2007 Citizen Services

Wallace Fung and Henry Chao

Created the IT infrastructure that supports the new Medicare prescription drug benefit.

The Medicare reform bill that passed in 2003 and created a prescription drug benefit (Medicare Part D) was a major source of disagreement, passing by only one vote in the House of Representatives. Once the bill was signed into law, there was one thing everyone agreed on: setting up a huge new program in a short time was likely to be a logistical nightmare. This country hadn’t seen so many doomsday scenarios since the Y2K scare, but thanks to Wallace Fung and Henry Chao, the nightmarish predictions for the new Medicare program’s administration met the same fate as the year 2000 forecasts. Today, more than 24 million Medicare beneficiaries are enrolled in Part D, with the program ensuring that more than 90 percent of Medicare beneficiaries, 39 million, now have some form of creditable prescription drug coverage through their employer or other government plans.

The scope of Fung and Chao’s challenge was truly mind-boggling. It would require extensive technical design work, building coalitions with business owners, management of numerous contractors and significant procurement actions within a very aggressive time frame. The following is just a small sample of the things they did to make this program operational.

They coordinated with more than 580 Medicare Advantage and Part D health plans about how the new system for Part D would be structured and implemented, and created an entire communications process to support these partners and beneficiaries.

They created the IT infrastructure which included new data sharing capabilities for the Medicare Beneficiary Database that gave community based organizations (CBO) and Medicare customer service representatives (CSR) timely access to important information, improving service.

They created online networks that enabled these community organizations and service representatives to submit applications for enrollment.

They created a system that allows managed care plans to transfer files over the Internet. This supports the efficient continuation of operations related to managed care payments.

They created a system that provides enterprise-wide user identification and authentication which creates administrative efficiencies, better security and improved service to applicants by providing a single sign-on.

If these systems had not come online on schedule, the Center for Medicare & Medicaid Services would not have been able to enroll beneficiaries accurately when the program was scheduled to go live in January 2006. Not only was the operating system ready on time, but an average of 80 percent of all enrollees report they are satisfied with the service. An 80 percent customer satisfaction rating would be unheard of at many of the top companies in the private sector. The fact that Wallace Fung and Henry Chao were able to pull it off despite tremendous challenges and widespread skepticism is a testament to their skill and dedication.

Four years after the law passed, there is still a great deal of disagreement about how the benefit is structured, but now there is one more thing all parties can agree on—Wallace Fung and Henry Chao have created an infrastructure and operating system for the Medicare prescription drug program that has enabled it to operate as efficiently and effectively as the law allows.