Handler’s belief that the MMIS should be more flexible and modular fits with the strategy IT leaders at the federal Centers for Medicare & Medicaid Services (CMS) have been pushing states to adopt for years. CMS’ Medicaid Information Technology Architecture (MITA) approach seeks to formally define a core set of functions for each state system and make the design of those systems more modular based on a service-oriented architecture. “MITA is pushing states toward a more component-based system and away from mainframe architectures,” said Dan Sisco, director of professional consulting for MAXIMUS, a Reston, Va.-based firm that fosters government-citizen relations.
States are now moving toward plug-and-play and shifting from “big-bang” implementations, and new systems must be configurable. For instance, Sisco said, the rules for different benefit plans must be modified regularly by Medicaid agency staffers, without requiring programming staff to make changes.
Vendors have responded, he added. They are working on developing independent components based on newer technology. Many have developed partnerships with best-of-breed software players to deliver these component pieces, and new vendors may soon enter this MMIS arena.
But some CIOs and consultants say many states are struggling to adopt the MITA approach.
“MITA is a good concept, but there are things that hinder states’ ability to embrace it,” said Andrea Danes, senior principal for Chicago-based CSG Government Solutions.
“If you have a very old legacy system and haven’t done an upgrade in a long time, it is a huge leap,” she added. “Agency leaders are used to a cycle of working with vendor X, and they create specifications and put out an RFP based on what they know.”
Vendors are trying to upgrade their offerings for MITA, but Danes said she believes that the solutions they’re creating aren’t all that different. “They are incremental changes, but not the huge leap that the agencies need,” she said. “The systems are still not flexible enough.”
John Singleton, vice president of state and local solutions for CSC’s North American Public Sector group, said that MITA is the impetus behind much of the positive change in eliminating stove-piped systems at the state level. His company is working with North Carolina on a single enterprise application called NCTracks that will use Web services to serve five different health and human services programs with a single portal on the front end. The new system will offer enhanced reporting and analytics compared to the legacy system now in use. “The key thing is adaptability,” he said, “and the ability to respond to change.” With an older COBOL-based MMIS, staffers would write change requests, and it would take programmers weeks or months to make those changes. Now, with a rules engine and a graphical user interface, changes can be made much more rapidly, Singleton said.