In today’s Medicaid environment, states must achieve their missions in an environment in flux—from healthcare reform and legislative mandates to expansions in covered populations and changes in the role of managed care. What’s more, they must do so amid intense public and legislative scrutiny to lower costs while improving patient outcomes.
As in the automobile industry, a platform approach is a configurable solution that meets diverse needs. Different engines, different bodies, different configurations, even different brands of cars are built upon common platforms. The platform provides for all the connections, interfaces and is the framework upon which all the other parts can interoperate. In the MMIS environment, the platform is a multi-tiered, service-oriented architecture layered with a series of preconfigured COTS products that deliver complete business functionality to meet MMIS requirements—claims processing, provider management, beneficiary management, managed care integration, health outcomes management, and payment and healthcare reform.
Building a new MMIS is not easy. Building a new MMIS in an environment of constant change is even more difficult. In today’s environment, continuing to approach this daunting task in an environment of constant change in the same ways will not yield better results.
States have struggled to get ahead of change. Many are stuck in a cycle that makes innovation difficult. They are implementing the same costly, slow-to-market MMIS systems again and again. Implementations over the last several years have been late, over budget and have failed to improve on their predecessors. Some are practically outdated the day they go live.
It is clear that state Medicaid agencies need a completely different approach to MMIS implementation. They need systems that can flex and adapt to what the future may hold, without costly upgrades or endless reinvention loops. Based on my understanding of Medicaid and public health administration—and the success of similar platform approaches in human services and enterprise resource planning—I believe that a platform approach to MMIS implementation is the only way for states to future proof their Medicaid infrastructure.
Leveraging a platform, however, means thinking, designing and buying differently. It means projects focus on the implementation of solutions that exist, rather than creation and customization of software that is being transferred (configuration rather than customization). It means that software is licensed and not owned. And, it means that business processes change to work with the new platform, rather then “breaking” the platform to force the support of an old process.
The platform approach is a disciplined approach to MMIS implementation that will help states move from a reactive to proactive position that drives lasting value. They can develop, maintain and operate a MMIS that meets today’ requirements and that can adapt to future changes.
In addition to adaptation, states can realize many other valuable benefits. They can develop comprehensive MMIS functionality faster and lower risk through proven components and pre-built functionality. States will be able to reduce the burden on staff related to review cycles for system changes and eliminate the need for multiple, complex change orders. They will enable their teams to allot more money, time and energy to focus on the mission. The foundation can be extended across other state public health administration programs. Aligning with Medicaid Information Technology Architecture requirements and CMS’ Seven Conditions and Standards for Enhanced Funding can be done more efficiently and effectively. Moreover, the move towards clinical data sharing and interoperability can be streamlined.
It’s a common sense solution to a complex process. Ultimately, the platform’s viability will rest on states’ breaking from the status quo. Future proofing their Medicaid infrastructure with a platform-based system will begin with states taking action to change their procurement focus from “how” it must be done to “what” must be done. With a focus on the desired end state, states will encourage industry to respond by bringing the best in innovation, and results, to market.
Republished from Policy & Practice, American Public Human Services Association
