Integrating several AWS services and advanced methodologies was key to our approach. Flexion wove fragmented data points from various CMS enterprise platforms, including plan, provider, claims, and beneficiary information, into one coherent, reliable narrative — the Beneficiary Experience Data Analytics Platform (BEDAP) — usable by all stakeholders.

The cloud-native architecture utilized a suite of AWS services tailored for specific operational needs: AWS Kinesis for real-time data streaming and delivery, AWS Redshift for scalable data warehousing capabilities, AWS Fargate for container management in a serverless environment, and AWS EventBridge for robust event management. These services facilitated the efficient aggregation and analysis of diverse datasets. To enhance process efficiency and infrastructure management, we employed tools such as Terraform for infrastructure as code and Ansible for automation and configuration management.

This infrastructure ensured a robust uptime Service Level Objective (SLO) of 99.9% for the BEDAP API, supported by AWS’s reliability and disaster recovery mechanisms.

BEDAP, through its centralized approach, streamlined the aggregation of diverse data from various CMS systems. It ingested and analyzed large sets of data from ten distinct data sources that broke down into over two hundred tables representing data that ranged from beneficiary and claims information to provider and plan details.

CMS processed three billion records monthly from multiple data sources in various formats, which were ingested into the BEDAP Redshift data warehouse, including:

• CSV
• JSON
• XML
• Parquet
• Cobol exports

Flexion’s success with BEDAP allowed CMS to expand beneficiary profiles with more comprehensive data than initially planned, considerably enriching beneficiary profiles.

Additionally, BEDAP included communication and transactional data for analysis and outreach activities targeting the Medicare population. The data and services provided significantly improved the functionality of CMS’s Medicare.gov applications and enhanced the beneficiary experience.

The new system significantly shortened the lead time for creating email lists for beneficiary communication from several months to a few hours.

By mining beneficiary claims history, it is now easier for CMS to:

• Identify chronic conditions and preventative care statuses.
• Personalize communication and outreach.
• Improve the authenticated beneficiary experience on the Medicare website.
• Enable access to financial information (i.e., deductibles, copayments, etc.).
• Learn about available providers in their area.

This successful consolidation of beneficiary data enabled CMS to interact with Medicare recipients more personally and consistently across various outreach modes, like call centers, emails, and letters, thereby optimizing the overall beneficiary experience. Improvements in outcomes were reflected in the increased utilization of free preventative care services and a surge in Medicare enrollment rates during open enrollment.

Flexion’s development of the BEDAP system for CMS is a testament to the transformative power of integrating advanced AWS and other technologies with strategic vision. The collaboration addressed the challenges of managing vast and diverse datasets and significantly enhanced the beneficiary experience. The success of the BEDAP platform underscores the potential of such innovative solutions in optimizing healthcare services and improving beneficiary interactions and experiences.