More HIPAA, Less MITA – 2

More than 10 years after the initial implementation of the HIPAA Transaction and Code Sets Rule, it’s time to celebrate. HIPAA required that a health insurance claim is in the same format and uses the same data everywhere. There are at least 8,000 carriers, third party administrators, and other health plans processing claims that look just like your Medicaid claims. CMS, in ushering in the first wholesale standardization of processing health care transactions, was brilliant.

MITA, on the other hand, has proven to limit competition within the MMIS industry. It has resulted in fewer MMIS vendors, not more. And more MITA consultants, with ever larger fees for state self-assessments.

We are attempting to turn that around by providing leadership to a work group that is looking at services based approach rather than systems for MMIS functionality.

Let us show you how to utilize services rather than systems to achieve efficiency and modernization in your Medicaid operations. Contact us at

More HIPAA, Less MITA – 1

As one of the leading consultants to State Medicaid agencies, why in the world would we suggest less MITA? The reason is simple. We believe MITA Assessments are too expensive and provide too little real value. You know it and we know it. Our clients and indeed the whole industry benefit from honest and open philosophical discussions about which investments truly provide value.

Under too many situations, MITA has shown itself to be primarily a consulting product, designed by consultants and benefiting consultants.

We have turned that around by working with two state clients to achieve the MITA goals through a reduced effort MITA state self-assessment that is fully compliant with federal requirements.

Let us show you how to do the same so you can get moving on achieving higher MITA maturity levels without the usual drain on your staff and budget. Contact us at

Center for Digital Government announces new work group Promoting MMIS as a Service (Maas)

Medicaid Management Information Systems (MMIS) sit alone as an Information Technology industry that, over a span of more than 40 years, has produced fewer and fewer options for its customers.

The good news is that very soon most states won’t need an MMIS to do their Medicaid business. Governing Magazine and the Center for Digital Government have announced a new work group to move MMIS functionality to a services model in line with the rest of the health care industry.

“Over the next few months, Governing magazine and the Center for Digital Government will examine how CMS and state Medicaid Agencies can add the simplified option of acquiring fiscal agent services where the system comes as part of the service.”

Under CDG’s initiative, Public Knowledge is leading a subgroup to develop MMIS certification criteria for a services model that will be forwarded to CMS for its consideration. We are also working with a state Medicaid agency that may be the first to get such an MMIS as a Service procurement out the door.

Download this MS Word Document to see the full announcement that was sent to Public Knowledge and others by CDG.

You are invited to join in the effort. Or if you just want to chat give us a call at 866-785-2387 or email us at

Do you really need an MMIS System?

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 (

Medicaid IT Systems: The Perfect Storm

Our own Jim Plane and Nicole McNeal were interviewed by the Government Technology about the future of MMIS. As you can expect from PK, they offer some out of the box thinking. You can read the article here.

Lets Keep the MESC Dialog Going…

It was great spending time with our clients at the annual MESC meeting in Denver this week. We enjoyed reconnecting with many state agencies and making new acquaintances as well.

Public Knowledge had great attendance at two of the breakout sessions with our Colorado and Wyoming clients.

MMIS Procurements in Today’s Marketplace

The first session titled ‘Procurements in Today’s Marketplace: Procurement and Evaluation Strategies for Creative Solutions That Encourage Competition’ was a highly interactive session around MMIS procurement, evaluation and protests. The State of Colorado Department of Health Care Policy and Financing’s Deputy Finance Office Director, Chris Underwood, covered several innovations in Colorado’s multiple RFP’s for MMIS, PBMS, and Business Analytics.

This session explored the significant risks for MMIS procurements and the lack of competition. Recent claims processing implementation and operational challenges have led states to explore more modern, innovative, adaptable, and modular solutions. However, states and vendors often rely on traditional RFP, proposal, and evaluation that do not consider modern service delivery models. We discussed how states could produce RFPs with clear requirements while looking for creative solutions that inspire vendors to invest proposal resources, appeal to non-traditional vendors, and encourage competition. We also discussed selecting the best vendor and solution to meet states’ needs as well as evaluation processes that are fair and impartial.

