HHS MMIS Whitepaper

7/31/2019 HHS MMIS Whitepaper

http://slidepdf.com/reader/full/hhs-mmis-whitepaper 1/16

Modernization of Medicaid ManagementInformation Systems (MMIS)

Date: June 2005

Prepared By: Microsoft Corporation

©2005 Microsoft Corporation. All rights reserved. Microsoft, the Microsoft logo, Active Directory, Biztalk, Visual Studio, andWindows are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries.The names of actual companies and products mentioned herein may be trademarks of their respective owners.



TableofContents

ExecutiveSummary.....................................................................................................................3

HealthandHumanServicesArchitecturalVision............... ................ ................. ................. 4

HHSConceptualArchitecture...................................................................................................7

MedicaidBackground.................................................................................................................8

TrendsintheMMISMarket........................................................................................................8

MMISArchitecture.......................................................................................................................9

TheMicrosoft.NETFramework................. ................. ................. ................ ................. .......... 10

TheMicrosoftProductComponents............... ................. ................ ................. ................. .. 10

.NETandServiceOrientedArchitectures............... ................. ................. ................ ........... 11

MMISEdgeImplementationApproach............... ................. ................. ................ .............. 12

COTSandMicrosoft’sPartnerEcosystem............... ................. ................. ................ ........... 13

.NETvs.J2EE............... ................. ................ ................. ................. ................ ................. ............ 14



ExecutiveSummary

Microsoftprovidesthefollowinginformationasanoverviewofthebenefits(andcapabilities)thatcustomershave

realizedasaresultofselectingaMicrosoftplatformtoimplementaMedicaidManagementInformationSystem(MMIS)

solutionusingthesoftwareandhardwareprovidedbyMicrosoft.

TheMMISsolutionofferedbyMicrosoftprovidesthebestreturnoninvestment(ROI)intheindustry,asindicatedby

variousindustry-standardbenchmarksandpublishedcoststructures,forlineofbusiness(LOB)applicationsthatinclude:

HIPAASecurity,ElectronicDocumentManagement,PharmacyBenefitManagementandPointofSale,Recipient,Provider,

Claimsencounter,andFinancial.

Ahigh-leveloverviewoftheMicrosoft®solution—therealizedbenefitsinsuchareasasuseradaptability,interoperability

andscalability—arealldescribedinthisdocumentemphasizingoverallcostsavingsthroughtheuseofMicrosoft

technologies.Thisdocumentwillalsodescribethe“valueproposition”thatMicrosoftbringstoitscustomers;onethatwe

firmlybelieveisconsistentwiththegoalsofdeliveringaqualityMMISsystem.

MicrosofthasfoundthatHealthandHumanServicesorganizationsimprovetheirperformance,decisionmaking

capabilities,andservicelevelsbyenhancingtheirMMISapplicationswithanimplementationstrategybasedonwell-

definedrequirements.

AsdescribedfromspecificMMISopportunities,therearevariousbenefitsofanMMISsystemthatinclude:

• EfficientClaimsprocessing

• Memberandprovidereligibility

• Managementandadministrativereporting(MARS)

• Fraudandabusereporting(SURS)

• Thirdpartyliability(TPL)

• Pharmacybenefitmanagementcapabilities(PBM)

• Datawarehouse/decisionsupportsystem(DW/DSS)

Carefulconsiderationoftechnologiesandunderpinningarchitecturescanincreasethelevelofcostsavings.Webelieve

thatMicrosofttechnologiescandirectlycontributetothesesavings.DirectcostsavingsfromMicrosofttechnologiesare

availableinseveralkeyareasincluding:

• Lessexpensivehardware

• Lowersoftwarelicensesandmaintenancefees

• Lowerinfrastructureoperationscosts

• Lowerapplicationdevelopmentandmaintenancecosts

AnMMISsolutionisdesignedforportabilityandinteroperabilityacrossawidevarietyofenterpriseplatforms.Beyond

provencostsavings,thisdocumentwilldemonstrateMicrosoft’scoreMMISsystemaslow-risk,reliable,andbestfor

citizensandconstituentstouseforwideadoption.

MicrosoftwelcomesdiscussionstosharebestpracticesofourknowledgeofimplementingMMISsystems.Ourintention

istoexploreandhelpidentifyanyareaswhereourcustomerscanincreasecitizenservices,costsavingsandefficiencies.



HealthandHumanServicesArchitecturalVision

State,county,andlocalgovernmentsprovidearangeofhealthservices.StateDepartmentofHealthagenciesmust

complywithfederalregulationsspecifiedinthemorethan20majorfederalprogramsthatprovidethelargestamountof

funding.Intotal,healthserviceexpendituresconstitutealargepercentageofstatebudgets.

