The Centers for Medicare & Medicaid Services (CMS) administers key U.S. healthcare programs, including Medicaid, CHIP, and the Basic Health Program (BHP). The Center for Medicaid and CHIP Services (CMCS) oversees Medicaid and CHIP, providing health coverage to low-income individuals and families. Medicaid covers low-income people, CHIP provides health coverage for children in families with incomes too high for Medicaid, and BHP offers affordable coverage for those with fluctuating incomes. CMCS manages Medicaid.gov and InsureKidsNow.gov to provide critical information about eligibility, benefits, application processes, and policy updates to millions of users

Goal

To modernize CMS’s website infrastructure, enhance security, improve user experience, and ensure compliance with accessibility and federal regulations by upgrading to the latest Drupal versions, implementing Agile and DevSecOps practices, and leveraging cloud technologies for scalability and reliability. This initiative streamlines content deployment, optimize business processes, and maintain the highest standards of security and accessibility for Medicaid, CHIP, and BHP users.

Challenge

Administering benefits through Medicaid, CHIP, and BHP is complex and constantly evolving due to policy changes, budget constraints, health crises, outdated technology, and growing user expectations. Sky Solutions leads this website modernization to address these challenges, including outdated infrastructure, security vulnerabilities, inefficient processes, and accessibility issues. The existing Drupal version had limited capabilities, impacting the delivery of updates and features.

Sollution

To address these challenges, Sky initiated an organized modernization effort. We tackle the outdated technology stack by migrating to the latest Drupal versions and implementing advanced automation testing such as Playwright for comprehensive testing on the code, for performance and security. Additionally, we introduce an Agile and DevSecOps culture that streamlines business processes therefore facilitating faster development cycles and improved collaboration. We optimize content deployment processes, ensuring the rapid dissemination of up-to-date information. With security being of the utmost importance, Sky implements robust measures to ensure compliance with ATO and FISMA requirements, along with significant infrastructure upgrades that leverage cloud-based solutions on AWS to enhance scalability and reliability and a migration to Google’s Vertex AI Search.

Sky has embarked on a comprehensive modernization journey targeting various facets critical to transforming the landscape. At the forefront was the cultivation of an Agile and DevSecOps culture, introducing automation that streamlined processes, significantly reducing the time and effort required for new feature delivery and content posting. To fortify compliance and security measures, robust cloud and platform management strategies were implemented. Governance standards were established to ensure adherence to regulations and security requirements, alongside the execution of a meticulously devised cloud strategy for Acquia cloud Drupal version upgrades.

An equally vital focus was the ability to maintain stringent compliance with accessibility standards and regulations. Sky diligently ensures compliance with a spectrum of stringent standards, including U.S. Web Design/DigitalGov, OMB Federal Web Standards, CMS and HHS policies, and W3C Web Accessibility Initiative (WAI) standards. Upholding Section 508 of the Rehabilitation Act was pivotal, demonstrating a commitment to inclusivity and accessibility for all users.

Sky engineered a robust CI/CD pipeline, ushering in a DevOps culture and embracing test-driven development methodologies. The integration of security and compliance tools into the CI/CD pipeline ensured proactive identification and resolution of vulnerabilities before deployment, enhancing the overall security posture of the platforms. The maintenance of Mini Orange for single sign-on (SSO) to Drupal sites and the utilization of Akamai for CDN configuration significantly improved user experience and site performance, underlining the commitment to enhancing accessibility and usability.

Technologies/Methodologies

• Drupal
• Agile & DevSecOps
• AWS (Amazon Web Services)
• Google Vertex
• Acquia Cloud
• DevSecOps
• CI/CD Pipeline
• Accessibility Tools include SiteImprove, ANDI, JAWS, WAVE
• Security Tools compliance with security standards like ATO and FISMA
• Section 508 Compliance

Outcome

Ultimately, our efforts enabled CMCS to keep pace with the changing health landscape and continue to provide a fast and reliable web presence via Medicaid.gov and IKN platforms, available to the public 24 hours a day, 7 days a week. We accelerate speed-to-market as it relates to ongoing regulatory and benefit changes that need to be communicated and accessible to beneficiaries in a timely manner. We help drive the best consumer and usability experience possible, making it easier and more intuitive for beneficiaries to find and use the information and resources they need. Lastly, we ensure compliance with all security guidelines and accessibility requirements, aligning to CMCS’s aspiration to be a model employer of people with disabilities and provide equally effective access to its programs and services.

