MMIS Modularity - Medicaid Directors

MMIS Modularity - Medicaid Directors

MMIS Modularity Making Disruption Effective Greg McGuigan, Deputy Director Data and Systems Group, CMCS/CMS November 7, 2016 Agenda Evolution of the Vendor Community MMIS Modularity Drivers MACBIS Modular Design Contracts & Budget MACBIS Key Success Factors (Lessons Learned)

CMS Resources 2 Evolution of the Vendor Community Toolkit Updates Industry Trends Driving MMIS Modularity 3 Changing Landscape While industry has made great strides in Agile,

Cloud and modular development most government systems have lagged way behind However we are now in a period of rapid system change so we need to adopt the industry standards for faster development cycles, increased software functions, sharing and lower costs as we move forward 07/12/2012 4 Observations of the MMIS Industry Landscape Multiple Vendors at 2016 MESC demonstrating Modular MMIS Framework. Multiple new players in the space:

Systems Integrator PMO Data Warehousing Provider Enrollment seems to have growing traction with modular solutions being developed and offered. MMIS Modularity Toolkit UpdatesDrivers 6 Technology Driver Lean Agile

Cloud Open Source COTS/SaaS Open API Business Rules Engines Interoperability Rapid Technological Advancements is enabling MMIS systems modernization. Innovative technological approaches that automate Medicaid business processes and services, such as systems related to: member eligibility and enrollment, claims payment, member benefit management and financial management A common security framework, cloud computing, data analytics, common

data repository, consumer-facing portals New business models, such as shared services (inter and intra state) Adaptations of existing business solutions from comparable sectors, such as: banking commercial healthcare large provider systems MACBIS Modular Toolkit UpdatesDesign 9 MACBIS Background In 2012, in recognition it was an agency priority to improve access to

timely, complete, and accurate Medicaid and CHIP data, CMS created MACBIS. Effectively managing the implementation of the Affordable Care Act and the state Medicaid and CHIP programs requires extensive system design and development efforts. The previous Medicaid and CHIP data environment did not adequately meet the needs of Medicaid and CHIP data users. Data, data products and technology did not provide the agency with sufficient access to information on the Medicaid and CHIP programs to facilitate effective program administration and oversight. 10 MACBIS Pillars The 4 Functional Areas of MACBIS MACPro WMS

MMDL CARTS CHIP/SEDS EPSDT MMCDCS SEA Pharmacy DDR MDR/FULS Pharmacy Program MET ADA

TA MET ADA TA Financial MBES IBNRS EQRO Operational T-MSIS MSIS

CARTS EPSDT PERM MFP Performance Indicator Data Collection 11 Realizing the MACBIS Vision OLD ISSUES Incomplete Data

Custom Data Validation Limited Analytics Execute Limited State Integration NEW SOLUTION S

Robust Data Establis h Legacy Medicaid & CHIP Data Enterprise Medicaid and CHIP T-MSIS MACPRO MSIS Data Siloed Demonstrat

e! PERM WMS MFP Etc. PHARMACY Future Data Validation/Ru le Engine Business Intelligence/ Reporting

Data Integration Comprehensi ve State Integration 12 Toolkit Updates Contracting & Budget 13 Contracting Strategy Market Research Request for Information (RFI)

Statement of Objectives (SOO) Choosing the appropriate Contracting Model Cost plus award fee Time and materials Firm fixed price Outcome or capabilities based, incentives based on delivered capabilities 14 MACBIS Transforming Outcomes Budgeting based on Agency Priorities Cost Allocations based on perceived business value Reporting and Governance OMB Reporting

Guidelines 15 MACBIS Key Success Factors Toolkit LessonsUpdates Learned 16 Transformation Roadmap Understanding Your Role Engage your Project Management Office (PMO) and Systems Integrators (SI) early to set the overall timeline, acquisition strategy and technical direction for the MMIS

program Engage strong domain knowledge to ensure continuity of operations while transitioning from legacy to new development and technological platforms Also, make sure your business teams are prepared for what Agile development means, what is going to be asked of them and how their roles are different as compared to Waterfall development methods. Manage Your Risk Embrace the Paradigm Shift

New Technical Stack Multiple Vendors Multiple Integration Point (Legacy/New) Complex Project Schedule Dev/Ops Shifting Priorities How can Updates we help? Toolkit 19

Resources Supporting Modular Development Currently Available: MMIS Cohort New MECT MMIS Newsletter SMDL #3 Guidance and FAQs on Medicaid.gov https://www.federalregister.gov/articles/2015/12/04/2015-30591/me dicaid-program-mechanized-claims-processing-and-information-retrie val-systems-9010 https://www.medicaid.gov/medicaid-chip-program-information/by-to pics/data-and-systems/data-and-systems.html In Development: National Medicaid Systems Reuse Library for artifacts Modularity Proof of Concept: An open source provider module available for all states free

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