Wyoming Is Taking Medicaid to the Cloud

Roger A. MaduroOver the past decade the state of Wyoming has become a national leader in migrating state government services into the cloud. A large and beautiful state, roughly the size of New England, Wyoming has a population of less than 600,000. With such a sparse population and tax base, the state decided to invest its IT budget in cloud-based services. Wyoming was the first state to roll out Google Apps for Government. It is using NEOGOV for human resources management, and it is studying Salesforce.com for use as a customer relationship management (CRM) system. Earlier this year, it was the recipient of one of twelve Recognition Awards for outstanding achievement in information technology in state government from the National Association of State Chief Information Officers’ (NASCIO).

Based on its success with cloud-based services, Wyoming’s Department of Health decided to replace its ancient Medicaid Management Information System (MMIS), with a MMIS-as-a-service approach. The project is called the Wyoming Integrated Next Generation System (WINGS). Had Wyoming followed the traditional Medicaid IT procurement process that involves a monolithic platform, it would had had to spend potentially upwards of hundreds of millions of dollars and be beholden to a single vendor.

With only 90,000 Medicaid enrollees the “big box” approach was simply not financially justifiable. In fact, Teri Green, senior administrator and state Medicaid agent in the Wyoming Department of Health’s Division of Healthcare Financing told Government Technology in an interview “ “when you look at the overall costs of traditional MMIS to the Federal government and the states, it is a little on the insane side….”

After years of research and planning Wyoming decided to follow a hybrid model where some of the components of the MMIS platform will be hosted in the cloud, while others will be owned and operated by the state. One of the core decisions made the state is that it had to have complete control of the patient records and allow vendors access to the data only with limited permission and under strict control of the state. For that reason, one of the key elements of the solution is a state-owned and operated data warehouse.

David PeraraDavid Perara

This is Wyoming’s response to the huge problem of “data blocking” where many proprietary electronic health record (EHR) vendors have ownership and control of their customer’s medical data records and prevent interoperability between medical systems. In addition, “data blocking” allows proprietary EHR vendors to hold thousands of hospitals and tens of thousands of clinics and physicians “hostage” by either preventing data migration, or charging steep fees, for those trying to migrate their medical records to another EHR, or even share them with a Health Information Exchange (HIE), or, the patients themselves.

Currently, Wyoming expects to hold seven procurements in total. Some of the procurements are single pieces of the system while others for multiple products and services. Core services include benefits management; customer call center; business intelligence; and fraud, waste and abuse detection, according to the state first step is to award a contract for the Systems Integrator (SI). This is designated as the Systems Integrator and Service Bus Contractor Services (SI/ESB) that will manage integration of multiple services modules, provide technical advice, and monitor contractor performance. Responses to the SI/ESB RFP were due on November 30. Work is expected to begin in May 2017.

According to the RFP:

The Scope of Work for the Systems Integrator/Enterprise Service Bus Contractor will provide an enterprise technology platform and supply a diverse set of IT integration services related to diverse infrastructures, applications and technology-enabled solutions. 

This project encompasses three main areas; Systems Integration and Enterprise Service Bus, Technical Coordination, and Data Management Services. The Contractor will be instrumental in the transition from the current MMIS environment to the desired WINGS vision including the essential communication, cooperation, and collaboration with other WINGS project Contractors for successful integration outcomes. 

In addition, the contractor is expected to provide “innovative ideas as to how the Agency’s mission and vision can be accomplished and adds value to the system.” This is a very important element of the project as the state sees the SI as an active partner in the project. In fact, the state expects the SI to simultaneously advise on the best solutions for the platform, the contract prohibits the SI from having any direct role in future procurements. That means that there will be no financial benefit to the SI from any of the modules of the systems that they may recommend. Thus, open source solutions will have a level playing field together with cloud services and modular COTS solutions. The RFP states:

The Systems Integrator may be asked to provide integration feasibility information related to components and COTS products through the project lifecycle however the Systems Integrator will have no direct role in future procurements. Only the Agency has contractual authority over the component/COTS product Contractors. The Systems Integrator will be in a consulting role to the Agency during procurements.  The Systems Integrator will work collaboratively with the component/COTS product Contractors, service Contractors and the Agency to ensure successful integration of their component/COTS products.

As the first state to deploy MMIS-as-a-service, other states are watching closely. Here are some of the key decisions made by Wyoming:

  • Hire a Systems Integrator (SI), which can be a big help in integrating multiple services modules. The SI role should be collaborative and the contract should be written so that the SI has no financial interest in the other components of the platform. That frees the SI to provide innovative solutions and advice, and levels the playing field for the best solutions, be they open source, cloud-based, or modular COTS.
  • States should implement and manage a state-owned data warehouse. That means that the state will have complete control of its Medicaid data, as well as the medical records of Medicaid users. Under no circumstances should vendors control the medical data or they can then hold the state hostage.
  • States should avoid giving a single vendor control of the state’s entire MMIS environment. Same issue as letting vendors control the medical records.
  • States should Leverage technologies that are already out in the market.
  • States should work closely with CMS to ensure the new MMIS qualifies for 75 percent federal matching funds for maintenance and operations.

The list is adapted from “A Handbook for MMIS Reform” prepared by the consulting firm Public Knowledge.