Healthagencyexecutivesmustrespondtocomplexsocialproblemswithlimitedresourcesthatareonlypartiallyunder

theircontrol:

• Thepublicdemandslessspendingwhileexpectingcontinuedmaintenanceofessentialservices

• Vocalinterestgroupsdrivepublicopiniontoincreaseresources

• CongressrequirescompliancewithlawssuchastheHealthInsurancePortabilityandAccountabilityAct

(HIPAA)ortheAmericanswithDisabilitiesAct(ADA)

• Courtsreviewanddefineappropriateaccesstocare

• Worldeventsrequirethededicationofresourcestoprotectagainstenvironmentalandbioterrorism

Resolutionstotheseproblemsrequirecoordinationacrossdepartmentsandpoliticalboundaries,butmanyoftheseentitiesaredisconnected.Multiplelegacysystemsarebuiltwithoutreferencetooneanotherandmanytimesprovide

supportservicestothesamepersonsorfamilies.Inotherwords,clientsmaybeservedbymultipleagenciesthatare

unawareofeachother’sinvolvement.High-riskpredictorsmaycometotheattentionofoneprogramandnotbeshared

withanother.Changesinaclient’slifecircumstances,suchasincarcerationoremployment,maybecapturedbyone

programbutnotanother.Asaresult,crisesoccurthatmightbeaverted;stateandlocalgovernmentsfailtomaximize

federalrevenuestreams;andineligibleclientscontinuetoreceivebenefits.

TheMicrosoftHealthandHumanServices(HHS)ArchitecturalVisionpresentsaflexiblemodelforaddressingthese

challenges.Inthepast,effortstointegrateservicesandadministrationhavebeenstymiedbytheassumptionthatthey

requiredlarge-scalereorganizationofdepartments.Advancesininformationtechnologynowenableaclient-centered,

multi-programmedapproachthatcan:

• Leverageexistinginfrastructure

• Simplifyadministrativeprocesses

• Preservetheorganizationalintegrityofindividualprovidersandagencies

• Enhanceserviceoutcomes

• Ensuresecure,role-basedaccesstoinformation

TheHHSArchitecturalVisionoffersadeliverynetworkthatdrivesefficientprogramoperations;enablesresponsive,

effectivecoordinationofassistanceacrossmultipleorganizations;andenforcesfullpolicycompliance.

Thenetworkmaintainscomprehensive,accurate,andtimelyviewsoftheclient,provider,andservicedata.Secureaccesstotheinformationisavailablewhen,where,andinwhateverformitisneededsothatitcanbeanalyzedandpresented

tosupportcriticaldeliverydecisions.

TheHHSArchitecturalVisionprovidesimprovedprogramperformancethroughoutthenetworkofhumanservices

organizationsresultingfrom:

• Theselectionanddeploymentofnewfoundationtechnologiessuchasportalsorbusiness

intelligencetools



• Newandimprovedlinksbetweenapplications

• EnhancedandextendedexistingapplicationsbydevelopingHHS-specific,reusable

applicationcomponents

Figure1.0depictsthenetworkoffederal,stateandlocalorganizationsandprivate-for-profitandnot-for-profit

organizationsinvolvedinthedeliveryofhealthandhumanservices.ThisHHSecosystemmustfunctioneffectivelyacross

multipleagencies,multiplejurisdictions,andmultiplelevelsofgovernment.

Stateandlocalgovernmentsarehighlydependentonthisextensivenetworkofprivate-for-profitandnot-for-profit

providerstodeliveranenormousrangeofservices,fromin-homenursingassistanceandambulatorycaretosubstance

abusecounseling,managementofgrouphomes,servicestotheaging,vocationalrehabilitation,emergencyassistance,

childcare,adoptionservicesandfamilyandyouthcounselingservices.Thechallengeofcoordinatingservicedelivery

acrossthisvastnetworkinallkindsofurbanandruralsettingsisanenormoustask,asisevidentfromthegraphic.

Developingapracticalcross-boundaryintegrationmodelrequirescooperationindefiningintegrationrequirements

relatedtospecificbusinessoutcomes.Forexample,itmaybesufficientsimplytopassinformationonaclientfromone

system(e.g.,TANF)toanother(e.g.,ChildCare)inordertosupportserviceeligibilitydetermination.Alternatively,it

maybenecessarytoaggregatedatafrommultipleagencies(e.g.,TANF,ChildWelfare,CourtsandSchools)intoanew

databasetoenhanceabusinessprocess(e.g.,revenuemaximization)orofferanewservice.Insomecircumstances—

particularlyinthecaseofneworganizationsandredesignedbusinessprocesses—itmaybedesirabletoconsolidate

multipledatabasesandredundantcollectionprocessesintoasinglenewapplication.

