CCLF as a Service
Client
Centers for Medicare and Medicaid (CMS)
Project
Innovative Design, Development, and Operations Contract (IDDOC) - 4innovation (4i) Platform
Background
Overview
One of the core functions of the 4i platform is to support hospitals, physicians, and other healthcare organizations participating in Alternative Payment Models (APMs) by enabling secure access to datasets that drive improvements in care quality and cost efficiency. Because our user base spans from large health systems with advanced data infrastructures to smaller organizations with limited technical resources, the platform must accommodate a wide range of technical capabilities. While some institutions can manage complex data ingestion and analysis, many users require intuitive, low-effort, and code-free access to critical information to prevent disruptions in patient care.
A key dataset within the 4i platform is the Claim and Claim Line Feed (CCLF) files—comprehensive, high-volume files that contain detailed information on the services patients receive, including inpatient, outpatient, skilled nursing, home health, hospice, professional, durable medical equipment, and prescription drug services. Due to their size and complexity, these files are especially difficult to navigate for non-technical users. Addressing this usability challenge was central to our efforts, as simplifying access to CCLF data is essential to enabling informed decision-making across all of the health organization that we serve, no matter the level of technical proficiency.
My Role
As Product Design Manager, I partnered with the Research Manager to lead a team of 4 dedicated designers and researchers. My specific role on this piece of the project included:
Partnering with the research manager to:
Conduct discovery research to assess current state challenges
Analyze research findings and deliver actionable recommendations, ensuring solutions were accessible and effective for all users.
Scoping and estimating design work to align with project timelines.
Collaborating closely with other team leads across disciplines.
Leading the designs of the 2 identified solutions.
Leading evaluative research to assess the effectiveness of the solutions and identify opportunities for future enhancements.
Discovery Research
Goals
Our objective was to observe how data ingestion, analysis, and utilization processes were carried out across a range of ACOs participating in different Models, in order to identify both common and organization-specific pain points. These insights would inform and help prioritize key areas for targeted solution development.
These questions were what we aimed to answer:
What are the key segments of the customer journey, for example, accessing the data, preparing the data, analyzing the data, etc.?
What are the current usage patterns? What other systems are users integrating with?
Who are the groups of people interacting with the data across the journey - for example, program managers, technical users, care providers, etc.?
Are there other pain points or opportunities to provide value to users? Additional data formats, data elements, custom look back dates, etc.? Security and privacy issues?
Methods
Conducted desk research to establish a baseline understanding of CCLF files—their contents, how ACOs use them, and the most commonly referenced data points.
Led in-depth interviews with representatives from six ACOs across three different Models.
Developed personas representing 3 levels of organizational CCLF adoption maturity.
Created a current-state experience map outlining user journeys across the 3 persona levels, highlighting both key challenges and areas of success.
Key Takeaways
Insufficient Technical Expertise and Capacity
ACOs in the Level 1 and 2 personas face significant challenges due to limited technical expertise, subject matter knowledge, and organizational capacity to manage the custom setup required for data pulls and analytics. Some rely on third-party vendors to interpret and format the data for practical use, while others lack the budget to do so. Ultimately, these organizations seek clear, actionable insights—such as leakage determinations and patient care locations—presented in a straightforward, accessible format.
File Delivery Timing
ACOs in the Level 3 persona’s primary challenge was the limited frequency of file delivery, especially when compared to commercial payers. While commercial payers often provide data weekly or on an ad-hoc basis to reduce lag, CCLF files in 4i are currently delivered only once a month.
Design
Framing the Challenge to Solve For
Before generating solutions, we needed to clearly define the problem from the user’s perspective. Using insights from discovery research, we crafted How Might We statements to focus our ideation:
How might we… deliver CCLF claims data more quickly, so users can take timely action and implement interventions without delay?
How might we… enable users to easily extract and interpret CCLF data, regardless of technical expertise, so they no longer need to outsource technical help?
Solution 1: Self-Service, Configurable CCLF Data Pull Interface
Develop a tool within 4i that enables users to create customized CCLF data exports tailored to their needs, with configurable criteria such as:
Date range
Most-used or basic data elements
Data granularity (episodic, patient, provider, etc.)
Entity
The tool would also allow users to schedule automatic generation and download of CCLF data based on their chosen configurations, with flexible frequency options—weekly, monthly, or immediately upon availability of new claims.
Solution 2: CCLF Data Visualization and Interactive Analysis
Design a user interface that presents model-specific summary information to support ACOs in coordinating patient care. The interface would feature an interactive dashboard with capabilities such as:
Clear, simple visualizations of analyzed data for key metrics, as defined by program and user needs
Drill-down interactivity, allowing users to click on a metric to identify the specific patients included in that numerator for the month
Searchable and filterable data for targeted analysis
Report export options in multiple usable formats, enabling seamless integration into existing workflows
This solution would provide ACOs with an accessible, actionable view of their CCLF data, reducing the need for manual parsing and accelerating data-driven decision-making.
Outcomes
We conducted post-production usability testing with the original users from the discovery phase to assess adoption of the new features. Overall, feedback was overwhelmingly positive, with users reporting that the enhancements directly addressed their challenges.
Key themes from user feedback included:
Time savings and efficiency: The new dashboard allowed users to view all necessary information in one place, eliminating the need to manually pull and interpret files. This freed up time to focus on making more informed care decisions for their patients.
No technical barriers: Users appreciated the removal of coding requirements and the reduced need for costly IT support.
Improved monitoring capabilities: The ability to track specific datasets more frequently than with the previous monthly pulls significantly streamlined workflows.
Better patient outcomes: Easier access to critical care data was credited with driving substantial improvements in patient care.
Adobe Analytics data reinforced these findings, showing:
73% of ACOs across the 5 Models in 4i opted to receive custom files through the portal.
55% reduction in compliance actions related to underperformance, attributed to increased visibility into patient care via CCLF data.