**California**: The Department of Health Care Services partners with IBM Consulting to modernise its Medicaid Management Information System, addressing limitations in service delivery for the Medi-Cal programme, enhancing operational efficiency, and transitioning functionalities to a cloud-based framework to improve access for nearly 15 million beneficiaries.
The California Department of Health Care Services (DHCS) has embarked on a transformative journey to modernise its complex Medicaid Management Information System (CA-MMIS), which serves nearly 15 million beneficiaries through the Medi-Cal programme. The state has partnered with IBM Consulting to address the limitations of the legacy systems that were becoming increasingly cost-prohibitive and inadequate in meeting the shifting demands of healthcare.
CA-MMIS is the largest Medicaid application in the United States, processing around 200 million claims annually. However, its outdated infrastructure significantly hindered California’s capacity to deliver effective healthcare services. To tackle this challenge, DHCS initiated a collaboration with IBM Consulting, which began in 2009-2010. Despite initial hurdles and challenges with previous vendors, IBM demonstrated a strong commitment to innovation, engaging deeply with the existing operational framework within California’s healthcare system.
According to the project’s stakeholders, the partnership has emphasised a shared vision that prioritises understanding and addressing the needs of both the DHCS and the individuals it serves. By focusing on the people involved, IBM Consulting sought to transition the mindset of CA-MMIS administrators from mere “process managers” to “product owners” who could drive innovative changes.
Through their collaborative efforts, IBM and DHCS successfully approved a proof of concept (POC) for a cloud-based CA-MMIS provider portal. This proof of concept has affirmed the potential benefits of cloud technology for improving state healthcare operations, including faster deployment and significant enhancements in user experience. Over time, the partnership has led to a substantial migration of functionalities from the legacy system to cloud platforms, with more than 30 functions transitioning to an AWS framework.
Some notable achievements from the CA-MMIS hybrid cloud journey include a substantial shift in user volume to the cloud—96.7% of Medi-Cal users are now interacting through cloud services—and a 60% increase in daily business transactions conducted in the cloud. Furthermore, the collaboration enabled the migration of 76 legacy applications, resulting in a 30% reduction in delivery costs.
IBM Consulting’s development efforts have focused not only on technology enhancements but also on streamlining business processes. Initiatives have included transitioning from paper-based systems to fully electronic processes, markedly reducing processing times for claims and improving overall operational efficiency for providers. The improvements have seen significant enhancements in provider and submitter communities, fostering faster service, including real-time PIN resets that previously took up to 30 days.
The successful outcomes of this initiative underline a significant evolution in how California manages its healthcare services. By embracing cloud technology and reinforcing a human-centric approach, DHCS and IBM Consulting have set a new standard in innovation and collaboration within the healthcare industry. The modernisation of the CA-MMIS system aims to result in not only improved operational efficiency but also enhanced access to quality healthcare for millions of Californians, ultimately contributing to better health outcomes for a vulnerable population that relies on the Medi-Cal programme for their healthcare needs.
Source: Noah Wire Services
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