How old is the Medicaid Management Information System (MMIS) in Illinois? “Our joke is that the grandchild of someone who worked on creating our MMIS is now in long-term care,” said Ivan Handler, who recently left his position as CIO of the Illinois Department of Healthcare and Family Services to become CTO of the Governor’s Office of Health Information Technology, where he will work on the state’s health information exchange.

Traditionally MMIS has been a single mammoth system that handles a series of functions related to Medicaid claims processing and administrative information retrieval. But Illinois’ legacy mainframe system is buckling under the weight of ongoing federal health reforms — and it must be replaced soon, Handler explained. The longtime employees who have worked on the system are starting to retire, and it’s becoming increasingly difficult to find COBOL programmers to write “Band-Aids” to provide new functionality, such as a national provider identity requirement.

Also, deadlines for a host of federal mandates loom, like updates to the Health Information Portability & Accountability Act (HIPAA) and a new clinical and reimbursement coding system called ICD-10. The creation of state health insurance exchanges means eligibility systems must be updated. These changes will require greater interoperability between systems. The mainframe-based systems of the 1980s do not easily interface with each other or with data warehouses, which makes analysis and reporting cumbersome, if not impossible.

In the Same Boat

Illinois is by no means alone. At least 10 states responding to e.Republic’s 2010 Digital States Survey said replacing or upgrading their current MMIS is a top priority.

But Handler is convinced that the old business model of procuring a huge system that costs upward of $100 million and takes six years to implement won’t work considering the pace of health reform change.

“We don’t have six years to wait,” he said. Illinois has to be prepared to handle a half million new Medicaid enrollees by 2014. For that matter, the model in which states possess their own data centers also is outmoded, he added. “We don’t need to be running mainframes. We need to move to a cloud utility model. I want to look at acquiring business services hosted in the cloud instead of procuring and running our own systems.”

Handler would like to have the state health information exchange, hosted by a commercial service provider, house data repositories for different state programs. MMIS primarily involves claims processing, but he envisions a data warehouse supporting business services in a Lego-block kind of architecture. “We want to structure it so it can be built incrementally,” Handler noted, admitting that there aren’t vendors offering the type of services he’s looking for — yet. But he is pushing the half-dozen vendors that traditionally service the MMIS space and perhaps some newcomers to think outside the box.

Handler is currently working on an “MMIS and the cloud” presentation for an upcoming Medicaid IT conference. He would like more IT executives to consider a similar approach. “I wish more people would talk this up,” he said. “If CIOs rely on vendors for ideas, they won’t get the change they need.”

David Raths  |  contributing writer