TheHHSArchitecturalVisionassumesthatpracticalintegrationstrategiesmust,atleastinitially,buildonexistingagency

technologyinfrastructureratherthanreplaceit.TheVision’scomponentstructurefacilitatesincrementaltechnology

investment,suchasimplementationofnewstandards,commonapplications,andorganizationandprocesschanges,

consistentwithemergingbestpracticesinthefieldthatleveragetheexistinginvestmentswhilebuildingthesystemsof

thefuture.



K-12 EducationEcosystem

State Tax

State Health &Human Services

Local Social Service Agencies

Criminal JusticeEcosystem

Child SupportCollections

State Departmentof Education Federal Department

of Education

HeadStart

Schools

Police

NoChldLeft

Behind

Network of Community Service

Providers

SeniorsCenters

GoodwillServices

WorkforceDevelop

SubstanceAbuse

Treatment

ABCResidential &Group Care

Courts- Criminal- Civil- Juvenile Justice- Family Court- Divorce

CommunityMentalHealth

JewishCommunity

Center

CatholicChairities

Head StartProviders

Regional State & Local ClientPlan & Assessment Teams

Child Welfare

WJA

Medicaid

TANF

SecuredInternet

RevMax

DataWarehouse

BI ToolsEAI Tools

ERP

Information Technology

Integrated CaseManagement

InformationTechnology

Productivity &Collaboration

Workflow &Scheduling

IntegrationTechnologies

DevelopmentalDisabilities

Community Health

Public Health

Mental Health

TANF

Child Support

SACWIS

EBT

Medicaid

Federal Dept.of HHS

MedicaidContractor

Banks Clients Suppliers Hospitals United Way

Planning &Resource Allocation

FinancialManagement

ProgramManagement

ProviderManagement

Human ResourceManagement

ComplianceManagement

IT Management

Aging

Voc. Rehab

Income(TANF Emerg.)

Medicaid

Income Sec. -Caseworker Team

Child WelfareCaseworker Team

Health & DisabilityCaseworker Team

Child CareFood Stamps

Workforce Inv.

Child Welfare- Foster Care- Protective

- Adoption

MentalRetardation

Team-basedintegrated

intake

DepartmentManagement

Multi-Discipline

Client Pan &Review

One Stop Centers- Multiple Locations- Interdisciplinary- Pre-eligibility Assessment- Emergency Assistance- Child Care- Service Delivery (e.g. Empl.)- Facilitate Self-Service

Portal

Client dataProvider dataReferral dataPerformance

Figure 1.0— Complexity of the Health and Human Services Ecosystem:Thenetworkoffederal,stateandlocalorganizationsand

private-for-profitandnot-for-profitorganizationsinvolvedinthedeliveryofhealthandhumanservices.Thechallengeofcoordinatingservice

deliveryacrossthisvastnetworkinallkindsofurbanandruralsettingsisanenormoustask.



HHSConceptualArchitecture

TheHHSArchitecturalVisionconsistsofaportfolioofcorebusinesssystemsintegratedthroughtheuseofbest-of-breed

technicalcomponentsonthefrontandbackendsoftheapplications(seeFigure2.0).Itincorporatesavarietyoftools

thatsupportcomponentdevelopmentandimplementationstrategiesthatleveragetheexistinginfrastructure.These

toolsinclude:

• Webportalstostreamlineclientaccesstoservices

• Providerportalstosimplifybusinesstransactionsandcoordinatethemanagementof

purchasedservices

• Anenterprisedatawarehouseanddatamarts

• Businessintelligencetoolstofacilitateanalysis,planning,andresourceallocation

• Messagingandmobiledevicestoenhancedataaccess,improvecoordination,andincrease

workerproductivity

Thearchitectureplacesapremiumuponsecuritytoensurethataccesstoconfidentialinformationisrole-basedand

limitedtopre-approvedindividuals.

Figure 2.0 —HHS Conceptual Architecture:HHSArchitecturalVisionassumesthatpracticalintegrationstrategiesmust,atleastinitially,

buildonexistingagencytechnologyinfrastructureratherthanreplaceit.TheVision’scomponentstructurefacilitatesincrementaltechnology

investment,suchasimplementationofnewstandards,tools,commonapplications,andorganizationandprocesschanges,consistentwith

emergingbestpracticesinthefieldthatleveragetheexistinginvestmentswhilebuildingthesystemsofthefuture.



