‘Lipstick on a Pig’

Despite a long procurement process, Washington state’s recent experience with MMIS replacement shows the potential for steady progress, according to Rich Campbell, director of systems and monitoring, and Medicaid CIO in the Department of Social and Health Services. Its legacy system, built in the late 1970s, had connectivity issues and its database was hierarchical. “We had tacked things on, but that had just caused our environment to be more complicated,” he said. “Initially we considered rebidding for maintenance of the same system, but we realized about the same time MITA was in its infancy, that we needed something more flexible, something we could change rapidly.”

Washington’s RFP in 2004 came at the same time that vendors were just starting to move to new architectures. “When we were looking, it was sort of a case of lipstick on a pig,” Campbell said. “It was the same back end with some really nice Web pages on the front end.”

For its new ProviderOne system that went live in May 2010 (which cost around $160 million with a 90 percent federal match), Washington partnered with a relatively new player, CNSI, which had previously done work with Maine and Michigan. Its system was based on Java and an Oracle database platform. ProviderOne is interfaced with eligibility systems to allow real-time updates of records. It offers an updated managed care solution, a real-time rules engine to implement policy changes, and enhanced fraud and abuse detection tools.

Campbell likes that the system is modular. “We asked them to give us the best of breed, so the call-center module is from Siebel and the interface with our state accounting system is from Oracle Financials. But if later we decide we want something else, we can pull that piece out.”

Campbell’s team is preparing the system for the CMS certification process this year.

Envisioning a New Architecture

According to Gartner Research Director Rick Howard, procuring a new MMIS gives CIOs the opportunity to change the perspective of the health and human services enterprise from a collection of discrete programs to a portfolio of interrelated services.

As Medicaid CIO in Oregon, Howard led an effort to rethink how a new MMIS might provide a core set of services to multiple program areas, and he said other CIOs are envisioning a new architecture from both an IT and a business point of view.

For instance, in the financial back end, MMIS handles the processing of payments, he said. That can lend itself to Medicaid, pharmacy benefits management and the Supplemental Nutrition Assistance Program. States could use one enterprise rules engine for all three, he said.

In the midst of all the health-reform activities, the biggest challenge for CIOs is gaining access to the Medicaid program executives who are being pulled in different directions to work on projects. “That creates a real access bottleneck,” he said. “There is much more interaction between CIOs and directors of these agencies as they work on IT decisions related to supporting health reform.” Howard added that such close cooperation hasn’t always been the case. “Now the CIO is a trusted adviser and broker of IT services, some of which his or her organization will be providing, many of which it will not.”

But beyond the federal reforms, there are drivers that make IT-enabled health care inevitable, as consumers, payers and providers seek greater transparency into costs, outcomes and quality data. “Those changes,” Howard added, “are already under way.” ¨

David Raths is a regular contributor to Public CIO. He also is senior contributing editor of Healthcare Informatics magazine.

David Raths  |  contributing writer