Client: Centers for Medicare & Medicaid Services (CMS)
Industry: Healthcare & Regulatory Compliance
THE CHALLENGE
- CMS lacked a standardized platform to measure hospital service quality for incentive-based government subsidies.
- A new federal mandate required hospitals to submit quality data for compliance and funding eligibility.
- Legacy manual, fragmented processes made data collection, validation, and reporting inefficient, impacting regulatory adherence.
Objective: Develop a comprehensive digital platform to streamline hospital quality data reporting, automate validation, and ensure compliance with government mandates.
MY ROLE AS A PRODUCT OWNER / SCRUM MASTER
✔ Translated program objectives and key results (OKRs) into actionable product roadmaps.
✔ Defined epics, user stories, acceptance criteria, and UAT test cases to guide development.
✔ Led Agile ceremonies, including sprint planning, backlog refinement, reviews, and retrospectives.
✔ Acted as a liaison between CMS regulators and development teams, ensuring alignment on requirements.
✔ Implemented KPIs for tracking epic and story burndown, committed vs. completed work, and scope change trends.
✔ Drove execution while optimizing efficiency through data-driven decision-making.
KEY FEATURES & SOLUTIONS
Automated Quality Data Submission & Validation
- Standardized reporting framework → Ensured compliance with CMS regulations
- Automated data validation → Reduced manual entry errors & improved accuracy
- Dynamic quality scoring → Allowed real-time hospital performance tracking
Regulatory Compliance & Performance Insights
- Integrated dashboards → Provided real-time hospital performance insights
- Custom reporting tools → Enabled hospitals to analyze & improve service quality
- Secure audit trails → Ensured transparency in subsidy calculations
Stakeholder Collaboration & Data Exchange
- � API integration with hospital EMRs → Streamlined data submission
- CMS-compliant reporting templates → Standardized quality benchmarks
IMPACT & RESULTS
- Enhanced Compliance → 100% alignment with CMS mandates for quality reporting
- Increased Hospital Participation → Improved ease of reporting led to greater adoption
- 50% Faster Data Validation → Automated checks reduced processing time significantly
- Optimized CMS Incentives → Ensured accurate subsidy distribution based on quality metrics
KEY TAKEAWAYS
- Automation & Compliance → Reduced administrative burden & ensured regulatory adherence
- Data-Driven Insights → Improved hospital decision-making through real-time analytics
- Seamless Workflow Integration → Enhanced collaboration between healthcare providers & CMS