Charles Lyons-Burt
Steve Sousa is a senior vice president and Health and Social Services Business Unit lead at CGI Federal, where he leverages over 25 years of experience in the public and private sectors to drive major information technology modernization efforts that support a range of clients in the Department of Health and Human Services. His work includes projects with the Centers for Medicare and Medicaid Services, the Social Security Administration and the Defense Health Agency.
Leveraging his role as CGI’s Global Health Council lead, Sousa brings CGI’s global reach to provide federal customers with internationally informed insights. He and his team have supported hundreds of systems and projects, ensuring regulatory compliance, fighting fraud, waste and abuse, improving the user experience and enhancing overall mission effectiveness. Most recently, members of his team joined HL7, a global organization developing health data interoperability standards, in an attempt to advance mission readiness on healthcare data.
Sousa holds a variety of leadership positions with industry organizations like the National Contract Management Association and Healthcare Information & Management System Services. He also collaborates with academic institutions like Carnegie Mellon University —a devoted robotics research hub — to advance best practices for government transformation.
The executive sat down with ExecutiveBiz to talk about his career, community involvement and how government IT is changing.
What motivates you and makes you (and CGI Federal) different as a federal IT consultant?
My career has definitely been a progression over many years at the intersection of health and IT, where I feel I’ve been able to have an impact on communities including underserved populations. I was fortunate to attend the right academic institutions and pursue positions at the right companies to bring my experience and perspective to the federal space — to the extent that some of the work we’re doing at CGI is serving as a model for governments of other countries. For me, this journey started on a path to medical school, and in different ways, put me at the right place and right time when technology was beginning to transform the way care is delivered. Today, we have a significant impact for the least visible populations on issues such as accessibility and care for the elderly. We are able to ensure that everyone has access to the care resources they need.
I feel I’ve also been able to bring fresh perspectives to government agencies that serve under-represented populations, especially through my past work with organizations like the Whitman-Walker Clinic in Washington, a leader in LGBTQ health, research and education. I’m active in the LBGTQ+ and youth community with a focus on career development and STEM education. I act as an executive sponsor for Pride@CGI, CGI’s member resource group for LGBTQ+ employees, and I work with SMYAL, a DC-based non-profit that provides leadership development opportunities, after-school programs and counseling services for LGBTQ+ youth.
What projects are you most proud of?
To me, it’s the number of systems we’ve transformed, which number at least 80 in all. Many started in the regulatory and policy phases, and we’ve built systems that support the goals of legislation, including Medicare modernization.
An overall career highlight for me is CGI’s long-standing relationship with CMS, where we’ve implemented many transformational solutions, including the Health Plan Management System, a web-enabled data repository that helps manage, monitor and track annual lifecycle activities for the submission, vetting and execution of Medicare Advantage Part C and Part D programs.
Another is the Medicare appeals system that provides workflow management, document management and business intelligence capabilities to those responsible for filing and adjudicating Medicare claims. CGI reduced performance tickets by 66 percent over a six-month period by proactively monitoring and improving MAS performance, as well as deployed 12 releases over a 30-month period with zero configuration management issues.
The Open Payments system is also a great example of our work on behalf of CMS. This system provides agnostic, accurate and timely information about payments or other transfers of value that occur between Medicare plan providers and pharmaceutical, biologic and medical device manufacturers. With CGI’s help, CMS published 12 million payment records and transfers of value totaling $8.2 billion in 2017. This represents a 166.7 percent increase in the total number of records published, and a 100 percent increase in the total value of payments over just a four-year period — a significant increase in transparency and accountability.
Overall, I’m proud that we’ve helped the government transform and adapt in a very high-speed environment in terms of technology and how frequently it changes. Other engagements that stand out to me are our work with the Department of Education, CDC, FDA and other organizations inside HHS. We’ve been a strong partner as technology shifts, and we’ve been able to take systems to the cloud, for example, as that technology has matured. Perhaps most importantly, this transformation has taken place while effectively managing risk. The federal government is at a point where maintaining existing systems costs more than it does to modernize, so we’re at the forefront of making that happen, and our clients are benefiting from lower costs, higher speeds and all the benefits that technology brings.
How is your work at CGI using and operationalizing data for government clients?
The federal healthcare community has a tremendous appetite for data, but the variety, volume and velocity of data, combined with the limitations of legacy systems, make it difficult to access and share it in a siloed environment. Agencies are dealing with hundreds, if not thousands, of non-standardized systems, each with its own isolated data set. In many cases, stakeholders of the larger ecosystem are unaware of data outside of their purview that can help them.
The challenges associated with this fractured environment include missing and late data. States, for example, provide monthly reports to HHS but the data is often late in arriving. This is occurring across multiple agencies, in part because the states must do so much work to get their data in a format that is usable at the federal level, by pulling from multiple legacy systems, formats and platforms.
This is a big reason why the CDC has piloted its North Star Architecture, a cloud-based data exchange platform for use by all U.S. states and territories that will gather data from different systems. The goal of North Star is to make data available for public health decision-makers in real time, instead of waiting for a reporting process that might take weeks or months to complete. When North Star has common technologies in place, Centers for Disease Control and Prevention and its state and local partners will spend less time managing data and more time focused on their mission.
CMS is dealing with similar issues but is a little farther along on a solution. In 2022, CGI started working with CMS to implement the Application Programming Interfaces Gateway. The first-ever implementation of its scale and type for CMS, the API Gateway creates a streamlined, data-sharing solution that advances the mission of detecting and combating fraud, waste and abuse in the Medicare and Medicaid programs. This is critical, as current estimates put financial losses due to health care fraud in the tens of billions of dollars each year.
In addition to that important work, we also spend a considerable amount of time helping our clients improve their customer experience capabilities. The importance of robust customer experience in the context of health data interoperability cannot be overstated. It is what gives patients seamless access to their health data, gives providers access to the data needed to treat their patients, and gives payers access to prior authorization information that’s required to settle medical bills. Simply put, by reducing these provider and payer burdens, we will not only see improved patient outcomes, but lower healthcare costs. The high cost of healthcare is due, in large part, to the difficulty in exchanging vital information about care, providers, costs, insurance, etc. So, by helping our federal clients improve data interoperability and transform customer experience capabilities, we are working to improve some of the biggest challenges in healthcare today.
The White House’s five-year Federal Health IT Plan, for example, outlines opportunities for digital health systems to empower patients, move to value-based care, reduce regulatory burdens and secure health information.
What challenges do you see on the horizon?
I think there are going to be challenges as the healthcare industry accelerates the adoption of practices such as telehealth. It’s important that this kind of remote care is accompanied by robust cybersecurity and protections for patient health information and privacy. In the meantime, the industry is grappling with increasing amounts of unstructured data, a huge amount of which remains on paper documents and is processed manually. Extracting this data and making it useful for patient safety and business decision-making is a major challenge for providers, payers and pharmaceutical companies and other enterprises across the health care sector. At CGI, we’re helping clients confront these challenges with mobile technologies, cognitive machine learning and RPA expertise.
Another issue we’ll be grappling with involves lessons learned from COVID. How do we prevent the next pandemic, and how can we improve the government response? A big focus today among federal agencies and the states is the challenge of unwinding pandemic funding. COVID-related Medicaid funding, for example, is ending this year so states and the federal government are looking at ways to use data to preserve coverage for recipients.
Overall, we’re also seeing a long-overdue shift in industry and government focus to mental health, which is vital at a time when we’re dealing with numerous mental health challenges in populations across the country, but most critically among veterans. We’re still discovering ways in which technology can address these challenges, and it makes this an exciting time to be part of the IT industry.
