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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.
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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
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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.
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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
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• 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.
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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.
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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.
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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.
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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
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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
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.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
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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.
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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
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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.
7/31/2019 HHS MMIS Whitepaper
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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.
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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
ThisHealthandHumanServices(HHS)ArchitecturalVisionisatechnologyroadmapforhealthandhumanservices
executives.Thedocumentaddressescurrentbusinesschallengessuchasplanningandresourceallocation,revenue
maximization,andlegacysystemreplacement.Theaccompanyingexecutivesummaryoffersahigh-levelvisionforbest-
practicesmanagementandservicedelivery.
http://www.microsoft.com/resources/government/hhsarchvision.aspx
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