• Millions of users use Medicaid.gov and IKN.gov to find information about these programs.
• 93,008,246 individuals enrolled in Medicaid and CHIP in the 51 states and the District of Columbia reported enrollment data for January 2023.

The post Accelerating and Enhancing Access to Critical Medical Benefits for Low-Income Individuals & Families  appeared first on Sky Solutions.

The United States Core Data for Interoperability (USCDI) plays a pivotal role in enabling seamless, nationwide health information exchange by establishing standardized data classes and elements. However, implementing USCDI and its advanced counterpart, USCDI+, presents significant challenges for healthcare organizations. Legacy systems, cumbersome approval workflows, and limited transparency hinder data standardization, regulatory compliance, and interoperability.

To address these challenges, Sky Solutions partnered with the Office of the National Coordinator for Health Information Technology (ONC) to revolutionize the development of national interoperability standards. By leveraging ServiceNow’s cutting-edge low-code technology, Sky Solutions introduced streamlined workflows and innovative digital solutions that modernized healthcare data exchange processes.

Goal

The goal of this initiative is to enhance healthcare interoperability by streamlining workflows, modernizing approval processes, and fostering transparency among stakeholders. Sky Solutions focuses on simplifying data submissions, improving efficiency, and empowering healthcare organizations to meet regulatory requirements. By supporting the ongoing evolution of national standards, the effort aimed to drive better patient outcomes and advance the modernization of health information exchange.

Challenge

The United States Core Data for Interoperability (USCDI) is a standardized set of health data classes and elements for nationwide, interoperable health information exchange. It establishes a baseline of commonly exchanged data across care settings for various uses.

Implementing USCDI and USCDI+ poses challenges for healthcare organizations due to siloed legacy systems, complex approval workflows, and transparency issues. These factors impact data standardization, regulatory compliance, and interoperability. A more agile, transparent approach was needed to enhance healthcare interoperability through refined national standards for seamless data exchange.

Solutions

Sky Solutions partners with the Office of the National Coordinator for Health Information Technology (ONC) to establish a new model for national interoperability standards, enabling seamless collaboration and secure information sharing across healthcare communities. By leveraging ServiceNow’s advanced digital workflows and working closely with regulatory bodies, Sky Solutions streamlines the development and approval process for the U.S. Core Data for Interoperability (USCDI+), driving the modernization of healthcare information exchange.

Solution highlights include:
Transforming workflows: Utilizing ServiceNow’s App Engine and low-code capabilities to enhance USCDI+ standard development
Reengineering ONC processes: Improving efficiency by streamlining existing workflows
Simplifying submissions & approvals: Making the process for data elements and classes more efficient
Providing Continuous development support: Facilitating the ongoing evolution of national healthcare standards

Technologies/Methodologies

• ServiceNow
• Low-code/No-Code development
• Flow Designer and UI Builder
• Integration Hub
• ServiceNow Managed Services 
• Scalable Cloud Infrastructure

Outcome

Sky’s solution not only streamlined the submission, review, and approval processes but also enhanced collaboration and efficiency among federal healthcare stakeholders. The Solution:

• Increases transparency and public input in healthcare standards
• Scales to handle higher submissions and integrates with ONC systems
• Simplifies submissions via the ServiceNow Service Portal
• Cuts IT costs, freeing staff for strategic tasks
• Strengthens ONC’s leadership in healthcare interoperability

The post Pioneering a New Era of Interoperability in Healthcare appeared first on Sky Solutions.

The Administration for Children and Families (ACF), part of the U.S. Department of Health and Human Services, administers the Child Care and Development Fund (CCDF) to support low-income families. ACF faced challenges integrating data from diverse grantees, meeting federal guidelines, adapting to changing reporting requirements, and ensuring secure user access. To address these issues, Sky Solutions developed the Childcare Automated Reporting System (CARS), a modern, cloud-based platform that streamlined data collection, improved governance, and reduced administrative burdens.

Goal

The goal of this project was to streamline data management with a secure, cloud-based infrastructure, automate reporting workflows for efficiency and compliance, and enable data-driven decision-making through improved transparency and governance. It aimed to enhance user engagement with an intuitive design and create a scalable, cost-effective system adaptable to future needs.

Challenge

The Administration for Children and Families (ACF), a division of the United States Department of Health and Human Services (HHS), supports low-income families through the Child Care and Development Fund (CCDF). ACF faced challenges such as integrating information from diverse grantees while adhering to strict federal guidelines, adapting quickly to frequent changes in reporting requirements, and ensuring secure self-registration and Single Sign-On (SSO) for its diverse user base. ACF required a resilient, cloud-based infrastructure to support mission-critical applications and improve overall service delivery.

