1. Modularity Is the Market Ready?
Considerations for Achieving the Objectives of Modularity
Kim Shaver, Principal Kim Shaver Consulting
Co-Vice Chair for Human Services IT Advisory Group (HSITAG)
Co-Chair for the PSTG/HSITAG Modularity Survey Committee

2. Modularity Survey: Background
Established a Charter to explore:
Available modules in the marketplace
Considerations in achieving the CMS stated objectives of modularity
Formed a collaborative cross industry workgroup:
Comprised of PSTG and HSITAG membership
Established December 2016
Developed a survey to gather data and inform a whitepaper to answer:
What technologies exist today that support MITA business processes, CMS certification requirements and the Standards and Conditions for Medicaid IT
Could modularity decrease cost, increase speed to market and promote competition
Conducted industry survey:
Tested survey instrument in a Pilot survey and revised survey based on feedback
Used results to inform White Paper to share results
On the decreased cost, in developing the survey, we polled some vendors that were on the committee and this would have been a difficult ask and not readily available. For the speed to market, this may be one of our next steps that we determine we want to further gain insights and information and will determine that in our white paper.

3. Modularity Survey: A Little More Background
With a eye to more inclusiveness, sent survey to over 100 companies
Current MMIS vendors
Vendors in HHS space but not MMIS
Vendors new to HHS space
There were 29 respondents with 16 divulging the name of their company, of those: Obtained response from 29 companies
63% in the MMIS market
25% new to the MMIS market
12% in the HHS market, but not MMIS
12%
Traditionally HHS, but new to MMIS
25%
New to the HHS & MMIS Market
63%
Already associated w/ MMIS Market
Of the 29 companies that responded, we did say that it was optional if they did not want to include their company name. We received 16 company names and so those are the percentages included.

4. Vendor Classifications
We asked vendors to classify themselves and their offerings (this was a multi-select option.)
The results from highest to lowest:
71%
Module Provider
57%
System Integrator
39%
Other*
29%
PMO Provider
QA Provider
Fiscal Agent
14%
IV&V Provider
Other was explained by the respondent as: analytics, mobility, content management, web portal and application development. The majority of the responses could have been identified as a module.

5. Modularity Definition & Reuse
Modularity Survey: Focusing on Some High-level Insights - Putting the end – upfront
The lack of module definition, which CMS purposefully left vague for states to individually define, could impact reuse as well as limiting product interest or investment
Modularity Definition & Reuse
Procurement viewed as a significant risk in making progress toward modularity. The concept of modularity is still very new and creating some confusion in the market as states are adjusting RFPs and project approaches to include modularity. Reissued or unclear RFPs create significant risk to the goals of modularity.
Procurement and Acquisition
Type of modules by company – the highest availability is provide eligibility and enrollment, population health and member eligibility and enrollment. Most also coming from very large companies that are already in the industry.
Bundling – in the results, most vendors did not respond to his which we could come to conclusions of that they may not have that functionality yet, did not want to answer, or it is difficult to answer. This may be a next step that we look to doing to reach out to individual vendors to inquire why the question was not answered.
Interface- Most of the vendors responded that their products can interface with other modules.
Conclusions – Obviously, larger companies have the market. We see some smaller companies that have offerings and need to assure that RFP’s, constrictive SLA’s etc. don’t accidently restrict a response from these vendors. By doing this, it will help smaller companies or new companies get into the market which will help drive choice, faster to the market because more vendors are able to do it and could drive down costs with more competition.

6. New Entrants to HHS/MMIS Market
Modularity Survey: Focusing on Some High-level Insights - Putting the end – upfront
Vendors new to HHS / MMIS are entering market, however, size and scale potentially remain relevant with the majority of respondents indicating company size of 5000+; smaller, innovative new entrants may be limited in approaching the market, potentially impacted by the lack of module definition from state to state.
New Entrants to HHS/MMIS Market
Respondents reported offering modules that had characteristics aligned with CMS and the stated objectives embodied in the Standards and Conditions for Medicaid Information Technology
Alignment with CMS Stds. and Conditions
Type of modules by company – the highest availability is provide eligibility and enrollment, population health and member eligibility and enrollment. Most also coming from very large companies that are already in the industry.
Bundling – in the results, most vendors did not respond to his which we could come to conclusions of that they may not have that functionality yet, did not want to answer, or it is difficult to answer. This may be a next step that we look to doing to reach out to individual vendors to inquire why the question was not answered.
Interface- Most of the vendors responded that their products can interface with other modules.
Conclusions – Obviously, larger companies have the market. We see some smaller companies that have offerings and need to assure that RFP’s, constrictive SLA’s etc. don’t accidently restrict a response from these vendors. By doing this, it will help smaller companies or new companies get into the market which will help drive choice, faster to the market because more vendors are able to do it and could drive down costs with more competition.

