Customer Success StoryState of Michigan : MAGI Case Study

Beth Long, CGIDon Kosy, Oracle Consulting

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MAGI Overview

MAGI Project Goal • Comply with new CMS Medicaid regulations as required by

the Affordable Care Act (ACA)MAGI Challenges• Short time to implement• Complicated regulations• Multiple SOM Departments: coordination and governance• Integrate with existing highly complex State systems, utilizing

the CMS defined Federal Account Transfer schema• Extreme security and reliability requirements for cloud host

environment

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MAGI Vendor SelectionWhy CGI / Oracle?• CGI provided a comprehensive project plan to meet the go-

live milestones• Oracle provided an existing MAGI Eligibility Engine, built to

model the Federal regulations• Oracle Policy Automation product

oEnglish language rules engineoSelf-explaining decisions

• CGI Façade maps the Federal AT schema data to OPA• CGI + OPA Team Experience / Skills• Bid Competitiveness to Overall Value

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MAGI Eligibility Service Architecture

FFM MMIS

Rules Repository

(Version Control File

Share)

SOM HUBSOM Zone 3

Data Warehouse

MAGIApplication

Server

Business AnalystsRules Admin

Rulebase DeploymentProcess

(SFTP to Cloud)

Transient CDS

Medicaid

CHIP

Federal Hub Correspondence

CGI Service Facade

VPN Circuit

VPN Circuit

Federal AT Schema

Packet

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MAGI Execution Methodology• Fully track the CGI project plan• Iterate OPA activities, Overlap design/build/test cycles• Adaptation not Creation• Agile scope control based on program entity framework• Thorough State & Federal UAT integration prior to go-live 1/14

MAGI Success Factors

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CGI – SOM Collaboration• Functioned as a Partner - not as a vendor • Demonstrated clear separation of responsibilities• Executive level support• Risk Management• Promoted a governance model for issue and risk

management

MAGI Success Factors

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During bid development • Alliance history• Oracle OPA solution seen as best fit and value for SOM

During execution• Partnership relationship rather than prime/sub• Oracle team OPA expertise• CGI project management and methodologies• CGI hosting solution and capabilities

Clear separation of responsibilities

MAGI Success FactorsCGI – Oracle Collaboration

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• MAGI eligibility engine experts

• Gap-based design experts

• Oracle Policy Automation product experts

• Iterative parallel ruleset development

• PM Level Support

• OCS Policy Automation best practices

MAGI Success Factors

Oracle Consulting’s Role

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MAGI Success Factors

Pre-built MAGI Eligibility Rulebase

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MAGI Success FactorsGap-based Design

Requirements

Rule Design

Requirements Traceability Matrix

Requirements Scope of Work

Plan

GAP

Assessment Construct

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MAGI Success FactorsRTM - Driven

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• Implementing rules uses the actual language of the requirements

• Built-in regression tester finds bugs before SIT/UAT

• Can build rulebase in parallel with Façade, call it as a web service

• Decision reports = audit trail back to regulations and facts of the case

MAGI Success FactorsOracle Policy Automation Platform

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MAGI Success Factors

Iterative Parallel Development Process

Requirements

Design

Configuration

Regression Test

Integration

Design Design

Requirements Requirements

Configuration Configuration

Regression Test

Regression Test

Integration Integration Integration

Week 0 Week 1 Week 5

Don

Ed

Rafa

Mike

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MAGI Success Factors

PM Level Support

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Embedded Requirement References

MAGI Success Factors

OCS Best Practices

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MAGI Success Factors

Decision Reports

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MAGI Challenges & Solutions

Meeting the Project Deadlines

Challenge Solution

Delivery deadline during bid less than 6 months away

Leverage a pre-built rulebase of Federal MAGI regulations

Very short ramp-up after bid awarded – first integration test in 6th week

Parallel development of Façade completely separate from Rulebase

Planned for 6 months, compressed to 4

Use an iterative parallel rule development process

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MAGI Challenges & Solutions

Tracking & Tracing Complex Requirements

Challenge Solution

Traceability of results to requirements Embedded requirement references

Traceability of results to causes Decision reports

Use same rules for same requirements across different programs

Pre-built rulebase eligibility framework

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MAGI has implemented 4 quarterly releases over 2014 including implementation of:• 5 required MAGI Medicaid/Chip programs & 2

state options

• Presumptive eligibility determinations for under 19 and pregnant women

• State Medicaid Expansion program “Healthy Michigan Plan”

• Integration with existing State of Michigan Medicaid and CHIP case management systems

MAGI Go-Live!

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•Lessons Learned•What worked well

Closing Comments

MI MAGI Customer Success

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FFM CHAMPS

Rules Repository

(Version Control File

Share)

SOM HUBSOM Zone 3

Data Warehouse

MAGIApplication

Server

Business AnalystsRules Admin

Rulebase DeploymentProcess

(SFTP to Cloud)

Transient CDS

Bridges

Maxstar

Federal Hub Correspondence

CGI Service Facade

VPN Circuit

VPN Circuit

Lessons Learned

You Need a DTM and an RTM

The devil is in the data• Need a "multi-lingual" data dictionary• Need a schema-based data-validator• Need a data council representing all producer

and consumer stakeholders• Need a “data czar” to oversee and enforce data

integrity

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What Worked Well

Leveraging a Pre-Built Rulebase

This was the biggest win: Adaptation not Creation• Could skip the design, configuration, and regression test for 80%

of the requirements in release 1

• Could understand and implement State requirements even when vague or incomplete

• OPA upgrades were no problem

• Baseline OCS has been extended to include Federal SNAP, TANF, and traditional Medicaid eligibility

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What Worked Well

Dedicated Team(work)

Rafa Ed Anisia Don Mike

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•Lessons Learned•What worked well

Closing Comments

MI MAGI Customer Success

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Questions & Answers