Improving transparency and observability on a critical Medicaid system

We’re helping modernize the Medicaid Drug Program (MDP), a critical federal system that calculates billions of dollars in drug rebates annually. Through comprehensive data engineering and testing frameworks, we’re transforming an undocumented “black box” system into a transparent, reliable infrastructure with automated workflows and clear visibility into rebate calculations.

Client

Centers for Medicare & Medicaid Services

The challenge

CMS processes complex drug rebate calculations involving billions in pharmaceutical rebates annually. Even small delays or inaccuracies can cause significant compliance issues and financial impact. Audits from internal or external actors, like the Office of the Actuary or the Office of the Inspector General, require time-consuming, ad-hoc data requests.

A legacy system has contributed to critical reliability and operational challenges, like:

• Single points of failure due to lack of cross-training
• Undocumented, opaque rebate calculations with unexplainable errors
• No testing framework or data quality assurance processes
• Manual workflows with hundreds of steps prone to human error
• Complex business logic spanning decades of regulatory changes never documented
• Outdated Angular and Java infrastructure

Our approach

Testing and data quality assurance

• Implemented SQLMesh testing framework with automated error detection and validation across all rebate models
• Developed real-time data quality checks tailored to regulatory requirements
• Built validation scripts and automated checks, reducing debugging time from weeks to days
• Simplified identification and root-cause analysis of data issues that surfaced from testing

Workflow automation

• Automated Federal Upper Limit reporting processes using AWS Lambda functions, reducing manual effort from hours to seconds
• Implemented layered ETL pipelines with integrated validation supporting automated data validation
• Prioritized automation opportunities based on impact, complexity, and feasibility

Documentation and knowledge transfer

• Collaborated with policy experts to translate complex regulatory requirements into visual diagrams and flowcharts
• Created comprehensive technical documentation transforming previously undocumented processes into transparent, maintainable workflows
• Established cross-training protocols ensuring all team members can execute critical rebate calculations, eliminating single points of failure

Keys to success

Blue Tiger is a key partner in ensuring the success of this ongoing effort led by Coforma.

• Systematic approach to understanding and documenting undocumented processes
• Incremental modernization balancing immediate operational needs with long-term improvements
• Cross-functional collaboration with policy experts and technical stakeholders
• Strategic prioritization of quick wins alongside comprehensive redesign
• Elimination of single points of failure through knowledge transfer

“You took initiative from something I mentioned ‘in passing’ during a meeting and developed a solution to my pain point! This will take so much manual review off my plate!”
— Government Partner

Results and impact

We are modernizing MDP’s infrastructure while maintaining system stability and meeting all critical regulatory deadlines.

• Transformed manual, quarterly “black box” process into monitored, testable system with clear visibility into rebate calculations affecting billions of dollars
• Reduced debugging time from weeks to days and eliminated hundreds of manual steps through automation
• Successfully delivered annual Drug Utilization Review surveys before critical deadline
• Created comprehensive documentation and cross-training protocols where previously zero documentation existed
• Built real-time monitoring framework enabling immediate identification and resolution of database issues
• Built data models based on ad-hoc data requests, allowing future requests to be parameterized, tweaked, and rapidly generated