Solutions

Sky Solutions partnered with ACF to develop the Childcare Automated Reporting System (CARS), automating the data collection, review, and reporting process for the CCDF program. Our approach emphasized collaboration, interoperability, and leveraging best-of-breed technologies to enhance service delivery and operational efficiency. Sky developed a modern platform focused on enhancing data governance and transparency, enabling stakeholders to make data-driven decisions while achieving federal compliance and reducing the administrative burden. The solution improved ACF’s ability to manage and leverage data as a strategic asset.

Technologies/Methodologies

• Cloud (AWS, Azure, ServiceNow)
• Appian
• MariaDB
• Tableau
• Okta
• Jira and Confluence
• Agile Scrum

Outcome

Sky Solutions’ approach yielded high-quality outcomes, establishing a flexible, scalable framework adaptable to future needs. By using Agile Scrum methodology, we shortened delivery times and optimized user interfaces, creating an intuitive system that eased the submission process. Other key outcomes of the solution include:

• Reduced operational and maintenance costs through AWS
• Developed a single portal for states and tribes to submit OMB-approved forms, ensuring compliance
• Developed a scalable system for rapid deployment of new features
• Increased user engagement and adoption with a user-centered design

From 2021 through present (2024), the team developed over 3000 stories with an average of 95% defect free and average completion rate of over 95% per sprint.

The post Collaborating to Transform Childcare Services appeared first on Sky Solutions.

Sky Solutions designed and developed a Proof of Concept (POC) for CDER’s OneNexus platform to validate system functionality and establish a foundation for future development. Using Appian on AWS GovCloud, Sky Solutions created the POC to demonstrate core functionality for NDA and ANDA application review. They also built a reusable workflow framework, managed user access, and established clear deployment guidelines. To address the challenge of atomic transactions, Sky Solutions utilized database stored procedures for transactional writes, while Appian handled the business logic.

Technologies/Methodologies

• Appian on GovCloud: Development platform for OneNexus
• Oracle DB on Premises: Database solution
• Microsoft SharePoint on Azure: Document collaboration tool
• Atlassian Jira & Confluence: Agile project management tools
• CDEROne Analytics: Integration for drug product details

Outcome

Sky Solutions delivered the POC, earning positive feedback from CDER leadership and advancing the OneNexus project. Key outcomes include:

• Harmonized processes and operational issues across CDER offices
• Improved data transparency for 1,500+ users
• Streamlined drug evaluation processes
• Reduced risks from decommissioning legacy systems

The post Modernizing FDA’s Drug Review Processes for Transparency and Efficiency appeared first on Sky Solutions.

The Center for Drug Evaluation and Research (CDER) is tasked with tracking, reporting, and maintaining records related to drug and biological product applications. These records are used for reporting to Congress on various performance goals under the Prescription Drug User Fee Act (PDUFA), Biosimilar User Fee Act (BSUFA), and other regulations. CDER’s previous tracking and archiving systems were outdated, leading to the creation of the Document Archiving, Reporting, and Regulatory Tracking System (DARRTS), a multi-tier, web-based enterprise application designed to streamline application submissions, document archiving, and report generation.

Goal

The primary goal of DARRTS is to consolidate multiple functions into one system, enabling CDER to efficiently manage, track, and archive application submissions while generating standardized documents during the application review process. The system also supports reporting to Congress, ensuring compliance with PDUFA, BSUFA, and GDUFA (Generic Drug User Fee Act) goals.

Challenge

CDER’s legacy systems were technically outdated and could not accommodate evolving business practices. Integrating the functionality of various legacy applications into a single, flexible, and scalable system was a complex challenge. Additionally, CDER required enhancements to support new application types and streamline application review processes across a large user base of over 4,000 CDER staff.

Solutions

Sky Solutions implemented a modernized solution for CDER by performing critical operations and maintenance, leading development and testing for new change requests, and deploying continuous integration and delivery (CICD) pipelines using Jenkins and Git. Sky developed REST web services utilizing existing Oracle Application Development Framework (ADF) models, enabling seamless integration for future modernization efforts. By adopting an Agile Development Life Cycle (ADLC) methodology with Scrum practices, Sky ensured transparency, collaboration, and iterative progress.

