The Challenge.

 

The Centers for Medicare & Medicaid Services (CMS) were tasked with creating and maintaining Federally Facilitated Exchanges (FFE) (a.k.a. “Marketplaces”) for health insurance starting in 2010 as part of implementing the Affordable Care Act (ACA).

As a division of the U.S. Department of Health and Human Services (HHS), CMS participates in fulfilling the mission of HHS to provide effective healthcare services by giving Americans the ability to get affordable health insurance in an environment where insurance providers can compete.

Providing a federally facilitated Marketplace for health insurance requires:

• Creating and managing the Marketplace.

• Integrating with state-based exchanges (SBEs) where CMS does not have direct oversight.

• Integrating with hybrid FFE-SBE exchanges.

• Working with insurance providers across the country to share data and ensure payments are made.

• Incorporating legislative and other changes to the Marketplace as needed.

• Working with other stakeholders such as the IRS, HHS, and others to provide timely data and reporting.

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The Solution.

 

To meet these requirements, CMS needed to first create, and then manage, the Marketplace as a “system of systems” supported by 52 stakeholder groups and 14 application development organizations (ADOs), with over 1000 team members grouped in 3 distinct capability areas:  1) Eligibility & Enrollment; 2) Plan Management; and 3) Financial Management.

With so many different players and contracts, there is a natural need for a central coordinating body focused on delivering IT products required by the Marketplace. This role is fulfilled by the Marketplace Systems Integrator (MSI).

MSI is organized to perform the following functions:

• Program Operations (including infrastructure, architecture, data management, software quality, and capabilities delivery).

• Scaled Agile Framework (SAFe) adoption across CMS and the ADOs contracted by CMS.

• Lean portfolio management.

• Communications, knowledge management, and governance.

• Enrollment data operations and quality assurance.

• Release integration and executive reporting.

• Delivering functionality for eligibility determination and enrollment processes, enhanced direct enrollment, external engagement, plan management, and financial management.

• Supporting cybersecurity operations.

• Supporting the architecture roadmap and IT infrastructure & performance management, security management, and configuration management are in place for the Marketplace as a whole.

• Supporting the Exchange Operations Center for site reliability, environment.

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Within this framework, Genesis has established itself as a value-add partner to MSI by providing SAFe coaching and Release Train Engineer (RTE) resources as needed.

Genesis team members were tasked with taking lead on several aspects of SAFe adoption.  On the coaching side, this translated into Program-level guidance in defining and establishing new ARTs and value streams.  Training programs, job aids, and mentoring were put into place to guide CMS and ADO staff in terms of adopting and maturing SAFe practices that helped teams deliver faster and with fewer defects.  It also translated into building an environment where previously-siloed teams started collaborating to improve the quality and speed of value delivered to CMS.

On the RTE side, Genesis provided program and team-level guidance, improving feature-level planning, backlog refinements and scrum of scrums. Consistent coaching and support has led to more collaborative backlog refinements and weekly alignment calls (Scrum of Scrums) as well as improved maturity on SAFe practices. ADO teams have grown to manage risks, impediments, and capacity issues more independently as a result of guidance and support provided by Genesis coaches and RTE. In return, the outcome has been value-driven system demos, more transparent escalation and communication of impediments and greater confidence from stakeholders. In past PI executions, the teams have proven to deliver features in record time-to-market and with improved quality.

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The Results.

 

With the leadership and guidance from Genesis coaches, the results achieved have been substantial:

 

• Genesis coaches and RTEs have been instrumental in transitioning CMS to fully-virtual PI Planning and Execution.  Success here was the result of having in-depth experience and knowledge of SAFe practices and ceremonies.  Genesis resources were able to translate these practices into equivalent exercises in a virtual environment, taking into consideration the challenges and advantages of this new domain.

• Genesis coaches focused on recommending and implementing multiple communication tools including Zoom, WebEx, Slack, Confluence, JIRA, Miro, and Mural.  During PI Planning events, these were used to supplant traditional in-person team breakouts, Scrum of Scrums meetings, Draft and Final Plan Reviews, Management Walk-throughs, and ad-hoc demos and discussions that are normally difficult to manage in a virtual environment.

• Working with CMS leadership and with ADOs, this work by Genesis resources gave CMS the ability to conduct highly effective, fully virtual PI Planning events involving over 300 participants from across the country.

• Carrying this into PI Execution, it was found that teams and CMS leadership continued using the tools and practices initiated by Genesis into their PI iterations.  Teams took the information and documentation developed during PI Planning and seamlessly incorporated them into their JIRA projects or other tools.  The program board, including risks and dependencies, was used as the basis for weekly Scrum of Scrum and PO Sync meetings.  And PI Objectives were successfully used to guide the end-of-PI integrated system demos for each ART

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• Due to having a more specialized SAFe background, Genesis RTEs were successful in providing greater value in this role than others who came with broader experience that was not necessarily focused on SAFe.

• Genesis RTEs were more successful in building relationships with teams, organizing stronger collaboration through Scrum of Scrum meetings and PI Planning preparatory activities, and creating useful PI Planning tools including Facilitators’ Guides and Confluence pages for use during PI Planning.

• Genesis RTEs were also more active during PI Planning and PI Execution as their expertise gave teams the confidence needed to reach out for help and support.

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• PI Planning preparation has matured significantly, as teams have advanced from simply taking direction (from coaches and RTEs) to acting independently based on the guidance provided.  ADO teams and CMS have become more confident in their ability to walk into a PI Planning event, ready to deliver a workable final plan for the upcoming PI.  This confidence is expected to result in more meaningful results from PI Planning and there is also the prospect of reducing the PI Planning event to just one day instead of two.

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• Collaboration and transparency between teams has increased during PI execution, resulting in risks being addressed proactively and dependencies being tracked and addressed in a timely manner.  It has been noted in Scrum of Scrums meetings that issues between teams have been identified, documented, and resolved much faster than before.  Delivery, including end-of-PI integrated systems demos, has become faster and the amount of rework and defects have decreased.