MedicaidBackground

Medicaidwasestablishedin1965underauthorityoftheSocialSecurityAct.Medicaidhasgrownovertheyears

expandingprogramofferingsandexpandingthenumberofeligiblerecipientstothepointtodayofprovidingbenefitsto

millionsofindividualsandfamilieswithlowincomesandresources.Atthesametime,Medicaidhasbecomeoneofthe

largestsinglebudgetitemsforstategovernmentsandthus,isthefocusofintensescrutiny.Forexample:

Whilespendingonhealthcareistypically31%ofastate’stotalbudget,Medicaidgenerallyaccounts

for71%ofastate’shealthcarebudget.ThetotalcostofMedicaidisusuallysharedbystateandfederal

governments.Thefederalgovernment’sshare,FederalMedicalAssistancePercentage(FMAP),can

rangefrom50-83%oftotalMedicaidcosts.TheFMAPguaranteesthefederalgovernmenttopayat

leasthalfofthestate’sMedicaidcosts.(adaptedfromINPUT©2005)

ThereisincreasingpressureatthefederalleveltoreduceMedicaidspendingandwhilenolegislativechangeshavetaken

placeforFMAP,thereisgrowingpressuretodecreasefederalcontributionstoMedicaid.Theresultisputtingtremendous

pressureonstatestoincreaseefficiency,reducecostsandimproveflexibilityinprogramsandadministration;especially

theirMedicaidITsystems.

Furthermore,statescannolongerreceivefederalfundingiftheyoperateITsystemsthatdonotcomplywithfederal

regulations.TheCentersforMedicareandMedicaidServices(CMS)provideoversightandworkwiththestatesin

administeringtheMedicaidprogramandcertifyingtheirMMIS.SinceanMMISistheleadingIT-relatedhealthcare

expenditurewithinastate’sbudget,thereisanurgentneedforsystemsmodernizationandincreasedefficiency.The

MMISmarketislargeandgrowing;theestimatedmarketforoutsourcedMMISdevelopmentandmaintenanceisover

$5.1billionandexpectedtogrow20%to$6billionoverthenextthreeyears.Thesefactorsandthelatelifecyclestage

thatmostMMISsystemsarecurrentlyin(i.e.,mainframe,10-20yearsold,inflexible)havecausedthestatestolookto

modernizationinitiativesfortheirMMISsystems.

TrendsintheMMISMarket

ThetrendtowardmodernizationofMedicaidManagementInformationSystems,andthetrendtowardoutsourcing

withinthestates,hasinitiatedmodernizationinitiativesinnearlyhalfofthefiftystatesthatwouldprovidebillionsof

dollarsinnewbusinessopportunitiesoverthenext18months.Outsourcersandsystemsintegratorsthatmanage

andoperateMedicaidManagementInformationSystemsmustcomplywithgreaterandmorecomplexgovernment

regulationswhileprovidingincreasedaccessandefficiencyastheypursuethesenewopportunities.Someofthedrivers

forthegrowingMMISmarketsarerequirementsforagreaterhealthcaresystemandadministrativeefficiencies,and

federalstandards(i.e.MITA).Becausestatesareundertremendousfinancialpressures,bothfromfederalscrutinyof

Medicaidprogramsanddecreasingtaxrevenues,statesaretakingactionwithprocurementsthatinvolvetechnology

upgradesandreplacements.Therearetrendstowardoutsourcing,forstatesthatarestillprocessingclaimsin-houseand

furthertrendstowardupgradingthecoreMMISsystem.

Statesarelookingatnewsystemsthatareusingthelatesttechnologytomodernizethearchitectureandincrease

theefficiencyoftheirMedicaidprograms.Themajorsystemsintegratorsandbusinessprocessoutsourcersarealso

modernizingtheirofferingstoprovidethebest,mostcostefficientsolutiontotheircustomers.Thesemodernization

initiativescanbecomplexandtimeconsuming,whetheroutsourcedorembarkingonafull-scalereplacementofthe

legacysystem.Alesstimeconsuming,lowerriskapproachtomodernizationistofirstfocusonenhancementand

upgradeofperipheralor“edge”systemsandassociatedbusinessprocesses,thenfollowwithacompleteoverhaulor

replacementofthecoreMMISsystem.Thisprovidesincreasedbenefit,earlierintheMMISreplacementphase.



MMISArchitecture

TherecommendedtechnologystrategyforamodernMMISsystemisbasedonMicrosoftsolutions—inlinewith

manystate-wideoragency-widetechnologydirectionsandwiththeMedicaidITArchitecture(MITA)direction—which

promotesaServiceOrientedArchitecture,OpenStandards,InteroperabilityandinclusionofCOTScomponentswherever

possible.