Sky Solutions led the effort in the following areas:

• Conducted operations and maintenance for the DARRTS application.
• Handled development, testing, and release management for both defects and new change requests.
• Developed REST web services to modernize CDER’s architecture using the existing ADF model.
• Supported technical and functional integrations, along with feasibility assessments for new modernization initiatives.
• Leveraged the Oracle ADF tech stack on WebLogic, Oracle DB on-premises, and REST web services.

Technologies/Methodologies

• Oracle ADF (Application Development Framework): Used for developing the application’s business components and UI following the MVC pattern.
• Oracle Fusion Middleware (WebLogic, OHS): Provides the application server environment for running the DARRTS application.
• Oracle DB (On-Premises): The primary database for storing and managing the application data.
• REST Web Services: Implemented using the existing Oracle ADF Model for integration and modernization efforts.
• Jenkins:(CI/CD) pipelines.
• Git Hub.

Outcome

The DARRTS system was significantly enhanced, providing a more flexible and scalable platform for managing drug applications. By replacing manual deployments with automated CI/CD pipelines, Sky streamlined the release process, reduced downtime, and improved overall system performance. The integration of REST web services using the ADF model allowed CDER to modernize its application architecture while maintaining acceptable response times. As a result, the FDA was better equipped to track, report, and archive submissions, improving their ability to meet Congressional reporting requirements and enhancing operational efficiency across the board.

The post Simplifying the Drug Application Management for CDER appeared first on Sky Solutions.

The U.S. healthcare system is among the most complex in the world, with multiple stakeholders, regulatory intricacies, varied payment models, a blend of public and private funding, and challenges related to data standardization and interoperability. At the center of efforts to address these complexities is the Centers for Medicare & Medicaid Services (CMS), which plays a crucial role in simplifying processes, enhancing healthcare quality, improving access to care, and fostering a more patient-centered and efficient healthcare system for over 100 million beneficiaries, many of whom have disabilities.

Within CMS, the Center for Medicaid and CHIP Services (CMCS) leads the formulation, coordination, integration, and implementation of national program policies and operations for Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). CMCS is responsible for producing and publishing documents and resources on the Medicaid.gov website, which beneficiaries rely on for essential guidance and access to benefits. By law, these resources must comply with Section 508 accessibility standards before they are made publicly available.

While CMS, along with its departments, including CMCS, is legally required to meet Section 508 accessibility standards, its commitment to accessibility goes beyond regulatory compliance. CMS strives to be a model employer of individuals with disabilities and is dedicated to ensuring equitable access to its programs and services, in line with Section 504 of the Rehabilitation Act of 1973. Furthermore, CMS is committed to providing an exceptional user experience for all beneficiaries, with accessibility as a foundational element.

Goal

The goal of this project is to help the Center for Medicaid and CHIP Services (CMCS) achieve Section 508 compliance for its documents, ensuring accessibility for all beneficiaries, especially those with disabilities. By leveraging accessibility checking tools and a user-friendly remediation process, the project reduces the backlog of noncompliant documents, streamline document delivery, and creates a sustainable framework for ongoing compliance, while enhancing the user experience and meeting tight deadlines.

Challenge

CMCS produces and distributes thousands of documents each year, sharing them directly with beneficiaries and posting them on CMCS-managed websites. These documents are essential in helping beneficiaries understand and utilize their benefits. Many of these materials have been in circulation for decades, creating ongoing challenges for CMCS as it strives not only to ensure 508 compliance, but also to promote equal access and provide the best possible user experience, especially for those with disabilities.

As beneficiary needs grow and evolve, the requirements around document creation and sharing also continue to grow. For example, CMCS often faces stringent deadlines to deliver documents to other government agencies (such as the White House) within a mere three hours.

Solutions

Building on our extensive experience in 508 compliance and remediation, Sky Solutions’ Human-Centered Design Center of Excellence (CoE) has led 508 remediation initiatives for several federal agencies. These efforts have significantly advanced the accessibility goals of these agencies, helping establish modernized processes and frameworks that ensure long-term compliance and an improved user experience.

For CMCS, Sky leverages deep expertise in Section 508 Standards and Web Content Accessibility Guidelines (WCAG) 2.0, along with a strong understanding of Medicaid policies and processes, and a Digital-First approach to modernization and process improvement. This approach ensured successful 508 compliance remediation that meets both expectations and requirements.

