The Medicaid technology market is poised for a transformational change. The Federal Centers for Medicare and Medicaid Services (CMS) announced at the annual Medicaid Enterprise Systems Conference that the monolithic Medicaid Management Information System (MMIS) was dead. Firms that have specialized in the “big-bang” ground-up development of these systems are scrambling, as are states.
CMS is, instead, driving the market to implement modular systems. CMS funds 90 cents on the dollar for these systems, so they have significant sway over how states approach MMIS system implementations. The many states that are slated to replace their systems are working to adjust to this new reality. There is some skepticism in the market – coming from both MMIS vendors and states – as to how this would or could really work. While outcomes remain to be seen, the reality is that continuing with the status quo is no longer an option.
The rationale for this change is driven by the need to introduce innovation into the market and ensure systems are agile and adaptable to changing programmatic demands, such as expanded Medicaid managed care, Medicaid expansion, and pay for performance. Another driving factor is highlighted in a recent study released by the State of Colorado, which showed that 21 of the last 21 MMIS implementations in the last 10 years failed – they were over-budget, over-schedule, or both.
In the past, states have relied on their MMIS vendor to manage the strategy, integration and technical design that allowed the diverse components of the Medicaid enterprise to work together. Under the new archetype – where modular components need to be prioritized, procured and integrated – that responsibility falls to the state. For most state Medicaid agencies, this is a new role.
In anticipation of this need, North Highland has developed the Enterprise Strategic Integration Management Office (SIMO). The SIMO is designed to support the development and execution of strategic direction within the Medicaid enterprise – with the MMIS as its core function. It is an agile and scalable entity that adapts with the demands of the Medicaid enterprise.
Its portfolio of responsibilities range from the strategic (e.g., enterprise information management), to the transactional (e.g., project management), and the transformative (e.g., organizational change management).
The SIMO supports the Medicaid enterprise as it evolves under the dramatically changing environment. It is designed as a foundation for the successful execution of enterprise architecture, enterprise portfolio and project management, integration management, benefits tracking, reporting, and vendor / contract management. For more about the SIMO, read our full perspective.