Lean and Continous Improvement at CMS

1. Lean and Continous Improvement at CMS Maryland World Class Consortium Kevin Larsen, MD, FACP December, 2018

3. Centers For Medicare and Medicaid Services • Federal Agency- part of Health and Human Services • Largest Health Insurer in the world • Responsible for • Medicare • Medicaid (state based health insurance) • Marketplace (affordable care act insurance) • 20% of the federal budget • 6,000 employees • 100,000 contractors

4. Lean at CMS • Long history of small scale deployments • 2012 current version started • 2016 current team formed within the administrator’s office (equivalent of the CEO) • 12 member team • Work directly for the COO • Charged with agency wide transformation of culture

5. Lean at CMS • Deploy lean (not six sigma) • Organizational development (coaching, facilitation) • Strategy • Launch new leadership initiatives

6. Methods deployed • Lean • using Lean Enterprise Institute • Complete Lean Enterprise- Value Stream Mapping for Office Environments – Drew Locher • Catalysis- (Formerly ThedaCare) specialize in healthcare executive team lean coaching and transformation • Human Centered Design • Agile (project management) • Balanced Scorecard (strategy and strategy deployment)

7. Continuous Improvement and Strategic Planning Staff (CISPS) Strategic Plan Initiatives (how we will achieve desired results and make an impact) Metrics(evidence of effectiveness and progress) Strategic Objectives (what we must do to achieve our goals, targets and close performance gap) STRATEGIC GOALS (Our Focus Areas) Build and sustain a CMS community of employees where everyone is enabled, everyday, everywhere in the organization, to deliver valueto customers through continuous improvement Foster improvements that are aligned with organizational priorities and deliver value to CMS business and customers • CI Academy • Community of Practice • Leader Coaching • Knowledge Library • Academy Experience • Refine Use of Problem Solving Tools 1.1 Strengthen Staff and Leadership Problem Solving Capability and Practice • Number of VSIs with Scorecards • Number of Kaizen Events • Improvement Event *CX • Value Stream Improvements (VSIs) • A3 Consultation 2.1 Improve CMS Processes so that Value is Delivered to the Customer OUR VISION All employees every day improve their work to provide better value to customers • CISPS Intake • Customer Response Rate: 2-day SLA • CISPS *CX • Intake Selection Process • CISPS Operating Model • Resource Allocation Process • CISPS Scorecard 3.1 Improve CISPS Operations OUR MISSION To build and sustain a CMS community that uses continuous improvement to solve problems and improve business processes • Skills Development • Leader Standard Work • # Staff supporting ≥7 activities • # Staff advancing 1-level for 2 skills 4.1 Improve CISPS Competencies and Capabilities *CX = Customer Experience

8. CISPS Portfolio Hierarchy CISPS Director Kevin L. CISPS Acting Dep Director Walt M. 2.1 Improve CMS Processes so that Value is Delivered to the Customer 1.1 Strengthen Staff and Leadership Problem Solving Capability and Practice 4.1 Strengthen CISPS Competencies & Capabilities 3.1 Improve CISPS Operations Resources Development Special Analysis Consultation CISPS Strategy Infrastructure Competencies & Capabilities VSI FOIA Request Processing (New York) Stephanie M.. Medicaid Medicare Analysis Heather C. VSI New Employee Onboarding Keri L. VSI IT Budget Process Debbie S. A3 Disaster Relief Joe K. VSI EMTALA Processing (Atlanta) Stephanie M. VSI Appeals Rush G. CI Leader Behaviors Lenny G. Burden Reduction Kevin L. W B W CISPS Communications Karen R & Heather G CISPS Operating Model Steve H. External Portal & Access Backlog CISPS Strategy R&R Walt M. Leader Standard Work Kevin L. Intake and Selection Walt M. CISPS Skills/Staff Development Bob P. CISPS Scorecard Walt M. Knowledge Library Abe H. VSI CIO Data Call Keri L. Non-Quad Activities CISPS VSI Bankruptcy Stephanie M. Interoper-ability Strategy Walt M. VSI Facilitation Capacity Debbie S. Community of Practice Bob P. & Diana L. Lean Leads Dev Stephanie M. OAGM CI Mgt. System Lenny G. CI Mgt. System Lenny G. CI Academy (Delivery) Abe H. CI Academy (Program Dev.) Abe H. Listing Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Listing Quad-Chart Quad-Chart Quad-Chart Quad-Chart Quad-Chart Listing Quad-Chart Quad-Chart Quad-Chart Competencies & Capabilities Coordinator Debbie S. / Bob P. Operations Coordinator Walt M. / Steve H. Problem Solving Development Coordinator Abe H. / Lenny G. Process Improvement Coordinator Stephanie M. / Rush G. CISPS Internal Initiatives CMS External Initiatives

9. Lean Academy Offerings Lean Basic Thinking A3 Thinking Coaching for Improvement Self-guided Lean Basics Curriculum COMING SOON!

