It’s not just about filling the boxes on your organization chart – it’s about forming a project team that ensures the success of your MMIS project. Among the most important phases of the MMIS Design, Development and Implementation (DDI) project is the planning phase, and within the planning phase, there is no more important step than establishing a strong MMIS DDI project team. The project team represents the most important contributing factor to the success or failure of the MMIS DDI project. While the approach to forming an MMIS DDI project team may seem similar to other state information technology (IT) projects, it is far from the norm. The size, complexity and risk associated with MMIS DDI projects require a greater level of detailed planning and creativity when forming the project team .

1. MMIS Solutions:
A New Approach to Forming MMIS
Project Teams
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2. MMIS Solutions: A New Approach to Forming MMIS Project Teams
October 2012
Contents
INTRODUCTION ............................................................................................................................................ 1
BUILDING THE BEST PROJECT TEAM......................................................................................................... 1
RESOURCE ASSIGNMENT............................................................................................................................. 2
A SUCCESSFUL PROJECT TEAM – KEY ROLES .......................................................................................... 3
KEY CHALLENGES ....................................................................................................................................... 4
A NEW APPROACH....................................................................................................................................... 4
THE BENEFITS OF SUPPLEMENTING YOUR TEAM..................................................................................... 5
MOVING AHEAD WITH YOUR MMIS DDI PROJECT ................................................................................. 6
CONTACT INFORMATION ............................................................................................................................ 6
AUTHORS ...................................................................................................................................................... 7
Exhibits
Exhibit 1. Sample MMIS DDI Project Team Organization .......................................................................... 3
Exhibit 2. MMIS DDI Project Team Staffing Challenges ............................................................................ 4
Exhibit 3. Benefits of MMIS DDI Project Team Contracted Support .......................................................... 6
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3. MMIS Solutions: A New Approach to Forming MMIS Project Teams
October 2012
INTRODUCTION
It’s not just about filling the boxes on your organization chart – it’s about forming a project team that
ensures the success of your MMIS project
Among the most important phases of the MMIS Design, Development and Implementation (DDI) project
is the planning phase, and within the planning phase, there is no more important step than establishing a
strong MMIS DDI project team. The project team represents the most important contributing factor to the
success or failure of the MMIS DDI project. While the approach to forming an MMIS DDI project team
may seem similar to other state information technology (IT) projects, it is far from the norm. The size,
complexity and risk associated with MMIS DDI projects require a greater level of detailed planning and
creativity when forming the project team. Utmost, MMIS project success requires the following:
Strong Leadership. The MMIS DDI project team should include – at a minimum – strong executive
leadership, project management expertise in multiple functional areas and subject matter experts who can
effectively represent the organization’s business and IT needs.
Ability to Meet Challenges. States have typically formed their MMIS DDI project teams by tapping
talent from within the organization, which often occurs at the expense of operational units that support
day-to-day business. In addition to staffing obstacles, there are multiple healthcare initiatives underway
that demand staff attention. Both limited depth within state organizations and strained budgets have
resulted in hiring limitations. These and other challenges have forced states to be creative and consider
alternative strategies for MMIS DDI project team formation.
Recently, state procurements have been calling for project management services that require contractors
to fill the majority of the MMIS DDI project team’s key positions. As states weigh the value of
contracting out for these services, consideration should be given to the risks associated with forming an
understaffed and inexperienced MMIS DDI project team compared to contracting out – an approach that
requires a marginal state investment and leverages enhanced federal financial participation (FFP). The
latter outcome is an experienced project team that reduces project risk by providing professional project
management services equipped with MMIS-specific expertise, tools, templates and maximum flexibility
to increase the likelihood for project success.
BUILDING THE BEST PROJECT TEAM
As states look to form their MMIS DDI Project Team, focus should be placed on the following:
Sponsor Recognition of Project Complexity, Risk, and Need for Effective Management. Executives
must recognize the importance of forming a strong MMIS DDI Project team and support strategies to
ensure that the team is adequately staffed and in place prior to the start of the project and remain staffed
throughout the project.
Forming a Highly Collaborative and Effective Team. MMIS DDI projects require the formation of a
highly collaborative team comprised of leadership from the sponsoring organization, experienced project
directors and managers, subject matter experts, support staff and vendors. The most successful project
teams often consist of a wide range of members, from executives to frontline staff. Typically, this is the
initial strategy used. States often, however, do not have adequate staffing to fill every position, which
makes building the right team difficult as there is a significant cost to the daily operations of the
organization when staff are redeployed.