Thecorebusinessrequirementsforastate-of-the-artMMISsystem,suchaseligibilitydetermination,casemanagement,

enrollment,participantcommunications,fiscalmanagement,reportingandcompliance,improvedaccessibilityand

servicelevels,areallunderlyingelementsofthisSolutionArchitecture(seeFigure3.0).

Microsoft Technology Architecture

Public Sector AgencyEmployee Productivity

Client, Supplier, and ProviderServices

Infrastructure, Application, and Integration Servers

Microsoft .NET

Windows Server 2003

Microsoft Office SystemMicrosoft Exchange

Server

Microsoft SolutionOffering for Intranets

Microsoft SharePointPortal Server

Microsoft Content

Management Server

Microsoft Commerce

Server

Microsoft Solution Offering for Internet Business

Microsoft OperationsManager

Microsoft SystemsManagement Server

Microsoft InternetSecurity and

Acceleration Server

Microsoft ApplicationsCenter Server

Microsoft BizTalk Server

Microsoft SQL Server

SQL Reporting Services

SQL Analysis Services

Data TransformationServices

SQL NotificationServices

Microsoft HostIntegration Server

Microsoft .NETFramework

Microsoft VisualStudio .NET

.NET Mobile Controls

InternetInformation Server

Active Directory CertificateServices

Windows SharePointServices

Windows MediaServices

.NET CompactFramework

Figure 3.0— HHS Conceptual Architecture:ModernMedicaidsolutionenabledbyaservice-orientedarchitectureonaMicrosoftplatform.

MMIS



TheMicrosoft.NETFramework

TheMicrosoft.NETFrameworkandMicrosoft.NETServers,togetherwithindustryleadingpartners,providethe

developmentandplatformcapabilitiestomeettheuniquerequirementsofamodernMMISarchitecture.

Thegoalsofprovidingefficiente-Governmentservicesforstateandcountyagencies,andeasyaccesstoinformationandservicesforMedicaidclientsandparticipantsareatthecoreofthisArchitectureincludingthefollowingspecific

requirements:

• Managingclienteligibility

• Realtimeabilityforcountiesto

communicatewiththestate

• Accurateandtimelyfinancialreporting

• Fastautomatedclaimresolution

• Increasedagencyemployeeproductivity

• Enhancedservicedelivery

• Webtechnologycustomizedforindividualpopulation’sneeds

• Flexiblefinancialpackageintegrated

intosolution

• CollaborativeIntranetportalfor

knowledgemanagement

TheMicrosoftProductComponents

TheMicrosoftplatformand.NETarchitecture(seeFigure4.0)affordtheflexibilitytocomplywithfrequent

businessandlegislativechangesandprovidea

lowercostofownershipbecauseconfigurationand

managementareaccomplishedthroughfamiliar,

time-savingMicrosoftWindows®managementtools

suchasMicrosoftManagementConsoleandMicrosoft

OperationsManager.

TheWindowsServerSystemand.NETframework

provideahighlyscalableplatformthatenables

acomprehensivesuiteoffunctionality.Systemmiddlewarelayersformanintegratedframework

thatreducesdevelopmentandmaintenancecosts,

andenhancescompatibilityandefficiencybetween

applicationsinanetworkedenvironment.Integration

andInteroperabilityareprovidedthroughMicrosoft

BizTalk®ServerandMicrosoftHostintegrationServer.

ThecoreintegrationwithWindowsServerSystemalsoprovidessecurity,privacy,controlleddatasharingandsinglesign-

oncapabilitythroughouttheentireMMISSolutionbyusingMicrosoftActiveDirectory®,MicrosoftIdentityIntegration

ServerandIntegratedAuthentication.

