Will retiring boomers bust Medicare apps?

Who's in charge

Timothy Love

CIO and director of information services


Wallace K. Fung

Chief technology officer and deputy director of information services


Stuart Guterman

Director of research, development and information


William Saunders

Deputy director of research, development and information

Top contractors

(in millions, Fiscal 2002)

Computer Sciences Corp.

$28.7


Lockheed Martin Corp.

$26.4


PricewaterhouseCoopers LLP

$22.8


EDS Corp.

$22.0


IBM Corp.

$19.6


Arkansas Blue Cross & Blue Shield

$16.8


AT&T Corp.

$13.7


Iowa Foundation for Medical Care

$13.6


American Management Systems Inc.

$9.7


Blue Cross/Blue Shield of Florida

$9.4


Total

$182.7



Sources include the Centers for Medicare and Medicaid Services and Input of Reston, Va.

'We are all aware of the demographic bulge looming, which will make demands on a system already under stress.'

'Timothy Love, CIO at the Centers for Medicare and Medicaid Services

Laurie DeWitt

Aging technology and the millions of baby boomers set to begin collecting benefits in a few years threaten to overload the Medicare system.

Concern about dealing with this potentially overwhelming combination is driving the Centers for Medicare and Medicaid Services to modernize its IT systems.

In addition, Congress is considering Medicare reforms that could further complicate administration of the 30-year-old program.

'We are all aware of the demographic bulge looming, which will make demands on a system already under stress,' said Timothy Love, CIO and director of information services at CMS, an agency of the Health and Human Services Department. 'With the combination of increased volume and increased complication, you have to have a comparable increase in the capability of IT systems.'

To face the challenge, CMS has drawn up plans to modernize systems' security, internal IT infrastructure, data warehousing and Medicare fee-for-service claims processing. The agency awaits approval from Congress for 2004 funding.

The first project slated for modernization is the Common Working File, the database that houses beneficiary enrollment and entitlement information critical for authorizing claims. 'This is a system that has been cobbled together over the last three decades,' Love said.

CMS expects to complete the first stage by next summer, determining business requirements for the redesign, Love said.

Nine data centers

The Common Working File, made up of 1.5 million lines of Cobol code, employs batch processing and requires the proprietary IBM System Network Architecture protocol, said Julie Boughn, deputy director of the CMS IT Modernization Program Office.

The system and data are distributed across nine Medicare claims processing data centers. These provide beneficiary entitlement and adjudication data to Medicare contractors within each center's geographic area. Users interface with the Common Working File through the private Medicare data communications network.

The system needs revamping to improve Medicare payment safeguards that detect and respond to abuse and fraud and to support business requirements necessary to conform with policy changes.

The redesigned Common Working File will use open-systems protocols and modern, object-oriented programming languages.

CMS awarded a contract to IBM Corp. in December to increase the Common Working File's capabilities and efficiency, for example, by removing obsolete code and convoluted logic. In the first stage, IBM is capturing requirements from the existing system and defining new requirements, Boughn said.

CMS has split off those parts of the existing Common Working File needed for daily operations while other segments undergo redesign, Love said.

The agency processes 1 billion Medicare claims a year and stores huge amounts of information in data warehouses. Medicare's infrastructure extends to dozens of contractors and thousands of users. CMS has one of the largest data repositories in the world'more than 32T, Love said.

The data warehouses reside mainly on IBM mainframes and Sun Microsytems Inc. servers at the CMS data center in Baltimore, Boughn said. The systems run IBM DB2 and Oracle Corp. database software, with several commercial and in-house applications for performing extract-transform-load functions. For data analysis and reporting, CMS uses software from Cognos Corp. of Burlington, Mass., MicroStrategy Inc. of McLean, Va., and SAS Institute Inc. of Cary, N.C.

About the Author

Mary Mosquera is a reporter for Federal Computer Week.

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