7. Modularity Survey: Standard Listing of Modules
Creating a common terminology around modules for the survey---
Solution Module
Fee-for Service Claims Processing
Member Eligibility and Enrollment
Pharmacy Benefit Management
Enrollment Broker
Business Intelligence/ Decision Support
Member Service and Management
Enterprise Data Warehouse
Behavioral Health Management
Provider Eligibility and Enrollment
Dental Benefits Management
Provider Service and Management
Care Management
Financial Management
Population Health Management
Third Party Liability
Systems Integrator*
Prior Authorization/Utilization Review
Other
Program Integrity/ Fraud Waste and Abuse
*While Systems Integration (SI) is not a module as envisioned by CMS’ definition, some states are considering the MMIS integration platform as a module so we included it as a category, primarily to gauge the market’s readiness to offer SI services.

8. Modularity Survey: Offerings Ready to be Deployed
From this common list of modules, respondents were asked to self-select the modules for which they have offerings that are ready to be deployed: %
Module Offering
66%
Provider Eligibility and Enrollment
38%
Population Health Management
59%
Business Intelligence/ Decision Support
35%
Fee-for Service Claims Processing
52%
Provider Service and Management
28%
Financial Management
Program Integrity/ Fraud Waste and Abuse
Third Party Liability
Member Eligibility and Enrollment
Other*
Care Management
24%
Pharmacy Benefit Management
48%
Enterprise Data Warehouse
Behavioral Health Management
Member Service and Management
10%
Enrollment Broker
41%
Systems Integrator
Dental Benefits Management
Prior Authorization/Utilization Review

9. Modularity Survey: Module Characteristics
98% of modules have on-demand/ad hoc reporting capabilities
90% interact with other modules by sending and receiving web services brokered by an enterprise service bus
88% have native workflow management triggers
86% use a rules engine, with the majority of those responding that the rules engine is native to the module
86% of modules exchange data in real-time with other modules
85% of modules separate the presentation layer from applications and data layers
80% of the modules support non-MMIS solutions, including commercial solutions 
Almost half of the modules were updated/enhanced quarterly
On the decreased cost, in developing the survey, we polled some vendors that were on the committee and this would have been a difficult ask and not readily available. For the speed to market, this may be one of our next steps that we determine we want to further gain insights and information and will determine that in our white paper.

10. Modularity Survey: Modules and Certification
Respondents asked to identify modules
Indicate whether the module was implemented within a certified MMIS
More than half of the modules listed by respondents were implemented in a certified MMIS

11. Modularity Survey: Modularity Risks
More than 50% of respondents indicated the biggest risk to modularity is state procurement and acquisition requirements/regulations
Lack of common definition and scope for specific modules
Lack of role definition and potential conflicts over who is making decisions on modules – the state, SI or module vendors
Procurements too frequently cancelled resulting in vendors leaving the market
RFP requirements that favor incumbents
Outdated procurement rules and requirements that do not align with what states are trying to acquire
Lack of clarity around the SI’s role and requirements
Insufficient enterprise planning
Lack of project management to manage dependencies from module to module
Other risks identified included:
On the decreased cost, in developing the survey, we polled some vendors that were on the committee and this would have been a difficult ask and not readily available. For the speed to market, this may be one of our next steps that we determine we want to further gain insights and information and will determine that in our white paper.

12. Next Steps Share White Paper with detailed results
Continue collaboration between PSTG and HSITG to conduct bi-annual surveys that will allow for the trending of data related to the objectives of modularity
Encourage and Prompt:
The identification of changes in State procurement law that create barriers to developing and procuring services consistent with a modular architecture
Sharing of the lessons learned from RFP/RFI experience, post-mortem on reissued RFPs or reasons for non-bids as well as the creation of open forum to allow vendor input
Use of white papers and studies to help elevate the challenges that result from the lack of standardized module definitions or roles and responsibilities in a multi-vendor environment
The White Paper, “Considerations for Achieving the Objectives of Modularity” will be available online at the CompTIA Website by May 1, 2018

13. Thank You
Survey committee members contributing to the survey and drafting of the white paper, “Considerations for Achieving the Objectives of Modularity”