Redesigning CMS Case Management for Velocity and Trust
From nine hours to three: Transforming healthcare quality case management through strategic Salesforce design and service architecture
Role
Senior UX Lead & Product Experience Strategist
Client
Centers for Medicare & Medicaid Services (CMS)
Platform
Salesforce Service Cloud & Experience Cloud
The Problem
A fragmented system was creating delay, rework, and risk in healthcare quality assurance
Before redesign, the QIN-QIO case management process was a maze—a tangle of emails, spreadsheets, shared drives,
and disconnected systems that required constant manual effort to keep cases moving. Each participant worked from
their own truth, not a shared one. The result was delay, rework, and risk in a process where accuracy and
timeliness literally impact patient care.
9+ Hours Per Case
Onboarding a single QA case required navigating emails, SharePoint, spreadsheets, and multiple system lookups.
No Single Source of Truth
Case data lived across Outlook threads, SharePoint folders, and personal spreadsheets.
Compliance Fragility
Accessibility (508/WCAG), PHI protection, and audit trails handled inconsistently across regions.
Research & Discovery
Understanding the ecosystem of healthcare quality case management
We conducted comprehensive research across the entire QIN-QIO ecosystem—from data entry and QA leads to
provider office managers and CMS reviewers—to understand pain points, workflows, and compliance requirements.
Stakeholder Interviews
Deep conversations with office workers, QA leads, provider managers, and CMS reviewers.
Service Blueprinting
Mapped end-to-end case workflows across all touchpoints and systems.
Process Analysis
Analyzed existing workflows to identify bottlenecks, rework loops, and inefficiencies.
Compliance Audit
Assessed 508/WCAG accessibility, PHI protection, and audit trail requirements.
Technical Assessment
Audited existing Salesforce configuration and integrations to identify technical constraints and opportunities.
Stakeholder Workshops
Facilitated collaborative sessions with CMS leadership to align on vision, priorities, and success metrics.
What We Learned
The problem wasn’t people—it was the system
“I spend more time hunting for information than actually reviewing cases. Every case feels like starting from scratch.”
Each team had smart, dedicated professionals trying to do quality work inside an unstructured, fragmented environment
that worked against them. High cognitive load from memorizing dozens of exceptions and local workarounds was exhausting staff.
Rework loops were killing velocity and morale
“Missing documentation or mismatched identifiers can stall a case for days. By the time we get it sorted, we’ve lost momentum.”
Cases frequently stalled due to missing documentation, mismatched identifiers, or unclear next steps. Staff had to constantly
backtrack, creating frustration and delays that impacted patient care timelines.
Inconsistent developer outputs hurt usability and compliance
“Every region’s interface looks different. Training new staff is a nightmare because nothing is standardized.”
UI layouts and interaction patterns varied by development team, creating inconsistent user experiences. This variation also
created compliance risks, with accessibility and PHI protection handled differently across regions.
Staff needed guardrails, not gatekeepers
“I know what needs to happen, but the system makes me jump through hoops to do basic tasks. Just let me do my job.”
Experienced staff felt constrained by overly rigid processes, while new staff felt overwhelmed by lack of guidance.
The system needed to provide intelligent guardrails that enabled velocity without compromising compliance.
Design Process
Building a unified platform on guardrails, velocity, and trust
Service Design & Architecture
Created comprehensive service blueprints mapping the entire case management ecosystem. Identified critical touchpoints,
pain points, and opportunities to consolidate fragmented workflows into a single source of truth. Established design
principles: guardrails over gatekeepers, velocity without compromise, trust through transparency.
View Final Service Blueprint | View System Flow Document
Design System & Governance Framework
Established comprehensive design system built on Salesforce Lightning Design System (SLDS) with custom components for
healthcare workflows. Created governance frameworks to ensure consistency across development teams while enabling
rapid iteration. Reduced handoff errors by 60% through clear documentation and reusable patterns.
View Development Decision Matrix | View Field Validation Document | View Quick Action Framework
Intelligent Workflow Automation
Leveraged Salesforce Flow Builder to automate repetitive tasks and create intelligent guardrails. Built validation
rules that caught errors early, reducing rework loops. Designed progressive disclosure patterns that guided users
through complex processes without overwhelming them with information.
Accessibility & Compliance by Design
Built 508/WCAG 2.1 AA compliance into every component from the start. Established PHI protection patterns and audit trail
requirements as foundational design constraints, not afterthoughts. Ensured all users could access critical case
management functions regardless of ability or assistive technology.
Iterative Testing & Refinement
Conducted multiple rounds of usability testing with nurses, QA leads, and administrators. Refined workflows based on
real-world feedback, ensuring the platform met the needs of all user groups while maintaining security and compliance.
Reduced development rework by 35% through early validation.
The Solution
A unified Salesforce platform that transforms case management velocity
Single Source of Truth
Consolidated all case data into Salesforce Service Cloud, eliminating the need to navigate emails, SharePoint, and
spreadsheets. Every participant—nurses, QA leads, provider managers, CMS reviewers—now works from the same
real-time information, reducing confusion and rework.
Intelligent Guardrails
Automated validation rules catch errors early, preventing cases from stalling due to missing documentation or mismatched
identifiers. Progressive disclosure guides users through complex workflows without overwhelming them, while
experienced staff can move quickly through familiar processes.
Consistent Design System
Established comprehensive design system built on SLDS with custom healthcare components. Every region now uses the same
UI patterns, interaction models, and accessibility standards—eliminating training confusion and ensuring compliance
consistency across all implementations.
Compliance & Accessibility Built-In
90% WCAG 2.1 AA compliance ensures all users can access case management functions. PHI protection patterns and audit trails
are baked into every component, not bolted on. Security and compliance become enablers of velocity, not barriers to it.
Impact & Results
Measurable outcomes that transform healthcare quality assurance
Centers for Medicare & Medicaid Services
67% Reduction in Case Onboarding Time
9 hours → 3 hours
Strategic design leadership and Salesforce optimization transformed a fragmented, high-stakes process into a coherent
service built on guardrails, velocity, and trust—proving that design and architecture can deliver measurable business
impact in complex healthcare environments.
Fewer handoff errors
Through design system governance.
WCAG 2.1 AA compliance
Accessible to all users.
Less development rework
Via early validation and testing.
Key Learnings
What this project taught me about design leadership in healthcare
Guardrails enable velocity, gatekeepers kill it
The most effective systems provide intelligent constraints that prevent errors without slowing down experienced users.
Automation and validation rules should feel like helpful assistants, not bureaucratic obstacles.
Design systems are organizational infrastructure
A comprehensive design system isn’t just about visual consistency—it’s about establishing shared language, reducing
cognitive load, and enabling teams to move faster while maintaining quality and compliance.
Compliance is a design constraint, not an afterthought
Building accessibility and security into the foundation creates better experiences for everyone. When compliance
becomes a design principle rather than a checklist, it enables innovation instead of constraining it.
Service design reveals the real problem
The presenting problem (slow case onboarding) was a symptom of deeper systemic issues. Service blueprinting revealed
that fragmentation, not individual tools, was the root cause—requiring architectural thinking, not just interface design.