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

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

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

4. 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

5. 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.

6. MMIS Modularity Drivers
Toolkit Updates

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

8. 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

9. MACBIS Modular Design
Toolkit Updates

10. 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.

11. 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

12. 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

13. Contracting & Budget
Toolkit Updates

14. 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

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

16. MACBIS Key Success Factors
Lessons Learned
Toolkit Updates

17. 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.

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

19. How can we help?
Toolkit Updates

20. Resources Supporting Modular Development
Currently Available:
MMIS Cohort
New MECT
MMIS Newsletter
SMDL #3 Guidance and FAQ’s on Medicaid.gov
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