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For decades, state Medicaid programs have relied on large, established Medicaid management information systems (MMIS) to support core functions. Historically, these solutions have been inflexible and expensive to maintain with long, and sometimes failed, implementations.
To address the costs and complexity in maintaining and updating these platforms, the Centers for Medicare and Medicaid Services (CMS) established guidelines to shift programs towards a new information technology (IT) approach focused on modular, interoperable solutions.
In response to the new CMS guidelines, we teamed with IBM to create a standardized Medicaid enterprise system (MES) called the HealthInteractive Platform. It’s a more flexible solution to manage state healthcare programs.
How the new HealthInteractive Platform works
The HealthInteractive Platform is a Medicaid management environment that aligns with federal guidelines running on the IBM Cloud.
At its core, the solution is a systems integration platform that uses IBM service bus components and provides a data management platform for data exchange and access. For operational automation, the HealthInteractive Platform uses both IBM Business Process Manager and IBM Operational Decision Manager. For security, the platform relies on IBM Cloud Identity and Access Management (ICAM). Some agencies also require a data management solution. In those instances, we incorporate IBM InfoSphere Master Data Management (MDM). We offer the hybrid cloud solution as a software-as-a-service (SaaS) single-tenant model so a state’s data is segregated.
Expanding on the fast deployment capabilities delivered through the IBM Cloud, we developed a rapid deployment framework, which enables the HealthInteractive Platform to be up and running in 24 hours. Critical workloads and data are migrated between on-premises environments and VMware Cloud Foundation on IBM Cloud.
We chose to team in developing the solution because IBM Cloud delivers the end-to-end cohesive products that align with state agency needs. We also have a deep, two-decade relationship with IBM. We know how to get the job done together.
Benefits of the new Medicaid platform
The HealthInteractive Platform helps address the challenges of heritage Medicaid systems that state agencies have faced for years. Some benefits include:
- A modular IT approach to help programs reduce cost and complexity
- Deployment time reduction from months to hours, providing state agencies with the agility needed to meet evolving federal regulations and client expectations
- Eliminating layers of patching and upgrades that make a system difficult and expensive to maintain and adapt
Consider everything that goes into a Medicaid system: member information, medical and pharmacy claims, health care provider data, payment details, and so on. These interrelated functions are part of one large system, but also can stand alone. Modularity helps break functions apart so that each module can take advantage of new technologies, update to comply with evolving regulations and adapt to customer needs. This helps manage costs and increase flexibility.
The HealthInteractive Platform increases connectivity between modules, allowing users to quickly and easily access up-to-date information from various functions. With near-real-time processing, users can access operational reporting and short-term analytics in hours or days versus waiting for monthly or even longer-term batch reporting.
Read the case study for more details.