1. Making Disruption Effective
MMIS Modularity:
Making Disruption Effective
Wyoming’s Approach to MMIS Modularity
Teri Green, Wyoming Medicaid Director/Medicaid Agent

2. Approach To WINGS Project
Before starting the project:
Significant internal and external meetings (stakeholders and staff)
Vendor fairs to expose your staff to new ideas
Conduct Replacement Alternative Analysis
Environmental and recent/upcoming project scan to identify like-minded states (Borrow, Beg, Steal, Share)
CMS consultation and involvement in CMS or national workgroups
MITA Assessment
1st Assessment (Complete Spring 2015)- Survey Based (Survey Monkey and Google Sites) with limited number of follow-up meetings. Low cost approach (<$150K) that completed assessment quickly (3 months) with lower staff commitment (<8 hours for most SMEs).
2nd Assessment (Ongoing)- Designing MITA assessment into business process documentation and redesign project so that MITA assessment is always up-to-date.

3. Approach To WINGS Project
Removing the Wyoming “snowflakes” to extent possible
Document (1,153 so far) and redesign business processes
Standardize policies to commonly used industry standards (including rate and payment methods)
Align services to achieve service level goals beyond applicable benchmarks
Modernize technology based on COTS, SOA, loosely coupled Modules, cloud- hosting and SaaS (plus Infrastructure-aaS and Platform-aaS if appropriate)

4. Wyoming’s MMIS Modules Identified To-Date

5. Description of the Modules
Pharmacy Benefit Management System (PBMS)-This has already been procured, and Goold Health Services holds the current contract. PBMS will process pharmacy point-of-sale claims and handle pharmacy related prior authorizations, among other duties. (Currently in implementation for Spring 2017)
System Integrator with Enterprise Service Bus (SI-ESB) -The main function of the System Integrator with Enterprise Service Bus will be to connect all of the modules together into an enterprise system so that the WINGS vision can be realized. (Open Procurement - Closes November 30, 2016)
Data Warehouse with Business Intelligence Tools (DW-BI) -The main function of the DW-BI will be to serve as data storage for all the other modules (with the intention of bringing in data from other Department of Health areas over time). Business intelligence tools will be used to create dashboards, compile reports and analyze the Medicaid data.

6. Description of the Modules (Cont.)
Fraud, Waste, Abuse Analytics and Case Tracking (FWA) Services - This module will support the identification, investigation, and collection of fraud, waste, and abuse of Medicaid services by providers and clients.
Third Party Liability (TPL) services -TPL will ensure that proper coordination exists between Medicaid and any other entity or individual with the obligation to provide financial support for Medicaid services rendered to a client.
Care/Case Management Services - (CCMS including HCBS waivers) CCMS will develop and monitor of plans of care, capture and monitor assessments and screenings, treatment plans, authorize services (send PAs to claims processing module), incident management, and reporting functions.
Benefit Management Services (BMS) services-This module will include Medicaid claim processing, provider enrollment, and benefit plan management, among other duties. (more details on next slide)
Consulting Services -Will act as support during implementation of the WINGS project. These services include: Testing and Quality Assurance/Quality Control Services (Testing-QA/QC) & Independent Verification & Validation (IV&V).

7. Benefit Management Services
Often referred to as “core” services. Wyoming may pursue as one procurement or as multiple modules (still in process of determining best approach).
Potential for services in procurement(s):
Provider enrollment, screening, and monitoring
Claims Processing
Financial Management -Fiscal Agent type duties
Encounters and Premium payments
Provider Call Center and other Provider Management
Prior Authorizations and additional logic

8. Medicaid Enterprise Certification Toolkit
Wyoming participated in module and MITA checklist/certification workgroups. WINGS modular approach aligns well with CMS MECT 2.1 Module and “Standards and Conditions for Medicaid IT” Checklists

9. Aligning Major Projects and Functional Areas
Governance and coordination is a priority because Wyoming also has four other major project groupings occurring at the same time as WINGS:
Enterprise Governance
Eligibility- WES Wyoming Eligibility System, and Customer Service Center
HIT/HIE- Wyoming Total Health Record, Medicaid HIE, Statewide HIE
HM/UM- Health Management Utilization Management (PA duties currently split between Optum, Xerox-ACS, and Qualis)
Creating coordination and governance mechanisms for these major projects to align with WINGS.

10. Change Management Governance and Planning beyond technology projects:
Projects will change business process, people/jobs/duties, technology, and culture
Establish Medicaid Enterprise IT leadership
Form an integrated project timeline
Formalize project prioritization
Identify integrated change management governance
Introduce organizational change management and transition

11. For More Information
WINGS project information and regular updates available at:
wings-project/
We will happily share any procurement or project documents with other States. Please contact if there are any items that you would like us to share.