CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) ADVISORY & ASSISTANCE SERVICES FOR CONTACT CENTER MODERNIZATION

I. SCOPE

The Centers for Medicare & Medicaid Services (CMS) seeks specialized consulting and advisory services to assess and provide actionable recommendations related to (a) the current ecosystem of contracting and operations structure of the CMS contact centers (1-800-MEDICARE and the Marketplace Call Center), (b) opportunities to improve contact center service capability and meet agency performance objectives, and (c) potential alternative approaches that would lead to greater efficiencies. Contracts supporting the contact centers cost CMS approximately $900 million annually, and CMS requires expert discovery, analytical, and consultative support to evaluate the current state of operations, develop future-proof and outcomes-based requirements for ongoing contact center support, and consider all options for modernization to include contract competition and cost considerations of various options.

The Contractor shall provide services to assess the following aspects of the current solution, which are currently supported by multiple contracts:

• Platform;
• Staffing model;
• Processes related to managing inbound contacts (calls, web chats, etc.) and data sharing;
• Contracts configuration; and
• Cost analysis.

A. Background

The CMS contact center (contact center) serves as a central point of contact for a wide range of inquiries related to Medicare and Exchange programs. This includes handling calls from beneficiaries, consumers, and their caregivers, playing a crucial role in providing information, resolving issues, and ensuring access to healthcare services.

Each year, the contact centers serve approximately 66 million Medicare beneficiaries and 21 million (insured and uninsured) Exchange consumers and handles over 40 million inquiries. Contact center operations are supported by approximately a dozen contracts totaling over $900 million per year, with over $700 million devoted to the contact center staffing contract.

B. Purpose

The purpose of this contract is to provide advisory and assistance services and actionable recommendations to CMS as they consider strategies to comprehensively modernize contact center operations.

Authority and Rationale:

☒FAR 6.302-2: Unusual and compelling urgency, 41 U.S.C.253(c)(2). Rationale:

CMS faces an immediate need to procure advisory services that result in actionable recommendations related to the modernization of its contact center. CMS is operating under a clear and public directive from the White House to rapidly deliver a patient-centered, seamless healthcare ecosystem. Any delay threatens to undermine CMS’ ability to implement promised transformation and deliver meaningful results for the American people by the first quarter of 2026. CMS’ contact center is the public facing “front door” for a wide range of inquiries related to Medicare and Exchange programs, serving more than 87 million beneficiaries and consumers annually and playing a crucial role in providing information, resolving issues, and ensuring access to healthcare services. However, the contact center’s service delivery model has not kept pace with technological advances that are now widespread throughout industry. Rather, CMS has created a complex web of over a dozen contracts totaling over $900 million per year, which impedes its ability to quickly adopt innovative methods of serving the American people. Continuing this operational status quo directly harms the experience of beneficiaries and consumers by delaying navigation improvements and access to care guidance. Furthermore, CMS’ broader digital modernization initiatives, such as interoperable digital health tools and real-time data exchange, are advancing on tight timelines. A delayed diagnostic and recommendation engagement would decouple call‑center improvements from these concurrent deployments, limiting the potential for seamless integration and increasing future complexity and costs.

SEE ATTACHED JOFOC