Sky assessed various alternative solutions from an accessibility perspective and selected Section 508 automated testing tools to deliver compliant products in a timely manner. Sky developed a user-friendly, efficient document remediation process for CMCS, enabling easy submission and retrieval of documents. This modernized process, combined with our expertise and tools, effectively reduced the legacy document backlog. It also provides a sustainable framework, allowing CMCS to manage increasing remediation demands, adapt to tighter deadlines, and uphold CMS’ commitment to accessibility going forward.

Technologies/Methodologies

• 508 Compliance
• Human Centered Design
• WCAG
• DPA
• Digital Transformation
• Center of Excellence
• Microsoft application suite

Outcome

The new, streamlined Section 508 compliance process significantly enhanced consistency, strengthened confidence in deliverables, and enhanced the quality of all documents and templates. Sky Solutions not only met but exceeds CMCS’ 508 remediation needs, furthering CMS’s mission to ensure accessible healthcare benefits for all beneficiaries.

Some of the key outcomes include:

• Eliminates accessibility barriers by making content easily accessible to the public and beneficiaries with disabilities
• Improves efficiency by reducing document remediation time from 12 hours to just 2 hours, even under tight deadlines
• Provides seamless Section 508 remediation across CMCS, including the Operations Services Group (OSG) and State Demonstrations Group (SDG)
• Establishes standardized operating procedures for 508 compliance, improving consistency and reliability across deliverables
• Enhances quality assurance by integrating artifact test results to reinforce confidence in deliverables and maintain high standards through proven quality control practices.
• Leverages automation tools and strong project management to optimize workflows
• Exceeds CMCS’ specific 508 requirements and underscores our support for CMS’ mission to ensure accessible benefits for all beneficiaries

The post Driving Section 508 compliance: Transforming CMS healthcare access appeared first on Sky Solutions.

Sky Solutions supported a large American medical laboratory on a critical project to improve the performance of their customer care application.  This organization is a leading provider of diagnostic information services, with call centers operating 24/7, year-round.

Goal

The client developed its in-house Customer Care application on the Pega platform. To support scalability, they needed to improve the application’s performance. Additionally, they required access for more customer care agents to handle the increase in calls driven by growing demand.

Challenge

The Customer Care application was experiencing significant performance issues, which were increasing call times and leading to longer wait times for customers. This negatively impacted customer satisfaction. Unless these performance issues were addressed, the organization would not be able to grant access to additional customer care agents to handle the backlogs, as adding more agents caused application crashes and downtime on the Pega server. These problems ultimately led to customer dissatisfaction and lost revenue.

Solutions

Sky Solutions provided expertise on the Pega platform to address issues at all levels: architecture, application, environment/server, and database. We analyzed all integration points to identify opportunities for performance improvements. As a Pega Partner specializing in Delivery and with over a decade of experience working with the Pega platform, we were able to quickly identify and remediate the issues.

Technologies/Methodologies

• Low-code development 
• Agile development
• Pega

Outcome

Sky Solutions’ performance tuning and application enhancements helped the Customer Care application become stable, scalable, and efficient, leading to significant improvements in performance and cost savings. Some of the key outcomes include:

• Improved application stability, allowing the addition of 150 more customer care agents (20% increase) without performance degradation
• Reduced call times and waiting times, increasing satisfaction for both agents and customers
• Decreased production ticket count to zero
• Achieved substantial cost savings for the organization
• Boosted confidence in the Pega platform for future scalability

The post Delivering Game-changing Performance for Healthcare Call Centers appeared first on Sky Solutions.

The state government sought to modernize four of its eleven Medicaid Home and Community-Based Services (HCBS) Waiver programs and improve tracking across various case management processes, including claims, complaints, appeals, prior authorizations, and more. They required workspace portals for case managers and case workers to support the multiple roles involved throughout the HCBS program lifecycle, from enrollment to disenrollment. These portals were designed to enable efficient management of diverse case types while adhering to established business processes.

Goal

The primary goal was to modernize four Medicaid Home and Community-Based Services (HCBS) Waiver programs, improve case management processes for handling diverse case types, and streamline eligibility determinations and service authorizations while providing real-time visibility into compliance and service delivery. Given the involvement of multiple agencies providing waiver services, the project also focused on generating detailed reports to support case managers and workers in maintaining effective communication within the system. Ultimately, the objective was to enhance access to essential Medicaid services for vulnerable populations across the state, ensuring they receive timely and efficient support.

Challenge

During the modernization of four Medicaid Home and Community-Based Services (HCBS) Waiver programs, several challenges were encountered, particularly in transitioning from the legacy system to the new platform. This process involved not only transferring data but also migrating attachments—a critical yet often-overlooked task—requiring meticulous planning to ensure seamless integration.

