Driving better patient outcomes. Our quality measure specialists and skilled clinical informatics professionals, partner with the Centers for Medicare & Medicaid Services (CMS) to advance clinical quality measures that incentivize hundreds of thousands of healthcare providers to focus on making patients healthier. Similarly, across U.S. Department of Health and Human Services (HHS), we correlate provider capabilities, care processes, and outcomes to support value-based care while reducing administrative burdens.

Putting people first. We enable real-time access to patient information, empowering providers to enhance the beneficiary experience at every stage, from eligibility determination and enrollment to case management and payments.

Enabling care through the Federal Marketplace. As beneficiaries move from Medicaid or employer coverage to the Federal Marketplace and back, our team tracks enrollment to verify and facilitate accurate payments to Qualified Marketplace Health Plans, enabling providers and plans to deliver care.

Serving those who need it most. We accelerate data exchanges that facilitate the federal and state partnership, working with CMS to provide a suite of tools for the submission, review, disposition, and management support of Medicaid and Children’s Health Insurance Program (CHIP) initiatives, Quality Measure Reporting, State Plan Amendments (SPA), Waivers, and Demonstrations. This allows CMS to keep pace with the needs and the variability of state Medicaid programs.

Preventing fraud and protecting access. Our subject matter experts and engineers are at the forefront of reimagining every touchpoint of the health journey from food, drug, and patient safety to provider credentialing and enrollment. We develop advanced fraud, waste, and abuse (FWA) detection models that minimize false positives; collaboration or case management workflow; self-service analytics and visualization; and the data access capabilities that support the CMS Fraud War Room.

Translating data into impact. eSimplicity contributes to the HHS mission by advancing public health initiatives and health research that improve outcomes for communities nationwide. From data-informed insights to operational support, our work supports agencies responding to emerging challenges, promoting health equity, and strengthening the well-being of all Americans.