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CMS embraces human-centered design to streamline citizen services, employee workflows

The Centers for Medicare & Medicaid Services has found itself on the frontlines of the pandemic response, providing not just access to health care for more than 140 million citizens, but also data and guidance related to transmission rates and vaccine administration. Managing that has required changes in how the agency works and delivers services, with a particular focus on customer experience.

Serving citizens is the federal government’s foundational mandate, and in many cases, citizens are trying to access those services during some of the most vulnerable, stressful times in their lives. Yet it’s often a burdensome process, weighed down by bureaucratic minutiae and inefficient, duplicative processes.

That’s become even more apparent during the pandemic, as the volume of citizens trying to access services for medical or economic reasons increased significantly. It prompted the White House and the Office of Management and Budget to make customer experience a major priority, releasing both an executive order directing agencies to improve CX and a memo offering guidance on how to do so.

Taking a human-centered design approach at CMS

At the same time, the pandemic also forced a paradigm shift in how work gets accomplished, necessitating a review of and changes to the back-office processes that let federal employees deliver services to citizens. In many cases, these two initiatives have become inextricably linked, both through the new technologies that make these improvements possible and through the mindset shifts required to adopt them, said Bobby Saxon, deputy chief information officer at CMS.

“Our almost exclusive interaction with our customers is via healthcare.gov. And there was a lot of work that needed to be done there, not only on the front end but on the back end,” Saxon said. “The real focus was on the back end side of this because it was our digital front door for our customers. We worked a lot with building stability and performance — and doing a cloud migration to give us a lot more additional capabilities.”

Now stabilized, the back end of the system is performing well, he said. Much of CMS’ Office of Information and Technology is now focused on the front end experience, particularly with providing human-centered design solutions to make the accessing of services more efficient and streamlined.

“That customer front end piece of it is where we still spend a lot of our time,” Saxon said. To tackle a human-centered design approach, the teams has been having a lot of interactions with customers, directly and through surveys.

“Once they’ve been to our sites, we get feedback from them. How can we do more? How can we help you? And also how can we help you across multiple devices?” he said. “When we built our front ends, for the most part, it was for an environment where it was mainly computer-based. But now, with more people using pads of some sort, using mobile phones of some sort, it’s more and more critical that we provide a holistic and total experience across all devices.”

Another area of emphasis are CMS call centers. Why? Because citizens can become frustrated with the digital process and opt to speak to someone on the phone, Saxon said. CMS therefore wants to make that digital process as user-friendly as possible to reduce the potential for frustration and in turn the volume of calls that come in to call center staffs. The IT team specifically seeks to enhance the mobile experience to reduce the need for customers to call the agency, he said.

Moving identity management to the cloud

On the back end, the agency also is shifting its identity management solutions from a data center-based system to a cloud identity management service.

The move should give the agency additional flexibility and capabilities, Saxon said. “We have also started to do an internal analysis of all of our identity management systems because we have several dozen different components at CMS,” he said.

What’s more, most of these components have their own budgets and teams and therefore different identity management tools. “From an enterprise point of view, how do we help them? We’re doing an internal evaluation right now of the nearly 10 identity management systems that we have at CMS. How can we answer an internal customer’s need with the enterprise solution that we have put in and still give them the flexibility that they want — and they need — to run the business of their components?”

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