Successful Go-live for Medicaid at Georgia Department of Community Health

The Team Capgemini PMO provided DCH with the rigor and insight needed to proactively manage our MMIS implementation through some tight timeframes and difficult situations. It was a truly collaborative effort. Vince Harris, CIO, GA

The Solution

In 2006 the State of Georgia, Department of Community Health (DCH) required a new system and fiscal agent to support the Medicaid business (e.g., process medical claims). The replacement Medicaid Management Information System (MMIS) to be implemented would be crucial to one of the most complex state Medicaid processes in the US, serving 1.8 million Medicaid recipients, and applying an extensive rule base to determine the eligibility of cases and appropriately paying or denying each claim.

DCH’s implementation of the previous Medicaid system in April 2003 had not been without its challenges, and resulted in a backlog of unprocessed claims. DCH staff and management were apprehensive about the possible impact of another major systems implementation on their critical day to day activities while management was also concerned about the bigger picture.

Georgia, like all Medicaid programs across the country, is under increasing financial pressure to deliver additional programs and coverage while battling budgets impacted by the economy. In addition, the 2014 implementation of the Patient Protection and Affordable Care Act (ACA) will bring significant expansion to Medicaid enrollment and, therefore, Medicaid costs. According to a September report by Kaiser Commission on Medicaid and the Uninsured, Medicaid spending increased on average by 8.8 percent across all states in FY 2010, the highest rate of growth in eight years, and 7.4 percent in FY 2011 (assuming economic recovery and jobless rates improve). To effectively manage these pressures, the MMIS capabilities have become more important than ever.

Specifically, MMIS must provide the flexibility necessary to rapidly implement changes to benefits (to control costs) and eligibility rules (to implement ACA requirements). As such, it has been essential that the new MMIS solution be implemented in a timely and high quality manner. Another implementation like that of 2003 was not going to be acceptable.

The Solution

DCH engaged Capgemini, in partnership with Fox Systems in April 2006 in a program management and quality control capacity to support the re-procurement of a vendor for MMIS. During the initial phase of the program, Team Capgemini provided advisory support to DCH on the definition of requirements, the development of the RFP, and the process guidance for proposal evaluation, which culminated in the selection of Hewlett-Packard (HP) as the vendor for the project. Following the award to HP, Team Capgemini continued its support as the lead provider of the Project Management Office (PMO) and quality management services for this complex $67 million program spanning 30 months. The team was expanded to be comprised of Project management, MMIS Subject Matter Experts and testers. Team Capgemini PMO staff coordinated, directed, and supported the efforts of the systems implementation vendor, along with 12 other vendors and state agencies, a client program staff of 120 in 32 business process area teams, as well as hundreds of electronic trading partners and external interfaces.

The Result

The system successfully went live on 1 November 2010. Three weeks later, over $100,000,000 in claims had been paid successfully with no major processing challenges identified. Emergency and contingency processes developed in the event of poor system performance after go live have not been needed. This success is due in no small part to the thoroughness of the program’s testing initiative. During the system integration phase, the Capgemini PMO team facilitated and managed the review and response of system integration test results from the MMIS vendor. During this process, the team was able to rapidly review and provide feedback on the functionality being developed (detection of errors in the development cycle is a proven method for delivery acceleration and higher quality).

During the user acceptance phase, Team Capgemini continued the management and facilitation of DCH’s performance of almost 11,000 UAT test cases and achieved an average pass rate of 92% – well above the stated customer goal of 85% and comparing very favorably with MMIS programs of this size and complexity. The Capgemini team provided detailed daily reports on vendor’s testing results to facilitate close scrutiny by the client and to confirm that issues were identified and managed early. These fact-based reports reduced potential points of conflict and enabled work to proceed efficiently. Staff at DCH have been pleased with the results. “The Team Capgemini PMO provided DCH with the rigor and insight needed to proactively manage our MMIS implementation through some tight timeframes and difficult situations.” said Vince Harris, CIO, GA DCH. “It was a truly collaborative effort.”