In an effort to manage the healthcare payments for those served by Medicaid, state Medicaid agencies are increasingly required to act as experts in technology. They have to implement and operate Medicaid Management Information Systems (MMIS). These systems have increasingly become more expensive and complex. Building a new MMIS costs the state and federal government between $90 and $150 million dollars. These costs do not include the ongoing operations, maintenance, or updates to the system. The need to constantly improve and adapt the MMIS has forced Medicaid agencies and their employees to manage systems, rather than the Medicaid program. This robs valuable time and attention from the people Medicaid programs serve and from making improvements and innovations to those programs.
Vendors of the MMIS systems are in a no win situation. They face growing requirements from Medicaid agencies and increasing complexity in technology. The agencies are attempting to get the best of the breed MMIS for their state in both the functions the systems perform and the underlying technology. States, reasonably, want their expensive investment to last longer. These systems take so long to build and customize that they are outdated, both in the requirements they fulfill and technology they use, when implemented. Vendors end up appearing “behind the curve” and states get antiquated systems.
Once a MMIS is in place, Medicaid agencies are faced with numerous changes in policy and procedure that the MMIS needs to accommodate. These changes need to be replicated in MMIS’ across all 50 states. This typically happens at an additional unplanned cost to the state and federal government. The vendor, when faced with limited resources and many customers to simultaneously please, build workarounds in order to meet demand quickly and inexpensively. This decreases the quality and life span of the MMIS.
The MMIS model is broken. It is not working for the vendors or government. A rethinking of MMIS by the Medicaid agencies could change this. If these agencies were freed from releasing technical requirements and specifying the details of an MMIS, they could focus on specifying what they need out of an information system rather than how the information system works. They could focus on desired outcomes and associated performance measures. The focus could change from being on the means (a technology platform) to being on the ends (program outcomes). States must view “MMIS As A Service” to accomplish their Medicaid program’s goals, not as a technical platform.
MMIS As A Service is a new approach to the Medicaid industry, but a similar concept has been in practice for years in insurance agencies, Administrative Service Organizations (ASOs), and Managed Care Organizations (MCOs) operating in the private sector. The idea of MMIS as a Service is rapidly gaining ground with state Medicaid Agencies, CMS, and MMIS vendors. The Center for Digital Government and Governing Magazine has convened a group of industry, state government, and federal government stakeholders to explore this approach. Public Knowledge, LLC is a member of this group. Our activities are defining a roadmap to rethinking “MMIS”.
Public Knowledge, LLC helps clients procure and implement MMIS systems. We are leading the charge to redefine MMIS as a Service. We will be discussing more about MMIS as a Service here on our website but If you want more detailed information please contact us (firstname.lastname@example.org).