPSM moves forward, the DMod team will eventually look to retire the legacy data stores and their use of InfoSphere by retiring the legacy datastores and migrating that data to the cloud.  

“This project gives us the experience, infrastructure, and confidence needed to migrate off of the legacy technology completely, allowing us to leave the pains of the legacy technology behind,” Wiley says.  

Please read the MPSM Q&A to learn more about the Data Modernization project.  

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