As of April 2017, 39 regions and states have contracted with a MMIS solution or module, and an additional 16 (including Ohio and Michigan) remain operated by the state.

“The Medicaid Management Information System (MMIS) is an integrated group of procedures and computer processing operations (subsystems) developed at the general design level to meet principal objectives.” To help grasp the three architectures that form MITA, within each MMIS, there are key competencies: Business Architecture (BA), Information Architecture (IA) and Technical Architecture (TA). These competencies mold the MITA framework and align with the MITA missions and goals.

Within each of the architectures, there are two categories: As-Is and To-Be. As-Is defines the current state, while To-Be describes the future state of the project, solution, and enterprise within the years to come. The To-Be timeframe can be as short as one to four years or expand past ten years.

BA consists of business process models (BPMs) and capability matrices to describe the current and future state of the project. In detail, this drills down to the business rules, policies, procedures, workflows, outsourcing, technical solutions, and the project’s revenue sources. It also includes a high-level overview of the goals and targets. Now when it comes to IA, think of IA as the sister of BA –  . IA consists of the data management strategy and data standards, as well as the information capability matrix.

When it comes to Technical Architecture (TA), it includes BA and IA, and serves as the cross-cutting architecture. IA truly defines and sets the flexibility, security, and privacy of the solution for the current and future state. To get a little more detailed, some sections within IA include performance measurement, data connectivity, logging, data access, data management, and decision management.

What’s SOA?

Service-oriented architecture (SOA) is an application architecture within which business functions and selected technical functions can be invoked using documented interfaces. So, what does this really mean? It allows businesses to leverage existing assets, create new ones, and easily enable the inevitable changes required to support the business. The underlying elements that create the MITA SOA are adaptability, extensibility, interoperability, and access.

We asked Softheon’s Managing Director of Software Development, Mark Graffia and Director of Software Engineer, Umer Mujeeb two key questions:

SFTN: What does SOA mean to Softheon?

UM: “Softheon’s SOA breaks down monolithic applications to individual modules, which improve interoperability and remove redundancies.”

Softheon’s solutions have been architected to support modular implementations, avoiding the risks and uncertainty of “rip and replace” challenges as other vendors attempt to extract code and potentially bring you new problems from otherwise functioning technologies.

SFTN: What is the most important skill needed to adopt SOA?

MG: “I would say adopting SOA is a mindset. It requires looking at a problem and the resulting process as a series of single responsibility actions. A thorough understanding of core software design patterns and BPMN help in building a true SOA platform.

Technology   Description 
Architecture  Softheon supports fault tolerance, scalability and throughput, the ability to federate with other ESBs, the supported topologies, and features supporting extensibility.
Connection  Softheon ESB is capable of interfacing with a wide range of messaging standards, communications protocols, and connectivity alternatives.
Mediation  Transaction and policy management, provisioning of resources, message transformation and mapping tied into ETL, and service-level agreement (SLA) coordination.
Orchestration  Softheon provides XML Web Services orchestration in SOAP and RESTful protocols, as well as business process execution language (BPEL) and business process modeling notation (BPMN) support.
Change & Control  The main components in this group are design tooling, life-cycle management, technical monitoring, and security.

There are some challenges within MITA, but SOA helps. The first of these challenges is, “highly interconnected systems utilizing point-to-point interfaces, which require pervasive modifications to accommodate changes to business requirements – making requirements challenging to change.” Services depend on each other – the more changes there are within a given format, the more difficult it is to reformat the functionality or its interface. If multiple platforms were to use a single set of interfaces, when a second or third platform connects to the system, it consumes the data and displays the result. Thus, utilizing the same SOA principles will be less pervasive, allowing systems to be changed more rapidly.

The second challenge is defined by the user navigating through multiple functional systems to perform a single task. Within SOA, users are presented with a consistent user interface (UI) with the ability for single sign on (SSO), which enables the Medicaid system to connect with multiple systems, providing a seamless way for users to log in without the need for multiple sign-ins.

The last challenge is described as “MMIS, to a large extent, is platform dependent and does not communicate easily across functional or technical boundaries, which makes it difficult to share information or reuse functionality.” The business processes and functions within the MMIS systems can be invoked by each service or workflow; this will drive message-driven interfaces, forcing more platform independence.

What’s the enterprise-wide view like?

As part of Softheon’s BPaaS SaaS platform for healthcare distribution and services, Softheon has developed a significant understanding of what a comprehensive and highly functional product needs to be. MITA 3.0 established interoperability standards that were intended to be forward-thinking. In addition to SOA, the Softheon framework was designed nearly a decade early with the same basic technological tenets:

  • Enterprise Service Bus (ESB) – is considered open communication for interconnecting all external and internal systems. ESB is comprised of inter-connected modules that are flexible, purpose optimized access methods for each external data source, designed for open data interfaces and exposed through advanced application programming interfaces.
  • Business Process Management (BPM) – this is responsible for providing a business-user friendly interface for definition and execution of business processes following the BPMN 2.0, BPEL, and other open standards. Softheon’s BPM layer orchestrates complex business processes that may span across multiple systems.

In the 56 reporting states and territories, 44 have no reported open Medicaid IT procurements, although with a funding of over $4 billion per year towards Information Technology (IT) development, and with a 90% federal match, the CMS Administrator is encouraging investment in the Medicaid IT realm.

By taking an enterprise-wide view with executive support and supporting the technology from the MITA methodology, Softheon has been successful where others have not. Others weren’t successful because they couldn’t look across the enterprise. Using that approach and getting executive backing on it is very important.  At Softheon, we strive to create simple solutions to complex problems. Understanding that healthcare is constantly evolving – this agile development process positions us to quickly adapt and adhere to the latest regulatory developments. Continuing our history of success, we are proud to be trusted by over 60 healthcare payers participating on public exchanges, managing 37% of the membership.

This blog is part of the #MITAMonday series. You may also be interested in:

Sources:

  1. https://www.medicaid.gov/medicaid/data-and-systems/downloads/mmis/mmisscsr.pdf
  2. http://wiki.readycert.net/index.php?title=Business_Architecture
  3. https://msdn.microsoft.com/en-us/library/aa480021.aspx
  4. ftp://ftp.software.ibm.com/software/cn/soa/lauch/SOA_for_dummies.pdf
  5. https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/downloads/mitasoa.pdf
  6. http://medicaiddirectors.org/wp-content/uploads/2016/12/5th-AnnualNAMD_OpsSurveyReport_DEC2016-FINAL.pdf
  7. http://wayback.archive-it.org/2744/20170118130116/https://blog.cms.gov/2016/01/11/encouraging-investment-in-medicaid-information-technology/

The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon. Please direct any questions or comments to research@softheon.com.

Reshika Mahase

UX Design Architect at Softheon
Reshika Mahase works with the Product Innovations team as a UX Design Architect, where she is responsible for new product development such as the Medicaid Administrative Cloud solution. Reshika has worked on a number of projects during her years at Softheon, including private health plans, Welltheos, and Marketplace Exchange UX/UI. She earned both her MBA in Information Systems Management and BBA from Dowling College.