• Collaborativecommunicationtoolsfor

maximumworkefficiency

• Unprecedentedaccesstodatawith

familiaranalysistools

• Speedtoimplementnewprograms

• Speedtomodifyexistingprograms

• Arules-basedsystemthatiseasily

configurable• ODBCcompliantrelationaldatabase

• Interoperabilitywithin-house

developedandlegacyprograms

• Advancedworkflow

• Lesscodingrequirementsfor

customizedsolution

Public Sector AgencyEmployee Productivity

Client, Supplier, and ProviderServices

Infrastructure, Application, and Integration Servers

Microsoft .NET

Windows Server 2003

Microsoft Office System Microsoft ExchangeServer

Microsoft SolutionOffering for Intranets

Microsoft SharePointPortal Server

Microsoft ContentManagement Server

Microsoft CommerceServer

Microsoft Solution Offering for Internet Business

Microsoft OperationsManager

Microsoft SystemsManagement Server

Microsoft InternetSecurity and

Acceleration Server

Microsoft ApplicationsCenter Server

Microsoft BizTalk Server

Microsoft SQL Server

SQL Reporting Services

SQL Analysis Services

Data TransformationServices

SQL NotificationServices

Microsoft HostIntegration Server

Microsoft .NETFramework

Microsoft VisualStudio .NET

.NET Mobile Controls

InternetInformation Server

Active Directory CertificateServices

Windows SharePointServices

Windows MediaServices

.NET CompactFramework

Figure 4.0 — The Microsoft Technology Architecture



.NETandServiceOrientedArchitectures

TheadventofServiceOrientedArchitecturesintroducesanewsetoffundamentalarchitecturalelementsforarchitectsto

workwithataconceptuallevel.Thesearesoftwareservices,messages,state,andprocesses.

Softwareservicesarediscreteunitsofapplicationlogicthatexposemessage-basedinterfacessuitableforbeingaccessedacrossanetwork.Service-basedarchitecturespermitveryflexibledeploymentstrategies;ratherthanrequiring

thatalldataandlogicberesidentonasinglecomputer,theservicemodelallowsapplicationstoleveragenetworked

computationalresources(illustratedinFigure5.0).

Theserviceisdefinedpurelybythemessagesitwillacceptandproduce,includingthesequencingrequirementsfor

thosemessages.Successfulroutingofmessagesbetweenservicesisacomplexprocess,whichisbesthandledbya

messaginginfrastructuresharedacrosstheservicesanorganizationexposes.

Servicescommunicatethroughserviceinterfaces,whichsendandreceivemessages.Service-to-servicecommunication

followsacontract,andbymakingthiscontractexplicititispossibletochangeoneserviceimplementationwithout

compromisingtheinteraction.Servicesalsoneedtobemanagedandsecured.Apolicyconsistsofasetofrules,and

eachruleappliestoanaspectoftherun-timebehavior.Forinstance,aservicemayhavemultipleinterfaces;youmay

haverulesthatapplytotheserviceasawholeandyoumayhaverulesthatapplytooneormoreofitsinterfaces.

Servicesmanagestate;thisstateistheveryreasonfortheirexistence.Servicesguardthisstateandtheyensurethrough

theirbusinesslogicthatitiskeptconsistentandaccurate.Thisstateistheonlytrueandcurrentsourceofinformation.

Businessprocessescontrolthestep-by-stepactionsofexecutingwork,movingthesystemfromonestatetoanother.At

eachstep,abusinessoperationiscalled.Theseprocessescanbehostedinabusinessprocessserviceorprocessservice.

Aprocessinsuchaprocessservicewillsendamessagetocallabusinessoperationcontainedwithinaservice,andthen

moveontothenextstep,whichmayrequiretheuseofadifferentservice.IntheMMISdomainthesearereferredtoas

WorkflowoperationsthatalsoincludeinteractionwithaRulesEngine.

Figure 5.0— .NET Service-Oriented Architecture: Implementedusingthe.NETframeworkincluding.NETtoolsand.NETservers

ArchitectureApproach



Applicationswithinaservice-basedarchitecturearecomposedofprocessservicesandmoreelementalservicesthat

implementbusinessfunctionsanduserinterfaces.Thismodelisvalidforbothtraditionalapplicationsthathavea

userinterfacecommunicatingwithbusinessservicesandforbusiness-to-businessscenarioswherebusinessservices

communicatewithotherbusinessservices(seeFigure6.0).

MMISEdgeImplementationApproach

TheMMISEdgeModernizationArchitectureandimplementationstrategyprovidesalow-riskandrapidapproachto

modernizinganMMISsystem.Thisapproachenablesthemodernizationandenhancementofmostbusinessprocess

andsupportingtechnologywhilepreparingforalaterreplacementoroutsourcingofthelegacyMMISsystem(see

Figure7.0).

Aspartofalargereplacementinitiative,orwithouttakingonacomplex,multi-yearMMISreplacement,anMMISEdge

Architecturecanbeimplementedquicklyandatalow-cost.Thisapproachbeginstoprovideimmediatebenefitsto

clients,participants,agencyworkers,administrators,IToperationsstaffandfiscalagentsresponsibleforthestate’s

Medicaidexpenditures.

