CMS Drug Claims (DDPS)
Investment ID: 009-000004260
Overview
Program Title
CMS Drug Claims (DDPS)
Description
This investment funds the collection, maintenance and processing of all Medicare covered and non-covered Prescription Drug Events (PDEs), including non-Medicare PDEs for Medicare beneficiaries. The PDEs compute beneficiary and plan utilization to be used for payment reconciliation. This investment also supports the function of reconciling payments that Plans receive for the low income cost sharing subsidy, reinsurance, the risk corridors, Part D final beneficiary reconciliation and premium withhold. This investment includes contracts for the Operations and Maintenance of Drug Data Processing System and Payment Reconciliation System (DDPS/PRS); the Integrated Data Repository for Drug Claims and annually-renewable license agreements for National Council for Prescription Drug Pharmacies (NCPDP), First Data Bank Integrated Data Repository (IDR) and One Program Integrity (PI); and Prescription Drug Front End System (PDFS). This investment also funds cloud hosting and supporting tools.
Type of Program
Major IT Investments
Multi-Agency Category
Not Applicable
Investment Detail
This investment funds the operations, maintenance, necessary system enhancements, supporting contracts, and cloud hosting for The Drug Data Processing System (DDPS). DDPS processes all drug events covered by the Medicare Prescription Drug Benefit of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003, particularly all drug event transactions covered under Part D. Data stored by the DDPS can be analyzed for evidence of fraud, waste, and abuse, as well as for risk adjustment, drug utilization, auditing, trends, payment, and benefit adjustments and reporting. The DDPS also stores the drug events to effect payment reconciliation through the Payment Reconciliation System (PRS), a system for payment management of the MMA Part D Prescription Drug Program. The payment management process helps to ensure that the Government is fiscally responsible and the participating Part D plans are compensated appropriately for their participation in providing drug benefits. The PRS compares Part D prospective payment information to actual cost in order to perform the three required payment reconciliations of low income cost sharing subsidy (LICS) reconciliation, Reinsurance reconciliation and risk-sharing/risk corridor reconciliation.
DDPS and PRS have migrated to a modern cloud based architecture with minimal or no risk to business operations. This migration supports OITs goal to Lead IT Modernization that protects our Infrastructure. After the full migration, DDPS/PRS realized a 35% reduction in overall storage requirements and a ~60% reduction in PDE processing run time.
With the contracting support providing the operations, maintenance, and migration of the DDPS/PRS, CMS introduced several cost-saving strategies, including auto-scaling and auto-termination in the Databricks workloads and utilizing spot instances to reduce EC2 instance costs. Additionally, DDPS reduced Databricks licensing costs nearly 50% by redesigning the system architecture to combine all lower non-production VPCs and performing all the necessary processes using only one Databricks VPC.
The DDPS contractor team also implemented the Security Hub tool in AWS. This tool provides a comprehensive view of security alerts and security postures across the GDIT DDPS/PRS AWS accounts. The AWS Security Hub continuously monitors the DDPS/PRS environment using automated security checks based on AWS best practices and industry standards.
DDPS and PRS have migrated to a modern cloud based architecture with minimal or no risk to business operations. This migration supports OITs goal to Lead IT Modernization that protects our Infrastructure. After the full migration, DDPS/PRS realized a 35% reduction in overall storage requirements and a ~60% reduction in PDE processing run time.
With the contracting support providing the operations, maintenance, and migration of the DDPS/PRS, CMS introduced several cost-saving strategies, including auto-scaling and auto-termination in the Databricks workloads and utilizing spot instances to reduce EC2 instance costs. Additionally, DDPS reduced Databricks licensing costs nearly 50% by redesigning the system architecture to combine all lower non-production VPCs and performing all the necessary processes using only one Databricks VPC.
The DDPS contractor team also implemented the Security Hub tool in AWS. This tool provides a comprehensive view of security alerts and security postures across the GDIT DDPS/PRS AWS accounts. The AWS Security Hub continuously monitors the DDPS/PRS environment using automated security checks based on AWS best practices and industry standards.