10. Lean Academy Highlights • Nearly 1,000 CMS Staff have taken Lean Basic or A3 Thinking • Since March 2017 • 57 A3 Thinking classes • 792 participants • 21% managers • Since May 2017 • 51 Lean Basic Thinking classes • 893 participants • 11% managers • Course attendance has been sustained for both classes • New Self-guided CI Basics to be launched this fall

11. The Design Process The CISPS Service Design project followed the Booz Allen Hamilton design methodology which includes four main phases, bookended with an initiation phase and a pilot phase. Over the year-long project, we completed activities across these six phases. Initiation & Planning Immersion & Inquiry Synthesis & Insights Ideation & Prioritization Prototyping &Testing Pilot Phase 01 06 02 03 04 05 Explore a subject area for opportunities and decide to pursue them or not Observe and document human experiences to gain qualitative knowledge Use discovered knowledge to reframe the problem and shape understanding Combine and contrast dissimilar information to provoke unexpected ideas Build, test and iterate light & lean examples to drive final selection Facilitate a complete implementation strategy for full scale development

12. Image: Service Jam role play Service Jam Outcomes We hosted this Jam to give the entire CISPS team and their key stakeholders a taste of what a service design project entails and to begin to develop a common understanding of the terms, tools, and methodology across the CISPS team. As a result of the Jam, CISPS and their stakeholders experienced the full design process from research to prototyping, and normed around the methodology used to complete the CISPS Service Design project.

14. Lean Academy: Coaching for Improvement • Coaching by Karl Hoover, Catalysis • Nearly 30 managers received coaching • Aim is to strengthen leaders’ capabilities to effectively lead in a continuous improvement environment • Focus on mentoring, coaching, humble inquiry

15. Coaching Feedback “…Personally, I found the sessions to be tremendously valuable to me as leader in a very challenging environment.   And, more importantly, I think the concepts have the potential to help drive some very meaningful change within Agency’s leadership and management team.   Once you get past any initial skepticism with the jargon and the applicability outside of a service delivery/production type environment, you quickly realize the potential for driving efficiencies.   A long way of saying, I would love to see this offered again - and I would strongly recommend some of my managers and peers participate. Thank you for your commitment to the continued learning and professional development of all of us in CMS. Carol Blackford Director CM/Hospital and Ambulatory Policy Group”

16. CY 2018Kaizen Events We have increased our capacity to support Improvement Events

18. 4.1 Objective Performance Metrics & Targets • Next Steps: • Plan staff skill assessment in September • Begin to operationalize the Skills Matrixes with skill advancement guidance and resources

19. CISPS Activity Tracking We are Strengthening Our Bench to Support Our Services

20. Initiatives – 4.1 Improve CISPs Capacity & Capability

21. Improvement Facilitator Role– Baseline & Goals

22. Teacher/Coach Role – Baseline & Goals

23. True North – Community of Problem Solvers

24. Management Barrier Sub-Themes

25. Management Barrier: Sub-Theme Examples

26. Management Barrier: Most Negative Sub-Theme

27. Challenges and Opportunities • Challenges • Current CMS sponsored Value Stream Improvements are complex • Value Streams that cut across all components or include external partners (e.g. MACS, UPICS) have team sizes that are over the ideal team size (22 VS. 12) • Few executives have been willing to sponsor improvement events • Addressing the Management Barrier to CI • Opportunities • Some organizations that have worked with CISPS have become “repeat customers” • CAMH Coaching support is enabling CISPS to develop in their role as improvement facilitators and coaches • Continuing to cross train within CISPS is deepening our bench strength and allowing more flexibility • CISPS Skills development activities can be leveraged by CMS to develop lean leads • Continuing to partner with component Lean leads on Lean Academy offerings will increase teacher capacity and build strength in curriculum at CMS • CISPS as a whole is maturing in performance and visual management which will enable us to better serve our clients. • The CIMS pilot in OAGM will enable CISPS to mature the management system and spread to other components.