Team Composition and Roles. It is important that project team members embrace the team environment
and understand their roles and responsibilities. In addition to the programmatic expertise required, there
are also a number of formal project management roles that team members must play that are critical to the
MMIS DDI Project, such as providing periodic status updates, reviewing deliverables and participating in
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4. MMIS Solutions: A New Approach to Forming MMIS Project Teams
October 2012
testing activities. Team members with formal Project Management Professional (PMP) certification and
experience are highly recommended.
Communication and Collaboration. The size and complexity of today’s MMIS DDI Projects demand
maximum communication and collaboration both internal and external to the sponsoring organization. A
strong MMIS DDI team needs to possess the knowledge, skills and abilities to ensure timely and accurate
communication and to cultivate an environment of trust. Shared or common goals must be developed to
foster this collaboration among all project stakeholders.
Identification and Removal of Project Barriers. Typically, human service organizations function in a
siloed environment where communication is not optimal. Program areas and departments have different
agendas and clients, and this can present challenges to the project. These challenges and barriers must be
anticipated and addressed strategically. The project team must be able to develop shared goals and
overcome obstacles.
Meeting the State’s Obligation to the DDI RFP and Contract. The MMIS DDI procurement and
contract document will likely have state responsibilities, deliverables and schedules that vendors will
expect the state’s project team to meet. States must pull together a project team that is capable of meeting
these vendor expectations. It may be wise if not required for the State project team to have complimentary
roles that match the DDI vendor’s project team’ s organization and project phases
RESOURCE ASSIGNMENT
When it comes to building your MMIS DDI project team, the old adage “actions speak louder than
words” really means something. Has the MMIS DDI project team been resourced properly? That is, has
suitable talent been selected for the appropriate roles and what is the commitment level? Is the resource
assigned to the project at a level of 100 percent, 75 percent, 50 percent or less? The MMIS DDI project
will only be successful if you have aligned the right expertise in the right positions for the proper amount
of time.
States should carefully consider how they assign resources for the core MMIS DDI project team functions
described below
Acceptance Test Management. Often, this is a challenging activity for any MMIS DDI project. Test
Management requires experience and expertise, and significant resources are needed to perform
testing as well as manage the testing process.
Business Change Management. There will be significant changes to business operations that must
be managed.
Certification Management. It’s never too early to begin planning for CMS certification. These
activities must be planned before “Go-Live” and must be executed immediately after implementation.
Communication Management. Project communication, both internal and external must be planned
and executed throughout the project. There also is a significant amount of communication needed for
key stakeholders like providers and member that will be significantly impacted by the new MMIS
operations.
Data Conversion Management. Conversion of legacy data must be carefully planned, executed and
monitored to assure integrity in the new system. Conversion problems must be resolved early on and
in a timely manner.
DDI Contract Management. The size and value of the DDI contract requires significant
management and oversight of project deliverables, service-level agreements, and contract issues and
amendments.
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5. MMIS Solutions: A New Approach to Forming MMIS Project Teams
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Financial Management. Large state and federal budget allocations and multiple vendor invoices
make financial management a full-time activity. Updates must be provided to CMS and related to the
Implementation Advanced Planning Document.
Implementation Management. There are many key activities to be planned and managed leading up
to and following the “Go-Live” of the new system and operations implementation date.
Issue/Risk Management. A robust issue and risk management process must be developed and
managed effectively.
Project Management. Every MMIS DDI project should have an executive-level project director and
deputy project manager(s) to effectively direct strategic decisions and oversee status reporting and
day-to-day project activities.PMP certified project managers are ideal.
Quality Management. Oversight of the quality of project deliverables and other aspects of the
projects such as configuration must be performed to assure good results and avoid re-work later in the
project.
Schedule Management. The integrated project schedule must be developed and managed as well as
assuring the DDI vendor’s schedule is closely monitored.
Scope Management. Project success is directly related to how well the MMIS DDI project team
manages scope. A rigorous process and effective tools are essential.
Team Management. With multiple roles and responsibilities, day-to-day team management and
leadership are critical
A SUCCESSFUL PROJECT TEAM – KEY ROLES
In Exhibit 1, a basic MMIS DDI project organization is presented. The composition includes key
functional roles that are critical to MMIS DDI projects, some of which are described below:
Deputy Project Manager.
Reports to project director and
responsible for day-to-day
management.
Senior Medicaid Leads.
Provide subject matter expertise
and coordinate department
SME participation.
Quality Assurance Manager.
Manages overall project
quality, configuration and
change management.
Schedule/Cost Manager.
Manages overall schedule and
budget for the project. Exhibit 1. Sample MMIS DDI Project Team Organization
Communications and Training Manager. Responsible for internal and external communications
and training.
Senior Medicaid Systems Analyst. Provides technical analysis and expertise in MMIS vendor
systems and represents the MITA business areas and processes.