Additionally, integrating with multiple subsystems within the PRISM environment posed significant difficulties. Each subsystem had unique data requirements and protocols, which complicated the process of retrieving and synchronizing the necessary information. Addressing these complexities required extensive collaboration and rigorous testing to ensure accurate and efficient data flow across all systems.

Despite these hurdles, the team remained steadfast in delivering a robust solution that enhanced overall service delivery for the HCBS programs.

Solutions

Sky Solutions designed a comprehensive solution featuring dedicated workspace portals for case managers and case workers, streamlining collaboration and processes from enrollment to disenrollment. These portals supported the diverse roles of providers and state government users, enabling efficient management of various case types in line with established business processes.

The solution enhanced tracking across multiple case management areas, including claims, complaints, appeals, prior authorizations, etc., while simplifying the prior authorization process within the HCBS programs. Recognizing the involvement of multiple agencies in providing waiver services, Sky Solutions developed detailed reports to aid case managers and workers in decision-making and communication.

Key highlights of the solution include:

• Leveraging Pega to modernize four Medicaid Home and Community-Based Services (HCBS) Waiver programs
• Implementing a centralized platform to streamline eligibility determinations, service authorizations, and case management
• Creating dedicated workspace portals for providers and state government users to manage diverse case types effectively
• Ensuring seamless integration with PRISM subsystems for real-time data access
• Providing users with readily available, relevant information to improve efficiency
• Incorporating robust tracking features to manage claims, complaints, appeals, etc.
• Equipping case managers and workers with tools to enhance service delivery

Technologies/Methodologies

• Pega
• FileNet
• Low-Code/ No-Code

Outcome

Sky Solutions has streamlined the Medicaid prior authorization process, cutting delays and boosting efficiency for members and providers. Member enrollment now takes less than 30 days, down from 5-6 months. Providers can now add or update member services within hours instead of three months. State users and providers now have real-time access to track and update waiver program stages via user-friendly online portals.

The post Legacy to Leading Edge: Empowering Medicaid with Seamless Workflow Modernization  appeared first on Sky Solutions.

Sky Solutions supports digital transformation for a large regional healthcare payer serving approximately 1.5 million members. Like many healthcare payers, this organization (the client) is committed to modernization initiatives aimed at improving healthcare access and enhancing the member experience. A critical part of this mission is the organization’s ability to respond quickly and efficiently to market changes and member expectations, ensuring members continue to receive timely and seamless access to their preferred healthcare options. One area within the health insurance industry that has long been a prime target for digital transformation—offering opportunities to significantly reduce costs, eliminate waste, and improve the member experience — is the member enrollment process.

Goal

The organization sought to enhance the member experience by streamlining the enrollment process, ultimately reducing the enrollment timeline, decreasing case resolution times, and boosting Enrollment Processor productivity.

Challenge

Outdated member enrollment processes and technologies posed numerous challenges, including manual, paper-based workflows, lack of integration with other systems and data sources, limited accessibility, increased administrative burden, increased compliance risks, and a poor member experience.

For over a decade, the client relied on Lotus Notes, a legacy CRM and ERP system, to support many critical business functions, including member enrollment. Enrolling a new member historically took anywhere from several days to a few weeks, involving multiple manual steps and requiring access to and interaction with various disconnected systems and data sources. This resulted in frustration and delays for members, data inaccuracies and discrepancies, decreased member acquisition and retention, and ultimately threatened revenue targets. It became clear that Lotus Notes could no longer provide the functionality needed to effectively address these issues.

Solutions

Sky Solutions assisted in migrating the member enrollment process from Lotus Notes to a modern, low-code, cloud-based system—Pega—that streamlined and automated several enrollment functions. The new platform enabled integration of the necessary disparate systems and data sources critical to the process, provided reporting and visibility into the reengineered workflows, and allowed for rapid scalability and adaptability for the future.

Technologies/Methodologies

• Low Code
• Agile
• DPA
• Pega
• Cloud 

Outcome

Since the new enrollment function on Pega went live over a year ago, the total enrollment timeline has decreased from several days or weeks to just a few days—or even minutes in some cases. Case resolution time has been reduced by approximately 86%, and Enrollment Processor productivity has increased by 95%.

The post Transforming Healthcare Member Enrollment, From Weeks to Just Minutes appeared first on Sky Solutions.