ThisarchitectureisdesignedtosurroundtheexistingMMISsystemwithamodern,service-orientedinfrastructureandinteroperabilitylayerbasedontheMicrosoft.NETFrameworkand.NETservers.Theinfrastructureandinteroperability

serviceslayerenablestheintroductionofmodern,best-of-breedapplicationssuchascall-center/CRM,provider/

participantportals,workflowautomation,IVR,DataAnalysisandmanyothernewcapabilities.Theinfrastructureand

interoperabilityserviceslayeralsotiesallofthesemodernapplicationsandnewuser-experiencesdirectlytothelegacy

MMISsystemanddatathroughafullyintegrated,synchronizedandsecurearchitecture.

Thisapproachprovidesincrementalstepstobusinessprocesschange,newfeatureandservicesintroduction,data

cleansingandmanagement—allleadingtoatimelineforthepossiblereplacementoroutsourcingofthelegacy

MMISsystem.

Microsoft Platformand

3rd Party COTS

• Rules Engines

• Workflow Engines

• Web Portals

• Call Center Management

• Translators

• Automated lettergenerators

• Desktop publishing

systems

• Computer Based Training(CBT) systems

• Automated, Web-basedsurvey tools

Mediaid Enterprise

RecipientManagement

ProviderManagement

PaymentManagement

Health QualityProgram Monitoring

Reporting

• EligibilityDetermination

• Benefit PlanAdministration

• Enrollment

• Eligibility

Verification

• RecipientCommunications

• RecipientMaintenance

• ProviderEnrollmentAdministration

• ProviderEnrollmentProcessing

• Provider

Communications

• ProviderMaintenance

• ServiceAuthorization

• Cost Avoidance

• Claims ProcessingAdministration

• Adjudication

• Providerpayments

• Adjustments andVoids

• Communicationsre: payment

• Decision SupportSystem (DSS)

• ManagementReporting

• Health OutcomeMeasurement

• Fraud and AbuseDetection

Figure 6.0— .NET MMIS Architecture:Enablingbest-of-breedCOTSfunctionalitytosatisfyMITArequirements.



ComputerBasedTraining

DesktopPublishing

RecipientPortalSharePoint

ProviderPortalSharePoint

WebBasedSurveyTools

CallCenter

AutomaticLetterGeneration

EAIBizTalk

IdentityManagement

ReportingandComplianceServices

TranslatorServices

DataWarehouseBusinessIntellegence

RulesEngineBizTalk

WorkflowEngineBizTalk

CoreMMISSystemMainframe

CDT8Products

InfrastructureServices

InteroperabilityServices

CDT8Products

Figure 7.0 — The MMIS Edge Modernization Architecture and implementation strategy:Providesalow-riskandrapidapproachto

modernizinganMMISsystem.Thisapproachenablesthemodernizationandenhancementofmostbusinessprocessandsupportingtechnology

whilepreparingforalaterreplacementoroutsourcingofthelegacyMMISsystem.

COTSandMicrosoft’sPartnerEcosystem

TheMicrosoftPartnerecosystemisthelargestintheworldwithover750,000certifiedpartnersprovidingbest-in-class

solutionsthatspanthebreadthofMMISbusinessrequirements(seeFigure8.0).

TheseMicrosoftCertifiedPartnershavebuiltexpertiseandsupportaroundspecificdomainareas,suchas:

• RulesEngines

• WorkflowEngines

• Webportals

• CallCenterManagement

• Translators

• Automatedlettergenerators

• Desktoppublishingsystems

• ComputerBasedTraining(CBT)systems

• Automated,Web-basedsurveytools



UtilizingCOTSofferingsfromMicrosoftCertifiedPartnersbuilton.NETwillenhancetheoverallvalueoftheMMIS

andproviderapidtimetomarket,lowercost,andbest-of-breedsolutionsthatconformtoMITAcallouts—SOA,Web

Services,etc.

.NETvs.J2EE

AstudywasconductedbyMiddlewaretoprovideacomparisonoftwofundamentallydifferentapproachestoenterprise

softwareembodiedbytwodifferenttechnologiesandplatforms.

.NETrepresentsMicrosoft’slongstandingapproach,whichemphasizestheseelements:

• FocusontheWindowsplatformtoprovidetightintegrationbetweentheOperatingSystemandthe

developmentframeworkandtools• StandardizationonVisualStudio®.NETastheprimarydevelopmenttoolfor.NET

TheJava/J2EEworldemphasizes:

• IndependenceoftheJ2EEplatformfromtheunderlyingOperatingSystemopenstandards

• Vendorcompetitionandconsumerchoicesfortoolsandruntimeplatforms

Figure 8.0— The Microsoft Partner Ecosystem: TheMicrosoftPartnerEcosystemisthelargestinthe

worldwithover750,000certifiedpartnersprovidingbest-in-classsolutionsthatspanthebreadthofMMIS

businessrequirements.



