If you are DeBorah Russell, deputy associate commissioner at the Social Security Administration’s Office of Systems, you draw on your 25 years of experience in information technology, the input of colleagues in your agency and outside, and lessons learned from related projects. Then you push forward—quickly.

The legislation was the 2003 Medicare Prescription Drug, Improvement and Modernization Act, which was signed into law in December 2003 and provides seniors with prescription drug coverage, called Part D. The legislation was a hot-button issue, passed amid much partisan debate about gaps in coverage and the potential for soaring costs.

Nonetheless, the career executives at SSA had a job to do. Their mandate was to develop the technology systems that would support the business processes to fulfill the new law. But to add to the pressure, the attendant business processes also needed to be developed.

SSA was given an appropriation of $500 million to cover everything required to implement the program, and 22 months to get the job done. And interim programs had earlier deadlines, such as the interim drug benefit card in May 2004, as well as the Defense Department’s TRICARE For Life supplemental Medicare coverage and the health savings account program, both in September 2004.

In May 2005, SSA started releasing pieces of the prescription drug plan, including a targeted mailing of applications to beneficiaries in anticipation of the program’s effective launch date of Jan. 1, 2006.

Russell, who has been with SSA for 32 years, had two roles. She was systems project manager for implementing the Medicare Modernization Act project, and she represented the Office of Systems on the SSA Medicare Planning Task Force, established to support overall planning for SSA.

“We were starting with a blank page,” Russell recalled. “We had to do regulations, policies and business processes. You have to have that before you decide what you’re going to automate. One of the things we did on the [task force] was develop the overall agency plan. I was able to put in milestones, including time frames for when we had to get IRS agreement, [the Health and Human Services Department’s Centers for Medicare and Medicaid Services] agreement, and come up with test plans, validations and file formats.”

William Gray, SSA deputy commissioner for systems, explained that planning began as the agency saw the legislation evolving. Once it passed, officials formed the systems management team, which started making very detailed initial plans.

“If we’re hiring people in the field, what equipment and support would we need?” he said. “We needed business requirements from each business unit by such and such a date to start programming. We needed business process walk-throughs that would translate into systems requirements. The team developed very detailed planning books and, amazingly, the plans they put together were pretty much the things we did.”

The Mission. The MMA project addressed a number of provisions for the interim drug card program, health savings accounts and the prescription drug benefit. According to Russell, one of SSA’s major tasks was to administer the subsidy associated with the prescription drug benefit. To determine the subsidy, which is based on income and resources, data exchanges were required with different agencies—the Railroad Board, the Office of Personnel Management and the Veterans Affairs Department, for example. Additionally, people could have premiums withheld from their Social Security checks, so income-related premium adjustments needed to be made.

The underlying systems had to to automate these tasks with easy-to-use external applications for the public as well as legacy and new internal systems that could interface with each other and with those of other agencies. Russell said a blend of technologies was developed, ranging from Internet and intranet applications to scanning technologies to store images and extract data from paper applications. Document management architecture was included as well.

The challenge was developing applications for this particular user population. SSA sought an approach to determine who actually qualified for the subsidy; when Congress planned the legislation, its predictions numbered in the millions.

Because of the compressed time frame, SSA officials developed three methods of applying for the subsidy—online, on paper and in person at the field office—instead of hiring thousands of new people in field offices across the country.

They then created applications specifically geared to each method. Someone completing a paper application might be asked how much money in total was in his or her bank accounts. It could be added up and put on paper. An individual completing the application online would be asked how much money was in each bank account, with the tally done on the back end by the SSA systems. “On the back end, we got the same information, but we tailored each application to make it easiest for people using that channel,” Gray said. “That’s why I think it was so successful.”

Additionally, because they knew generational differences existed in how people use Internet applications, they learned techniques for usability testing from private-industry companies, such as the Fidelity investment firm, and incorporated them into their own usability research.

However, there were unanticipated glitches. “We were surprised by a lot of responses we received,” Russell said. “If you asked me my spouse’s name, I wouldn’t give one because I don’t have one. But a lot of widowed seniors would name their spouse. We’d process the application and find out the husband had been dead for 10 years. We had to revise the wording on the applications.”

The legislation’s scope meant that the processes and systems SSA developed re-quired collaboration on several fronts. First, there was the integration of skill sets within the agency itself. “We had to be really careful, because we were interfacing with existing systems and needed institutional knowledge,” Russell said. “But we had to supplement our staff. We hired a lot of experienced people and had contractor support.”

The Art of Collaboration. Then there was collaboration at the field office level. SSA has more than 65,000 employees, 10 regional offices, six processing centers and 1,300 field offices. To ensure that MMA was on target, Russell convened several conferences at which people from the field offices would discuss the issues facing them.

Tina Skinner, Atlanta regional MMA project manager, attended three of the first four conferences. “They were hugely informative,” she said. “They asked us for our feedback and suggestions. They wanted us to know how the systems would work and how we could make changes or corrections as issues came up. They communicated well with us and worked with us in the field to get it done.”

Skinner said that Russell and three colleagues made a trip with her to six field offices in South Florida because they wanted to talk firsthand with users and learn about any concerns. They learned about people who applied for extra financial help but whose spouses had no Social Security number because they were illegal immigrants. “They took that back to the central office and worked out a solution for us,” Skinner said.

Russell and her team were also engaged with colleagues in several other agencies. One of their most significant partners was the Centers for Medicare and Medicaid Services. CMS needed SSA to identify low-income beneficiaries and help with premium withholding from government checks.

As Julie Boughn, CMS’ chief information officer, explained, the prescription drug plan is run by health plans CMS contracts with. “The health plan tells us who wants to enroll,” Boughn said. “We do the basic checking to make sure they can enroll. The plan will notify us that the beneficiary wants their premium withheld. We notify SSA, and they check that the request can be done and then notify us. Every month, SSA sends us a data file of everyone for whom premiums are withheld, plus there are data transfers of the funds withheld, and we make the payments to the plans and report on those withholdings.”

Boughn said the agencies worked together very closely, with a lot of meetings between the systems teams to work out processes and details to make the data exchanges work. She pointed out that both agencies had to know enough at a detailed level about each of their systems that they could represent the interests of the agencies and—always the top concern—the interests of the beneficiaries. Russell “did an excellent job,” said Boughn. “She has really good staff people who took this ball, treated it with care and ran with it.”

Of course, inter-agency collaboration has its limits. Russell recalled that SSA had hoped the IRS could provide information on income and resources of individuals who might be eligible for subsidies. This would help filter the number of applications to make the process more manageable. However, IRS privacy legislation made that impossible.

“Everyone’s on the same page, but we have to remember each agency has its own priorities,” Russell acknowledged. Ultimately, however, once SSA received applications from individuals, they could get the information they needed from the IRS.

And, working under the political microscope? Russell certainly felt the pressure.

“Everyone had an opinion on how we should administer the program, how the paper applications should look, how questions should be asked, even what kinds of questions should be asked,” Russell said. “I was already flexible, but now I’m really flexible. It taught me to be more sensitive to what people outside the agency care about. It also affected the staff, and I think it’s a good thing. It helps people see the bigger picture. I really believe if people understand what they’re doing and why they’re doing it, it helps.”