No Room for Error: How Project Managers Kept the New Medicare Card Project On Track

One of COVID-19’s many side effects is that it monopolized attention, distracting us from all other news, even positive developments.

Just as the pandemic set in, CMS was wrapping up the monumental four-year effort to replace Social Security numbers with the more secure Medicare Beneficiary Identifier (MBI) and mailing new cards to 60 million beneficiaries.

The New Medicare Card Project (NMCP) was instigated by the 2015 Medicare Access and CHIP Reauthorization Act, which mandated that Social Security numbers be replaced on all cards by April 2019 in order to protect personal health and financial information, and federal data. The project involved up to 250 people, impacted about 80 systems, and commanded a total budget of $230 million. 

Medicare Enrollment and Payment Systems Program Expert Tammy Johnson, one of CMS’s longtime veterans, says, “It’s the biggest project I’ve ever been on.”

And it was successful.

“We had to do it in four years, and we did it in four years,” says former Division of Program Management Director Monica Kay, who led the entire endeavor. Her team may have mailed a lot of Medicare cards, but they didn’t mail in their effort. 

There was no time to publicly savor the victory, however. Right after the project wrapped, the federal workforce rapidly transitioned to remote work as a dangerous pandemic began to sweep the nation. 

That does not diminish the finely coordinated operation that kept the NMCP on track. 

Everything, Everywhere, All At Once

The NMCP required expertise in technology, business, communications, policy, and outreach. There were an amazing number of details to keep track of, from the relatively minor (ensuring no offensive combinations of numbers and letters) to the major (making sure beneficiaries did not lose access to healthcare during the transition).

To integrate all of the interlocking parts, Kay instituted a pyramid-like organizational structure with high-level decisions driving the decision-making of downstream and external partners. At the top were three standing meetings. One was for the Executive Steering Committee. Its participants – all on the Director level – were responsible for the centralized coordinated management of the strategic planning, management, and control of the overall program. Next was the Integrated Program Team, a cross-functional, multidisciplinary group of Subject Matter Experts with collective, in-depth knowledge of the business functions that comprise the Medicare and Medicaid programs. 

The topics and structure of those two meetings were decided in a weekly Data Analysis Meeting where the Project Management Office (PMO) team could conduct initial data analysis and invite relevant product owners or component staff to provide updates. In Kay’s words, the Data Analysis Meetings were structured to provide “clear understanding of outstanding questions and issues, status and reporting needs, associated risks and issues and internal/external communication needs.”

Marni Land, a project manager in OIT at the time, served on the PMO as budget lead and liaison to the Office of Financial Management as well as liaison to other federal agencies impacted by the new Medicare number.

“When we were doing the mailing, we had regular check-ins,” Land says. “Everyone involved from end-to-end was on that call: the printer, systems and IT people, outreach folks, the Office of Communication. It had to be at least once a week, sometimes more often. All our meetings were structured and purposeful. We had to make sure all those crucial conversations were happening and that they ended with a ‘handshake.’ By doing that, we were able to successfully mail the cards.”

The mailings took place over nine months in clustered markets, coordinated with marketing campaigns. Mailings were timed not to overburden the U.S. Postal Service with the goal of completion before annual Medicare elections (when the CMS call center gets busy).  Geographical market clusters were staggered to help mitigate mail fraud, and they were sized to fit within the printer’s capacity.

“It was some pretty nifty logistics management,” Land adds.

People First

When asked about tools to manage such a large project, Kay says that people skills were more important than any piece of software. “Communication, negotiation, conflict resolution,” she lists. “Finding a solution when there’s an impasse in policy or system design. Having the crucial conversations that get people moving.” 

In the end, pulling off a project like NMCP was not a technological problem. Kay, who studied project management in the social service sector for her doctoral dissertation, says that the most necessary step in managing an organization is getting a team to adopt a culture of change. 

“When I first came to CMS, I would talk about project management, and people would run for the hills,” says Kay. Now the agency invests more in planning – whether traditional or Agile – for large projects and identifying the steps to completion.

Johnson oversaw the database and suite of systems that generated MBIs. All Health Insurance Claim Numbers needed to be cross-referenced to MBIs across the entire agency, other federal agencies, and external partners.

According to her, success hinged on communication. “If we didn’t have the communication,” Johnson says, “it didn’t happen.” Even after all the software changes had been rolled out, “we held daily touchpoint meetings, listening for any negative feedback to address. Everyone was kept in the loop.” 

Land, who ran point on the mailings, added that success depended on support from leadership and buy-in from everyone else. It was key that the business people understood the IT people, the IT people understood the policy people, and so forth. She reached out to folks outside of meetings to make sure everyone was on the same page, since not everyone feels comfortable speaking up in a meeting. 

The office that managed this effort has since been moved from OIT. Land is now a Division Director in the Center for Consumer Information and Insurance Oversight. She is still convinced that, whether an operation is tech-heavy or not, “If you invest in project management, you will get your project done on time and under budget.”