Thesetwoapproachesarereflectedintheresultsofthisstudy.

Developerproductivity.Microsoft’stightintegrationapproachpaidoffinthedevelopmentphase,whereVS.NETand

the.NETplatformprovedmoreproductivethaneitherRRDorWSADwiththeWebSphereplatform.Amongthereasons:

• ThepositionofVS.NETasthepremier.NETdevelopmenttoolallbutguaranteedanequivalence

betweenVS.NETexperienceand.NETplatformexperience.Forexample,adeveloperwiththreeyears

experienceof.NETexperiencemostlikelyhasusedVS.NETforthreeyears,whereasadeveloperwith

threeyearsJ2EEexperiencemaynothaveusedRRDorWSADatall

• VS.NETsharedsomeofthebestfeaturesofbothRRD(visualpagedesign;databinding)andWSAD

(directcodingofbusinesslogic;tightintegrationwiththetargetplatform.

Installationandconfigurationofsoftware.Tightintegrationpaidoffforthe.NETteam.Mostkeyelementsofthe

.NETruntimeinfrastructure(basicapplicationplatform,Webserver,loadbalancer,sessionserver,messageserver)were

alreadyinplacewiththebasicWindowsServer2003installation.Thisfactsavedthe.NETteamagreatdealoftime

andtrouble.

TheWebSphereteam,bycomparison,spentagreatdealoftimeduringthedevelopmentphaseinstallingthesoftware

andconfiguringitforbasicfunctionaltests.Theyalsospentconsiderabletimeovercomingfundamentalconfiguration

obstacles,suchaspatchingtheLinuxkernelforEdgeServerandconfiguringWebSphereforsessionreplication.The.NET

teamdidnotfacesuchobstacles.

Systemtuning.The.NETteamcompletedtheirtuningprocessmuchmorequickly.Oneobviousreasonisthattheyhad

fewerknobstoturn.AJ2EEsystemhasmanymoremovingpartsthatinteractinmanycombinations,makingthetuning

processallthemorecomplex.TheWebSphereteamtookamethodicalapproachtotuningthatcertainlyprovedmore

timeconsuming.

Manageability&reliability.The.NETimplementationconsistentlyandreliablyhandledserviceinterruptions,both

controlledandunexpected.Italsoallowedtheteamtodeployapplicationupdatesmuchmoresmoothly.

TheWebSphereteam,ontheotherhand,encounteredcatastrophicfailuresthattheycouldnotdiagnoseorexplain

sufficientlytoovercome.Theyalsofoundsessionpersistenceperforminglessthanreliably.Theteamfeelstheycould

havesolvedtheseproblemsgivenmoretime.

Overall,bymostindicatorsinthisstudy,the.NETimplementationrunningonWindowsServer2003wasbetter,insome

casessignificantlyso,thaneitherWebSphere/J2EEimplementationrunningonLinux.

Itmakessensethatusinganintegratedout-of-the-boxoperatingsystemand“applicationserver”frameworksuchasWindowsand.NETwouldhaveamuchlowersetupcostthanattemptingtointegratemultipleproducts(albeitfromthe

samecompany)andathirdpartyOS.

Thedevelopmentproductivityresultsfavorthe.NETside;productivityhasalwaysbeenoneofMicrosoft’sstrongpoints.

GiventhattheJ2EEapproachtoenterprisesoftwareisverymuchaboutcompetitionandchoices,wemightwellask

whetherthemostsignificantproblemsencounteredbytheWebSphereteamcouldhavebeenhelpedoreliminated

throughdifferentchoices.



Linux?GiventhechoiceofEdgeServerforloadbalancing,theWebSphereteamhadtopatchandupgradetheLinux

kerneltomakeitwork.ThisprocessrequiresskillscommontoLinuxexpertsbutnotnecessarilytotheaverageJ2EE

developerorITteam.ThereisnoquestionthatLinuxaddedalayerofcomplexitytotheconfigurationprocess.

Inconclusion,theinitialimplementation(includinginstallingallnecessarydevelopmentandruntimesoftware)was

carefullymeasuredtodetermineoveralldeveloperproductivity.The.NETimplementationwascompletedsignificantly

fasterthantheJ2EEimplementation.

Sources:

INPUT/Output©2005

.NET-WebSphere/J2EEComparisonReport

Copyright©2004TheMiddlewareCompany

IndustryWhitePaper

TheMicrosoftVisionforHealthandHumanServicesArchitecture

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http://www.microsoft.com/resources/government/hhsarchvision.aspx

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