Write once, use 50 times: How CMS' coder challenge will benefit states

The Centers for Medicare and Medicaid Services in May launched an online competition to quickly and inexpensively develop a new module to help manage Medicaid programs.

If all goes according to plan, by the end of the year the challenge will produce a finished, open-source product at a cost of no more than $600,000 that could be used by any state to automate the process of screening Medicaid service providers.

The challenge, which is funded through the Office of Management and Budget’s Partnership Fund for Program Integrity Innovation, is part of an effort to change the way government develops and procures IT systems. It also could help bring some order and scale to the IT architecture behind the federally funded, state-run Medicaid system.


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“There is a saying: If you know one Medicaid program, you know one Medicaid program,” said Julie Boughn, deputy director for the CMS Center for Medicaid and Children’s Health Insurance Program Services, commenting on the proprietary state systems. The Medicaid challenge is intended to produce a common platform that can be used by all 50 state programs.

Medicare and Medicaid are federal programs that are funded primarily by the Health and Human Services Department, but they are run by the individual states.

The provider screening module being developed under the current challenge is one small part of the Medicare/Medicaid Management Information Systems used by states, but it could begin a transition to standardized resources that could be used either in stand-alone systems or shared in a cloud environment. The competition is being conducted through an interagency agreement between CMS and NASA on the space agency’s Tournament Lab.

CMS-NASA joint venture

The lab is a platform established by NASA in partnership with Harvard Business School and TopCoder, an online company that brings together customers with a virtual community of more than 400,000 programmers around the world who compete to provide solutions for cash prizes.

“I think this is a particularly good application for the platform,” TopCoder president Rob Hughes said of the challenge. It allows the states to define the goals and objectives, and programmers and developers around the world will take their best shots at crafting a program that meets them. “We expect a fully functional product” that could be integrated into vendors’ platforms, Hughes said.

The Innovation program expects to pay out from $500,000 to $600,000 in prizes in a series of as many as 150 contests over five months to produce the module.

“We don’t known how many prize winners there will be, but there will be multiple winners sharing the money,” Hughes said.

The challenge or contest model for software development is relatively new in government, but it is one that has been gaining traction in the last few years. NASA’s Federal Center of Excellence for Collaborative Innovation established the Tournament Lab in October 2010 as an innovative way to harness disparate skills and fill gaps in government’s in-house development programs. TopCoder, which was established 10 years ago, provides the online platform and the access to a community of programming talent to crowdsource complex tasks. NASA and several other agencies have used challenges to produce solutions.

The development process is not amateurish, said John “Chip” Garner, a senior technical adviser at the CMS Center for Medicaid and CHIP Services.

“TopCoder has created a very robust product management environment,” Garner said. It offers access to a variety of talents for the development cycle, from conceptualization to coding and debugging. “You get the very best in their specific disciplines.”

The Medicaid CMS Provider Screening Innovator Challenge had its genesis about 18 months ago in Minnesota, where an RFP for a system to replace the current 20-year-old Medicare and Medicaid management program produced no viable results, said Thomas Baden Jr., CIO of the Minnesota Human Services Department.

“I was probably the instigator of this thing,” Baden said. He was talking at a NASCIO meeting with officials from Utah, Oregon, West Virginia and Illinois about the problem of building and maintaining expensive, proprietary state Medicaid systems. “All the individual systems we build for states are tremendously expensive and do not allow sharing between states.”

Aneesh Chopra, then federal chief technology officer, and Vivek Kundra, then federal CIO, suggested to state officials that the OMB Partnership Fund could help. The five states, along with the Centers for Medicare and Medicaid Services, signed onto the idea, and the fund provided a grant for the competitive challenge. Winning participants in the challenge will receive cash prizes, and the federal government will own the intellectual property, which can be licensed for use by states and vendors.

Where to start?

The first challenge was to decide what to build in the initial competition. An entire Medicaid management system would be too large and unwieldy to tackle.

“We wanted to do something that had a targeted scope but was complicated enough to show it would work,” Baden said. New provider screening requirements from CMS fit the bill. As part of an effort to reduce billing fraud and abuse, all states will need a module to screen service providers for eligibility before enrollment in the Medicaid systems. It was a new requirement and fairly complex, but with a clearly defined scope, that all states would be able to take advantage of if they chose.

The various competitions will fall into three broad categories, Garner said: developing innovative concepts to meet state-defined requirements; more directed development of design elements, and final production of programs, including debugging.

The first competition opened May 30 and was expected to close in mid-June, with other competitions lasting from two weeks to several days each following and overlapping through October. The goal is to have a prototype in August, with a final product delivered by November. “It will be before the end of the year,” Baden said.

Although coding competitions can produce fast results once under way, they depend on up front effort by the customers in defining objectives and needs, Boughn said. “You do quite a bit of work to make sure the challenge produces tangible results.”

Much of that work is being done by the five states initially involved in the program. Baden said additional states are in the process of joining the group that is conducting the challenge with CMS. The final product will be available to any state that wants to adopt it, whether it participated in the challenge or not. The goal is a product that can be integrated into existing state management platforms or shared in a cloud environment.

Trying a nontraditional model for IT development was not a hard sell at CMS, Boughn said. “Chip and I are hard-core IT people from way back,” she said. “You are talking to true believers in this kind of process.”

Baden was a little more reluctant. “At first I was a little skeptical,” he said. “I’ve been building software for 30 years” and had traditional ideas of how to do it. But, “so far it is working really well,” he said. “We couldn’t have a better partner than CMS, and I’m very impressed with the quality of the work.”

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