February 27, 2020 FTC

From Cloud Migration to Community Collaboration: A Case Study

How the FTC Team Leveraged the AWS Cloud to Transform Value-Based Care for a Smarter, More Engaged Department of Defense (DoD) Uniformed Services Family Health Plan (USFHP) Stakeholder Community

EXECUTIVE SUMMARY

Sponsored by the Department of Defense (DoD), the Uniformed Services Family Health Plan (USFHP) provides comprehensive healthcare coverage to TRICARE beneficiaries under the Prime options. With over 150,000  active duty, activated and Reserve National Guard, and retired service members and their families receiving care from six independent healthcare providers spread across the United States, the USFHP program required a business intelligence ecosystem that would enable Defense Health Agency (DHA) program managers and stakeholders to improve point-of-service care, effectiveness, and accessibility. In 2018, DHA awarded FTC the 5-year US Family Health Plan Data Support Services contract, engaging FTC to provide information technology support, data warehousing and data processing to the Military Health System (MHS) to enable USFHP Designated Providers (DP) nationwide to access real-time data for better patient care.

With a shared vision to improve performance, enhance value-based delivery, and increase transparency within what is an enterprise of highly-siloed systems, the FTC team and DHA Program Manager/COR Vickie Laperle worked in close partnership to set the path for impactful change. New, streamlined processes improved workflows, data-rich reporting allowed stakeholders to identify key strengths in care delivery mapped against DHA’s long-term goals, and agile, transparent feedback systems equipped stakeholders with the data and technology to continue system enhancements.

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Count Up to 6
6

USFHP Designated Providers nationwide

Count Up to 150,000
150,000

Veterans and Dependents receiving care

Count Up to 1
1

AWS GOV CLOUD

Count Up to 9
9

MONTHS TO ARCHITECT THE SOLUTION

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THE CHALLENGE

From the outset, significant obstacles hounded the FTC team’s timeline. Schedule disruptions from a stalled transition from a prior vendor, delayed access to critical program materials, data sets, and information systems, faulty data sets, and low-bandwidth connections constricted what was already a tight deadline for delivery. Even security approvals for CAC authentication lagged the anticipated timeline; this being the first such program to migrate to the Amazon Web Services (AWS) GovCloud through the DHA B2B connection, significant regulatory reviews slowed the approval process until just one week before implementation.

With the program already behind-schedule, valuable time extensions that might allow the team to execute and perform test cycles according to the program plan were not an option for the FTC team. Indeed, to stay on schedule with the program deadline, the original timeline for testing was compressed by a third, forcing the FTC team to work around the clock to conduct system migration by the mandated deadline.

In addition, with six disparate USFHP Designated Providers (DP) nationwide accessing data from what has historically been a highly siloed enterprise IT system without a strong sense of partnership, the program suffered from a lack of cohesion, transparency, and mission-alignment.

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OUR SOLUTIONS

To overcome these significant challenges, the FTC Team leveraged its significant AWS networking and Cloud implementation expertise, applying an Agile management methodology at every stage to optimize flexibility, responsiveness, and communication amidst the project’s ever-shifting timeline and panoply of obstacles. With 1GB connections limiting data migration and access to contractually required materials, system and data access stalled in transition from the outgoing vendor, the FTC Team was required to think outside the box for workarounds through data replication during periods of delays – the FTC Engineering and QA teams mimicking potential production scenarios and architecting alternative solutions within simulated environments.

Through sheer determination, dedication, and the application of an effective risk management framework, the team re-architected the entire system of claims management, enrollment, medical and pharmaceutical claims validation, and system interaction with multiple DHA and DMDC systems despite a significantly compressed testing timeline and continued delays due to inter-agency miscommunication and faulty data sets

Ultimately, within just 9 months, the team transitioned existing data support systems to a modern cloud-based infrastructure and orchestrated the information services and support needed to migrate the entire USFHP program to the AWS GovCloud – overcoming the significant technical and governance challenges in being the first DHA program to migrate to the AWS GovCloud through the DHA B2B connection along the way.

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Count Up to 5
5

MONTHS FROM LAUNCH

Count Up to 3
3

CUTS IN INFRASTRUCTURE COSTS

Count Up to 900
900

DECREASE IN OUTSTANDING CLAIMS PAYMENTS

Count Up to 1
1

FULLY ENGAGED STAKEHOLDER COMMUNITY

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THE RESULTS

Just five months from launch, infrastructure costs have been cut by one third. FTC program management is leveraging our Federal counterpart’s drive for performance enhancements that has reduced outstanding claims payments and beneficiary credits by more than 900%.

Moreover, having engaged the stakeholder community for valuable data and feedback throughout the process, the program management team cultivated a culture of knowledge sharing and consensus building that has had a powerful impact in fostering closer mission alignment and more open, transparent dialogue across the stakeholder community. Recognizing a new sense of stakeholder engagement, the FTC Team worked jointly with the Program Manager/COR to design the first-ever DHA USFHP Conference, a two-day summit for the stakeholder community, consisting of DHA, USFHP six regional health plans, and the support contract team, to discuss system enhancements, clinical quality, best practices, value-based care initiatives, and the future of the Military Health System. Held at FTC’s Vienna, Virginia, corporate headquarters in August, 2019, the event featured keynote speakers such as DHA’s Chief of Health Plan Design, the DHA Deputy Chief and the Chief Clinical Officer and far exceeded expectations with more than 60 health professionals traveling across the country to participate. Stakeholders across the USFHP community welcomed the opportunity to showcase their healthcare partnerships with the DoD’s Centers of Excellence and highlight the value of both the vendor/government partnership and program improvements. More importantly, the DP Senior Leadership were gratified to be given an active voice at the table with government decision-makers, and the rich dialogue fostered even closer partner alignment and new opportunities for enhanced enterprise Value-Based care studies in the future.

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INSIGHTS

Equipping healthcare providers with new cloud-based technology and a modern data-driven approach to process improvement has had an immediate and dramatic impact in transforming the quality of care for active duty, activated and Reserve National Guard, and retired service members and their families. Moreover, the new, more open dialogue, collaborative culture, and deep mission alignment within the stakeholder community will continue to drive substantive process and program improvements through the development of value-based programs/pilots, collaborative thought leadership and research, and expanding access to care for key TRICARE eligible beneficiaries.

The potential impact of this new stakeholder engagement is far-reaching; not only has this industry-government collaboration transformed the ability to deliver value-based care, but the program’s new mission-alignment, community engagement, and focus on transparency has the potential to enhance Military Health Services (MHS) across the DoD enterprise.

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