MMIS: Outsiders NOT Welcome

Friday, November 13, 2015

Unlike the United States political arena where being labeled incumbent has become a liability, outsiders apparently are still not welcome in the Medicaid Enterprise Modernization world. Think about it, with the MITA framework firmly in place, States have the chance to configure industry’s best solutions in practically every business area associated with a modern Medicaid Enterprise. And still we find ourselves struggling to takeover and enhance legacy solutions that have already cost the government billions of dollars.

While the commercial world has long embraced such practices as cloud computing, software as a service, open source, and online gaming States still insist on requiring “demonstrated experience doing the same old thing over and over”. When is the last time you saw an RFP that read “innovation encouraged, no experience necessary, award based on merit, best practices and best-of breed commercial solutions only”? You could count them on one hand. Don’t believe me? Try buying a lottery ticket on your phone!

Don’t get me wrong, experience does matter. Experience with analysis of customer needs, experience with sound development practices, proven project management techniques, and demonstrated ability to deliver solutions that work is really what you need. Combine that with sound goals and requirements from the State in their own MITA Self-Assessment and you could open the door to real innovation that would benefit the taxpayers, the beneficiaries, and the stakeholders in every Medicaid Enterprise.

So what’s the hold-up and what’s the solution? I suggest it requires rethinking on both sides of the fence. For States it is as simple as using the MITA framework to its fullest potential, recording their As-Is conditions thoroughly and truthfully, and setting To-Be goals based on information gained from the commercial vendors. In other words, asking “what is possible” before deciding “what is necessary”. On the private side vendors can take the initiative to determine the true meaning of best practices and best of breed. Combining core offerings with the latest technology offered in loosely coupled COTS components keeps solutions modern. Good requirements and sound development usually leads to innovation. Teamwork is always a prerequisite for success.

Electronic Health Resources, LLC is a small private company that decided that the only way MITA could lead to innovation was to develop a MITA process solution that would benefit both States and Vendors. Our product, ReadyCert, allows transparency throughout the Medicaid modernization process and encourages participation between States, Vendors, and the CMS.  ReadyCert helps States easily record their goals, evaluate those goals, solicit commercial product information, issue RFP’s, evaluate responses side by side by business area, business process, and MECT requirements, and track deployment process through certification. ReadyCert allows vendors to compare their core solutions against the State requirements, rate their solutions for MITA maturity, prepare proposals, track deployment, store test and production reports, and demonstrate compliance to Federal and State-Specific requirements.

If you find your company on the outside looking in, maybe it’s time to get innovative. Order a copy of ReadyCert, MITA-SIZE your offering, work with other firms that offer COTS solutions (for areas that are not in your sweet spot), and get to know the States you want to do business with. Show them your wares in a MITA compliant fashion and who knows, you may just be the next “Trump Card” for Medicaid Enterprises.

Written by:
Wayne Cooper

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