Member Benefits Transparency

Category Tag: Member-Facing Digital Transformation · Healthcare Transparency

Large Federal Employee Health Benefits ProgramT

The Problem:

A paper-based benefits system was creating confusion, call center overload, and member frustration across more than 5 million federal employees and retirees. When a member received a referral for a procedure — a rotator cuff repair, a cardiac workup, a specialist visit — they had no fast, reliable way to answer the questions that mattered most: Is this covered? What will it cost me? Which providers can perform it, and are they in-network? What is my total out-of-pocket responsibility?

The answer was a 140-page benefits booklet mailed to their home — and a phone call to a service center that was already overwhelmed. Leadership knew something had to change. The path from paper to digital required more than a technology build. It required coordinating Benefits, Legal, technology vendors, and compliance teams simultaneously — with a legal attestation framework that satisfied regulatory requirements without degrading the member experience.

What We Did:

Managed the full implementation end to end — from stakeholder alignment through legal review, vendor coordination, and deployment. Built a cross-functional delivery structure that kept Benefits, Legal, and technology moving in the same direction without losing the member as the center of the work. Designed the attestation framework in partnership with Legal to ensure regulatory compliance while keeping the tool clean and usable for members who are not benefits experts.

The Tool:

An interactive member-facing benefits transparency tool that allows any member to enter a procedure, diagnosis, or provider name and immediately see: coverage status under their specific plan, estimated out-of-pocket cost, in-network provider options with location and recommendation data, and total financial responsibility before any appointment is scheduled. Built in plain language. No jargon. No booklet required.

The Results:

The tool ranked among the most-used features on the member portal from launch. It now serves millions of members annually. CSR call volume dropped measurably as members shifted to self-service for benefits questions that previously required a phone call. Benefits information that once required a 140-page document and a trained representative to interpret became accessible to any member in under two minutes.

Why It Matters Now:

Healthcare transparency is no longer a differentiator — it is a regulatory and competitive requirement. The organizations that build the infrastructure for member-facing transparency today will own the member relationship tomorrow. This engagement is a direct proof of concept for that work at scale.

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Agile Transformation

Category Tag:  Federal Program Transformation · Agile Delivery · CMS

Client:  Centers for Medicare & Medicaid Services (CMS)

The Problem:

Three inherited waterfall teams maintained critical call center infrastructure serving more than 100 million Americans. None of the three teams had a program roadmap. None had a shared dashboard. None had an agile delivery foundation. Work was reactive, priorities were invisible to leadership, and there was no mechanism for the teams to define — let alone track — what "done" looked like.

This was not a technology problem. It was a structure, visibility, and culture problem. And it was happening inside one of the largest federal health programs in the country.

What We Did:

Built the program roadmap, the bi-weekly CMS executive dashboard, and the agile delivery foundation — simultaneously, across all three teams. Facilitated the value stream mapping sessions that surfaced the obstacles nobody had formally documented. Founded the Agile Community of Practice that gave the teams a shared language and a place to build capability together. Managed the resistance that comes with any cultural shift by helping each team define "done" on their own terms — which turned resistance into ownership.

The Results:

All three waterfall teams successfully transitioned to Agile delivery. The first-ever program roadmap was built and delivered. A bi-weekly CMS dashboard established unified reporting across teams that had previously operated in silos. The Value Stream Map identified and removed obstacles that had been invisible to leadership. Long-term agile capability was built into the program — not imported temporarily and then lost when the engagement ended.

Why It Matters:

Federal programs do not fail for lack of talent. They fail for lack of structure, visibility, and shared accountability. This engagement is proof that those three things can be built — quickly, sustainably, and without disrupting the mission-critical work already in flight.

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Legacy Mainframe Modernization

Category Tag:  Legacy Mainframe Modernization · Federal · IBM MVS/TSO

Client:  U.S. Army

The Problem:

A critical batch program supporting the U.S. Army Force Builder Program had been consuming excessive CPU time and costing the government significantly on every job run. The root cause had not been formally identified. Documentation was out of date. Leadership had the cost data but not the diagnosis.

What We Did:

Conducted direct code analysis to identify the CPU bottleneck. Confirmed the finding using IBM OMEGAMON performance monitoring — providing leadership with a verified, defensible root cause, not an estimate. Fixed the issue with zero disruption to production. Brought documentation current for the first time, leaving the program with an accurate record of what the system actually does.

The Results:

Significant CPU processing time reduction. Hundreds of thousands of dollars in cumulative processing costs stopped. Zero disruption to production deployment. Documentation brought current — giving the next team an accurate foundation to build on.

Why It Matters:

Most consultants do not go near mainframe environments. Ni-San does. If your organization runs on legacy infrastructure that nobody has formally documented or optimized, that cost is compounding quietly every day. We find it, fix it, and leave you with something you can build on.

Contact us to discuss your situation