The California Department of Health Care Services (DHCS) operates the California Medicaid Management Information System (CA-MMIS), a complex system serving California’s Medicaid beneficiaries, known as Medi-Cal. CA-MMIS processes about 200 million claims annually for almost 15 million beneficiaries, the largest Medicaid population in the nation. However, the decades-old CA-MMIS application, critical to the smooth functioning of the system, was hindering progress.
DHCS partnered with IBM Consulting®, and that initial step led both partners to embark on what became a transformative journey.
People, perseverance, and partnership
When IBM Consulting entered the scene in 2009-2010, they had to navigate a complex and uncertain landscape. Despite the initial challenges and previous vendor's shortcomings, IBM Consulting demonstrated a strong commitment to innovation throughout the project. The team navigated the technological and cultural constraints of the State of California, carefully considering the client's existing infrastructure and operational norms. By clearly articulating the potential for transformative change and consistently moving together towards a shared vision, IBM successfully expanded the State of California’s initial understanding of what was possible and helped make it a reality. Their commitment to the project and perseverance in understanding the client laid the groundwork for a significant breakthrough: a contract awarded by the State of California in 2018-2019. This marked a pivotal moment, empowering IBM to take the reins in managing the entire CA-MMIS suite of applications.
With direct client access, IBM Consulting determined that the path to transformation had to start by addressing public-facing services and security approaches to technology upgrades for their system. The consulting team first established credibility by showcasing their expertise and understanding of IBM's capabilities. Next, they spent months in understanding the aspirations, desired goals and objectives of the client—not just the organization, and technology but the people representing the client. By mapping the client organization’s needs, IBM Consulting developed an overall approach that identified hidden pain points and opportunities, but would still be acceptable and preferred by the client organization. This empathetic approach fostered a sense of shared purpose and aligned IBM Consulting’s efforts with the client's strategic goals.
To bring their vision to life, the IBM Consulting team harnessed their expertise and resources, placing the client at the heart of their approach. By employing IBM Garage™ design thinking methodologies and an agile mindset, they emphasized that their offering went beyond technology and were intended to better serve the people of California. They demonstrated a deep understanding of the client's people, their unique ways of thinking, and their motivations—specifically, how to shift the mindset of CA-MMIS administrators from "process managers" to "product owners" who drive innovation beyond mere technology improvement. This human-centered approach, coupled with IBM Consulting's proven track record of successful Medicaid IT projects, fostered a collaborative and trusting environment. This collaborative spirit, built on mutual respect and open communication, enabled the IBM Consulting team to effectively address the division's concerns, navigate the complexities of the project, and ensure the final solution truly addressed the client's specific requirements and aspirations, including the critical need to improve provider satisfaction and streamline administrative processes.
IBM Consulting and CA-MMIS: A successful partnership
The successful collaboration between IBM Consulting and the client resulted in the approval of a proof of concept (POC) to develop a cloud-based portal for CA-MMIS. The success of the POC built confidence in cloud technology, proving that the collaborative method between DHCS and IBM of co-creating an IT system was possible and beneficial for all. The IBM and DHCS teams ensured that the portal was user-centric and efficient. Further, the DHCS and IBM teams challenged status quo ways of doing business so that inefficient business processes do not carry over into modern technology solutions. Examples include transition from paper-based business processes to fully electronic and business processes with little to no value were decommissioned. Business processes that previously took weeks and months, with considerable human effort now takes minutes with minimal or zero human-interaction. Robust security measures were implemented to meet HIPAA compliance standards. The portal demonstrated the benefits of cloud technology, such as faster time-to-market and efficient deployment, and also showed that IBM could deliver innovative and transformative work, which inspired the client to consider migrating its entire CA-MMIS application suite to the cloud.
Some of the achievements with CA-MMIS hybrid cloud journey:
96.7% Medi-Cal user volume on cloud
60% daily business transaction volume on cloud
76% legacy EOS/EOL applications migrated to cloud
30% delivery cost reduction from inception of cloud journey
5 new programs leveraging hybrid cloud
2+ average features deployed per week
Over 3,100 organizations adopted paperless processes
Numerous Business processes redesign and enforced through automated workflows
IBM Consulting also recognized the potential of cloud technology to improve operations and efficiency. That’s why the development, maintenance, operations and infrastructure teams worked with the client team to develop a roadmap for migrating to a more secure, multi-tenant IBM Z® Cloud. Using RedHat® OpenShift® on AWS (ROSA), the team that started with a proof of concept sparked a broader transformation. This resulted in the migration of more than 30 functions from legacy systems to AWS cloud platform with the remaining functional apps in the pipeline for migration.
The features developed for the provider portal, such as single sign-on and shared cost applications, have been successfully deployed and made available to all active provider organizations. The initiative has onboarded over 30,000 providers and helped the provider and submitter communities with faster service turnaround time, for example resetting PINs in real time instead of taking 30 days. The initiative also delivered new capabilities for CA-MMIS organization user management, electronic migration of paper records and scalable frameworks, all on a high availability and performant system.
The successful partnership between IBM Consulting and the client has not only transformed the customized CA-MMIS legacy system and enhanced it with the latest technology and framework, but also set a new standard for innovation and collaboration in the industry. By embracing AWS cloud technology and a user-centric approach, the project has delivered significant value and paved the way for future digital transformation initiatives within the CA-MMIS program.
By modernizing the CA-MMIS system and improving the provider portal, this project directly impacts the lives of Californians. Access to quality healthcare is a fundamental right for all, and the Medi-Cal program plays a vital role in ensuring that millions of low-income and vulnerable individuals receive the care they need. Streamlined claims processing and reduced administrative burdens for providers lead to faster and more efficient access to care. Furthermore, enhanced data security and privacy protect the sensitive information of Medi-Cal beneficiaries, while improved communication and collaboration between providers and the state facilitate better coordination of care and ultimately promote improved health outcomes for beneficiaries.
About The California Department of Health Care Services
The California Department of Health Care Services (DHCS) (link resides outside of ibm.com) is the state's primary healthcare agency, serving over 14 million Californians through Medi-Cal, the state's Medicaid program. DHCS is committed to providing equitable access to quality healthcare for all Californians by focusing on whole-person care, expanding access, improving health outcomes, and strengthening its workforce. Through initiatives like CalAIM and ongoing program enhancements, DHCS strives to improve the health and well-being of all Californians while ensuring the efficient and effective use of taxpayer dollars.
