CMS and Modular
Centers for Medicare and Medicaid Services (CMS) urging States to make a paradigm shift in the way their MMIS’ are procured and implemented—CMS is now actively encouraging modularity as the way to revolutionize MMIS procurement and implementation.
CMS suggested modular approach to MMIS is a low risk, incremental implementation of reusable modules that work with existing systems. Modules can be replaced independently without requiring a complete overhaul of the entire system. The objective is to break down the large MMIS procurement and implementation into projects that are managed more efficiently, to effectively utilize assets and resources already invested, and to initiate smaller acquisition timelines. While CMS has consistently proposed a modular system as the standard for MMIS, they have not clearly specified how the large MMIS can or should be broken down. CMS does not and will not prescribe a specific technology solution or an architectural design that would define what modules constitute an ideal MMIS. CMS is expecting States and vendors to invest once, and then leverage existing investment by reusing the modules, as opposed to building custom solutions for each MMIS acquisition. In addition, Modularity has become the technological marker creating the paradigm shift in healthcare that focuses on outputs and outcomes rather than just the processes.
Modular MMIS
MMIS systems have evolved over the last few decades, and technology has been the biggest factor of disruption in the architecture. Beginning with disparate systems that existed as independent islands of information in the era of mainframe computing, MMIS’ evolved into large monolithic systems where distributed computing and relational databases power enterprises. Systems today have the technical ability, namely Service Oriented Architecture (SOA), Enterprise Service Bus (ESB) and Web Services that allow access to data irrespective of location, storage and accessibility—providing the impetus for the shift to modularity. The MITA framework encourages States to leverage open standards, the latest advancements in technology and best in class Commercial-Off-The-Shelf (COTS) products to define the new modular MMIS. It is the technology that allows the breaking up of a single MMIS system into smaller, more manageable modules, and technological conditions help us to determine the best architectural model that will accomplish the goals of a State while still adhering to the directives of CMS.
Modularity Challenges:
There are many challenges with Modular MMIS development. Some of them are listed here.
- Selecting most suitable System Integrator.
- Deciding perfect technical platform for development, integration and hosting.
- Having a clear understanding of roles and responsibilities.
- Managing artifacts and project deliverables.
- Integrated testing of all Modules and final business user testing.
- Managing scope and policy changes during development.
- The necessity of leadership, change champions and change agent.
- Including change management strategies in project plans.
- Management of all stakeholders, including project team members.
- Understanding the organizational culture, drivers and strategies.
- Appropriate and timely communications throughout the project’s life cycles.
- Governance of entire MMIS Modular development end to end starting from RFP to certification.
- Without proper documentations and evidences, CMS Certification will be difficult for modular systems.
- States must balance these benefits of the modular approach with the complexity associated with “too many” modules.
Modularity Advantages
- Cuts the risk of time and cost overruns and accelerate the implementation of certain capabilities. Modularity also allows for easier upgrades or complete replacement as technologies evolve and program needs change.
- Opens up the Medicaid market to new vendors and increased competition. This can help inject new ideas to drive significant innovation and cost reduction.
- The opportunity to establish capabilities that are needed across the state enterprise, while leveraging a shared funding model
- Maximum flexibility in deciding the modularity strategy that will work best for their state and their program.
- Bring together best-in-class and proven commercial capabilities — delivered as services — through a prebuilt, cloud infrastructure. This allows states to plug in, configure and scale based on need at any given time.
- Eliminate the risk of big monolith systems and the need for system updates. Our solution is prebuilt so implementation will take 12–18 months in most cases.
- Employ evergreen technology so that your state will never miss an upgrade or industry change, because we maintain it to meet the latest advancements and industry regulations.
- Fully pre-configured to allow states to meet their outcomes and business goals faster and with more reliability.
- Fully aligned with CMS regulations, MITA 3.0 and the Seven Conditions and Standards.
Conclusion:
Achieving the multi-faceted objectives of today’s Medicaid in today’s healthcare ecosystem requires a radical change in states’ approach to Medicaid Enterprise Systems. CMS has paved the way for this transformation by encouraging states to deploy modular systems, and eliminating obstacles to competition within the market.
It is now up to states and vendors to take up the gauntlet and implement the systems capable of meeting the business and beneficiary objectives of today’s Medicaid programs.
Hippalus Technologies designed and developed a unique Modular Medicaid Management Information System governance product. For more details, contact Hippalus Technologies and watch this video
Hippalus Technologies | Medicaid Management Information System
