Meaningful modernization of Medicare claims processing

Challenge

CMS set out to modernize its systems for processing Medicare fee-for-service claims. The need was urgent: outdated workflows were slowing progress, & the agency needed to respond to rapidly changing needs.
Modernization efforts often defaulted to technology fixes rather than true business & process transformation. Instead of aligning people, process, & technology, CMS treated these as separate tracks. The result? Limited impact & stalled momentum.

To address these challenges, CMS sought cohesive product management & product strategy leadership—guidance for a human-centered modernization journey that connected people & systems into one cohesive effort.

Approach

We started by listening.
Our product strategist at Flexion earned trust by listening with humility, incorporating multiple viewpoints, & helping teams navigate shifting priorities. By walking multiple paths at once—developing alternatives, exploring options, & focusing on meaningful outcomes—she helped CMS leaders scale success & adapt with confidence.

CMS leaders & teams needed to see modernization as more than technology upgrades; they needed real-world examples that showed what was possible. A critical opportunity emerged: CMS had to meet a deadline to process a new type of claim. CMS chose to process those claims in the cloud, & we helped demonstrate that modernization wasn’t theoretical—it was necessary, achievable, & tied directly to CMS’s mission.

Here’s how we moved forward:

• Focused vision: We helped visualize the work & tie products to a unified modernization goal—so everyone could see what we were building & why.
• Shared roadmap: With stakeholders, we built & maintained a program backlog & roadmap to visualize work, track progress, & ensure CMS solved the right problems at the right time.
• Integrated change: Technology modernization was paired with organizational change. As systems evolved, so did the ways modernization interacted with the broader agency—creating alignment that unlocked real impact.

Outcomes

By combining empathy, clarity, innovation, & collaboration, Flexion helped CMS turn modernization from a buzzword into a working reality—showing the impact of thoughtful product strategy in government programs.

With clear product strategy guidance, the MPSM program became lean, focused, & positioned to keep CMS at the forefront of an evolving healthcare landscape.

Together, we achieved two critical milestones:

1. Built a cloud-based claims processing system capable of handling Medicare claims outside of legacy systems.
2. Supported organizational change that ensured processes & people modernized alongside technology.

When CMS was later tasked with an ambitious new goal, the program didn’t hesitate. With a shared vision & a modernized system initiated, it was ready to deliver outcomes quickly & effectively. The impact is lasting: modernization has accelerated, stakeholders are aligned around a cohesive strategy, & CMS is now equipped with the clarity, tools, & confidence to transform how Medicare operates.

At Flexion, we don’t create solutions for our partners; we build outcomes with them.