From Replacement to Reinvention: Uncovering the Keys to People-Centric, Technology-Enabled Medicaid Transformation in New Mexico

• Published in: Policy & Practice Vol. 81; no. 3; pp. 30 - 41
• Main Authors: Morgan, Paula, Sharma, Anil, Wirth, Mike
• Format: Trade Publication Article
• Language: English
• Published: Washington American Public Human Services Association 01-10-2023
• Subjects: Collaboration; Customer services; Decision making; Empowerment; Information sharing; Management information systems; Medicaid; Pandemics; Software services; New Mexico; United States > US
• ISSN: 1942-6828

Unlocking the Puzzle of Effective Medicaid Delivery Enabled by a Modern Medicaid Enterprise System (MES) New Mexico Medicaid faces multiple challenges enabling health care services to more than 43 percent of state residents today.1 Some challenges are faced by other states, some unique to the "Land of Enchantment" state. The HSD is leading the New Mexico Medicaid Management Information System Replacement (MMISR) project, an initiative launched to replace our more than 20-year-old Medicaid Management Information System (MMIS) with a modular solution following guidance from the Centers for Medicare and Medicaid Services (CMS). Key considerations we made in this selection were: * The cloud-based deployment of KRIS gives us the scalability and dependability to support our growing Medicaid needs. * KRIS is flexible and the Spruce-KPMG team replaced several standard services in the platform with HSDspecific services to promote IT reuse. * KRIS can support integration capacity, increasing capacity automatically if unplanned Medicaid transactions occur. * The modular and flexible architecture of KRIS, using industry-leading commercial-off-the-shelf products, helps empower MMISR with key capabilities. * The Spruce-KPMG team understands the person-centric goals of MMISR, and KRIS includes project accelerators, like pre-defined interface patterns, to make cross-agency data connections possible. * The Spruce-KPMG team understood the specific New Mexico economics of the project and the KRIS platform and services work within the state's budget. Aligned with the Medicaid Information Technology Architecture (MITA) Framework v3.0 principles, the KRIS platform is designed to seamlessly connect multiple vendor technology modules, enabling Medicaid Concept of Operations services to members, providers, and the department alike.