MMIS As Services

The second session titled ‘Challenge: Purchase MMIS Processing as Services Using Federal Match’ opened up a dialog around acquiring MMIS processing as services rather than systems using federal match. Wyoming’s State Medicaid Director, Teri Green opened the dialog with an announcement that Wyoming would be exploring a “services” approach to its upcoming MMIS replacement strategy. Caroline Brown of Covington and Burling covered the supporting language in CFR and other regulations for such an approach.

This session explored alternatives to procuring a traditional MMISs. Medicaid programs continue to grow in complexity while states face evolving regulatory changes. MMISs struggle to keep up with program and technical demands. Many implementations take 3+ years, while experiencing budget and schedule overruns. Consequently, many states are seeking alternatives. This session highlighted Medicaid claims processing and payment management as a service. This represents a paradigm shift in the way systems and services are acquired. We also discussed how federal requirements and contracting rules might apply to this type of framework as it relates to enhanced federal matching funds.

Looking to Continue the Dialogue?

Public Knowledge is currently scheduling meetings with State Medicaid Agencies throughout the country to expand on MMIS procurement and starting down the path of MMIS as services rather than systems.

Our first meetings are occurring in early September and continue through December of this year. If you are a state with an interest in MMIS planning and procurement, we want to meet with you. We will come to you for a brief 30 minute meet and greet or can allocate up to 4 hours to provide an in depth look at where the MMIS market is headed based on real experience drawn from our current projects.

If you are interested, contact Nicole (McNeal) or Jim (Plane) at to schedule a meeting. In return for your time we promise to deliver information of value to you, tailored to your situation. These are not sales calls. These are “let’s get acquainted” meetings to better position each of us for future Medicaid systems and services opportunities.

Best Practices for Piloting an Information System: Conclusion

In the course of our work we have developed a set of eight “best practices” for piloting an information system.  This series of posts provides an summary of those practices. In previous posts we discussed the need for Executive Sponsorshipgoal setting, and expectation management and communication and project management.  Concluding our discussion of piloting, in this post we will discuss setting the pilot boundaries and dealing with what comes out of the pilot.

7. Know what you need to get started and when you’ll be done before you start.

Have a checklist of “entry criteria.” This checklist should ensure staff members are appropriately prepared, have the training they need, equipment they need, and have a means of reporting findings the minute they occur. It should also cover bigger issues such as a means of collecting and reporting findings and a defined project management plan and communication plan that is being executed.

Have a checklist of “exit criteria”. The first item on this list defines what done means. It can be when all features in scope have been exercised (or exercised a defined number of times), or you can time-box your pilot and just say it will be conducted over a month or three weeks.

Have a set of suspension criteria. If a feature of the pilot can’t be tested because it doesn’t work you pull the plug on the whole pilot? Or will you suspend execution of the pilot until the feature can be fixed?

Plan to develop a “close out” or lessons learned report. This serves as a formal endpoint for the pilot and provides a compilation of the findings, conclusions, and recommendations arising from the pilot.

8. Be prepared to deal with what you find.

As previously mentioned, you need a way to capture findings as soon as they occur. Individuals conducting the pilot are under tremendous pressure and unless they stop the moment they have an idea or identify an anomaly, they will not remember it at the end of the day. Web forms or printed worksheets work well for this.

Have a means of collecting, collating and summarizing the findings information. Ideally, this should be done daily and the information obtained shared with appropriate parties as defined in the communication plan.

Have a method of prioritizing findings. Keep it simple. Generally two categories work well.  The first are findings that must be resolved before you can go live. These are things without fixing you cannot perform your work – there is no workaround. The second are all other findings. Give those reporting the issue input to the priority, but the sponsor should make the ultimate decision.

Share your findings regularly with the pilot team and stakeholders. On a month-long pilot have standup team meetings – short 15-minute meetings – at least twice a week to review results. Share summarized versions of your findings with stakeholders as appropriate. Never gild the lily – bad news is better delivered early than late.

As part of a broad range of services designed to help you prepare for implementing information systems, Public Knowledge, LLC helps public sector agencies successfully plan and execute information system pilots.