Government Research Reports

New Players and Future Prospects for MMIS, 2012 (Aug 2012)

With Medicaid representing the single largest line item in state budgets, states are seeking new savings via modernization of Medicaid Management Information Systems (MMIS).

Description

Surging enrollment drove Medicaid spending to 26.2 percent of state budgets in 2011. States are using enhanced Federal Funding Participation (FFP) and federal architectural guidelines to evolve more adaptable and affordable MMIS systems.

Key challenges that are driving the current wave of MMIS modernization include:

• Better reporting and analytics – predicting vs. reacting
• Customizable dashboards
• Focus on quality, not quantity
• Reducing waste, fraud, and abuse
• Integration and interoperability with other programs and systems, including health information exchanges, health insurance exchanges, and integrated eligibility systems
• Compliance with federal mandates – ICD-10, etc.
• Adoption of new technologies – Web-based, service oriented architecture (SOA), cloud, etc., all of which can come with risks

States looking to apply for the enhanced funding will need to invest in modular systems that accomplish reusability, maintainability, and reliability. In 2011, CMS stated a strong desire for states and the vendor community to develop lighter-weight and loosely-coupled approaches to the design of health care systems. This report provides a detailed overview of the key requirements, implementations, and opportunities that will point the way toward the future of MMIS.

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