Making Disruption Effective MMIS Modularity Making Disruption Effective Greg McGuigan, Deputy Director Data and Systems Group, CMCS/CMS November 7, 2016

Agenda Evolution of the Vendor Community MMIS Modularity Drivers MACBIS Modular Design Contracts & Budget MACBIS Key Success Factors (Lessons Learned) CMS Resources

Toolkit Updates Evolution of the Vendor Community Industry Trends Driving MMIS Modularity Toolkit Updates

Changing Landscape While industry has made great strides in Agile, Cloud and modular development most government systems have lagged way behind However we are now in a period of rapid system change so we need to adopt the industry standards for faster development cycles, increased software functions, sharing and lower costs as we move forward 07/12/2012

Observations of the MMIS Industry Landscape Multiple Vendors at 2016 MESC demonstrating Modular MMIS Framework. Multiple new players in the space: Systems Integrator PMO Data Warehousing Provider Enrollment seems to have growing traction with modular solutions being developed and offered.

MMIS Modularity Drivers Toolkit Updates

Business Rules Engines Technology Driver Lean Agile Cloud Open Source COTS/SaaS Open API Business Rules Engines Interoperability

Rapid Technological Advancements is enabling MMIS systems modernization. Innovative technological approaches that automate Medicaid business processes and services, such as systems related to: member eligibility and enrollment, claims payment, member benefit management and financial management A common security framework, cloud computing, data analytics, common data repository, consumer-facing portals New business models, such as shared services (inter and intra state) Adaptations of existing business solutions from comparable sectors, such as: banking commercial healthcare large provider systems

MACBIS Modular Design Toolkit Updates

MACBIS Background In 2012, in recognition it was an agency priority to improve access to timely, complete, and accurate Medicaid and CHIP data, CMS created MACBIS. Effectively managing the implementation of the Affordable Care Act and the state Medicaid and CHIP programs requires extensive system design and development efforts. The previous Medicaid and CHIP data environment did not adequately meet the needs of Medicaid and CHIP data users. Data, data products and technology did not provide the agency with sufficient access to information on the Medicaid and CHIP programs to facilitate effective program administration and oversight.

MACBIS Pillars The 4 Functional Areas of MACBIS METADATA T-MSIS MSIS CARTS EPSDT PERM MFP Performance Indicator Data Collection MBES IBNRS EQRO MACPro WMS MMDL CHIP/SEDS MMCDCS SEA Pharmacy DDR MDR/FULS Program Operational Financial METADATA

Realizing the MACBIS Vision Establish Execute Demonstrate! Realizing the MACBIS Vision OLD ISSUES Incomplete Data Custom Data Validation Limited Analytics Data Silo’ed Limited State Integration NEW SOLUTIONS Robust Data Data Validation/Rule Engine Business Intelligence/ Reporting Data Integration Comprehensive State Integration Enterprise Medicaid and CHIP Legacy Medicaid & CHIP Data T-MSIS MACPRO MSIS PERM PHARMACY WMS Future MFP Etc. 12

Contracting & Budget Toolkit Updates

Contracting Strategy Market Research Request for Information (RFI) Statement of Objectives (SOO) Choosing the appropriate Contracting Model Cost plus award fee Time and materials Firm fixed price Outcome or capabilities based, incentives based on delivered capabilities

MACBIS Transforming Outcomes Budgeting based on Agency Priorities Cost Allocations based on perceived business value Reporting and Governance – OMB Reporting Guidelines

MACBIS Key Success Factors Lessons Learned Toolkit Updates

Transformation Roadmap Understanding Your Role Engage your Project Management Office (PMO) and Systems Integrators (SI) early to set the overall timeline, acquisition strategy and technical direction for the MMIS program Engage strong domain knowledge to ensure continuity of operations while transitioning from legacy to new development and technological platforms Also, make sure your business teams are prepared for what Agile development means, what is going to be asked of them and how their roles are different as compared to Waterfall development methods.

Manage Your Risk Embrace the Paradigm Shift New Technical Stack Multiple Vendors Multiple Integration Point (Legacy/New) Complex Project Schedule Dev/Ops Shifting Priorities

How can we help? Toolkit Updates

Resources Supporting Modular Development Currently Available: MMIS Cohort New MECT MMIS Newsletter SMDL #3 Guidance and FAQ’s on Medicaid.gov https://www.federalregister.gov/articles/2015/12/04/2015-30591/medicaid-program-mechanized-claims-processing-and-information-retrieval-systems-9010 https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/data-and-systems.html In Development: National Medicaid Systems Reuse Library for artifacts Modularity Proof of Concept: An open source provider module available for all states free Modular Precertification SMDL #4 Modularity and Reuse