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6. MMIS Solutions: A New Approach to Forming MMIS Project Teams
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Test Manager. Responsible for managing overall testing effort and coordinating user acceptance
testing.
It is important to note that project scope and complexity will dictate the necessary size of the MMIS DDI
project team. Team composition will vary based on whether the project is an MMIS takeover, modular
enhancement or full replacement. The state DDI project team may want to mirror the vendor project team
in size and complexity
KEY CHALLENGES
States that are unable to address staffing challenges typically form MMIS DDI project teams that are ill-
equipped to manage a large, complex, expensive, lengthy and political MMIS DDI Project. Some of the
common challenges that state agencies should be aware of are listed below.
MMIS DDI Project Team Staffing Challenges
Underestimating Estimating the true size and scope of an MMIS Project is challenging.
staffing needs Unfortunately, underestimating staffing results in an MMIS DDI project team that
is too small and can quickly become overwhelmed by the multiple project
activities and deliverables.
Lacking cohesive executive The MMIS DDI project touches a large portion of the human services enterprise.
leadership For this reason, the project must be supported at the highest executive level with
solid governance. Lack of cohesive executive leadership can result in the MMIS
DDI project team struggling to receive adequate participation from competing
program areas and delays in key decisions.
Inexperienced Project Managers States may have staff who have lead smaller projects or initiatives but do they
may not have formal Project Management training, certification and experience.
Leading a MMIS project is more challenging than most other State projects. A
strong lead business analyst or operations manager does not always make a
good project manager. Experienced project managers, preferably with PMP
certification should be on the MMIS DDI team to ensure project management
standards and best practices are followed.
Difficulty finding the Typically within the state, the best and brightest on staff are already leading and
right skills and experience to fill managing high-priority areas that are essential to supporting daily operations.
key positions While some MMIS DDI project staff with the right mix of skills and expertise will
join the MMIS DDI project team to fill key positions, it will be at a cost to the
organization, which will need to backfill these vacated positions.
Lengthy hiring process Faced with having to recruit MMIS DDI project team members, states often must
wade through a lengthy hiring process that can take up to six months. This can
result in delays even before the project begins.
Personnel policy constraints States often face personnel requirements that are challenging to navigate − from
lengthy multi-stage hiring and salary exception processes to “limited-duration”
positions and outright hiring freezes. These and other personnel policies create
obstacles to filling key MMIS DDI project positions.
Staff turnover State staff members with significant expertise and knowledge are retiring.
Additionally, election results can play havoc with senior management positions
and operational demands can quickly pull key staff away from project work. Also
staff can burn out quickly due to challenging and lengthy nature of MMIS
projects.
Exhibit 2. MMIS DDI Project Team Staffing Challenges
A NEW APPROACH
Today’s healthcare environment is rapidly evolving. States are scrambling to keep up with a plethora of
new federal mandates, policy changes and initiatives, such as ICD-10, adoption of certified Electronic
Health Record (EHR) technology and health information exchanges. Given the multiple initiatives
underway designed to improve Medicaid systems, combined with the daunting size, complexity and risk
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7. MMIS Solutions: A New Approach to Forming MMIS Project Teams
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associated with MMIS DDI projects, states that are preparing for an MMIS DDI project must ask the
following questions:
1. Do we have the skills, experience, and expertise to adequately staff our MMIS DDI Project?
If the answer is yes, great! If the answer is no…
2. How do we obtain the skills, experience and expertise necessary to adequately staff our MMIS
DDI Project?
3. Is there an approach that reduces overall project risk and increases our chances for a successful
MMIS DDI project?
4. Do we have a team to match the MMIS vendor’s DDI project team and to meet the deliverables
and timeframe established in the MMIS DDI contract?
With the challenges states face in staffing MMIS DDI project teams and the current changing dynamics of
the Medicaid environment, states should consider the following areas that represent a new and emerging
approach to building an experienced MMIS DDI Project Team.
Develop an accurate staffing model. Often, underestimating staffing needs is one of the first significant
mistakes made during the planning phase. States should accurately develop a staffing plan that positions
them for success, free of state-imposed limitations that may add risk to the MMIS DDI project from the
outset. Include the costs to support the ideal project team in the MMIS DDI IAPD.
Leverage qualified and available staff. States should assess their internal staff and determine whether or
not staff members with the skills and experience to do the job exist and are available. Even the very best
staff will have to overcome a steep learning curve for MMIS DDI projects.
Fill key leadership positions. States should focus on finding a key leader within the organization who can
assume the role of project director and provide overall project strategy and direction.
Identify MMIS DDI project team gaps. States typically can fill certain project team positions more easily.
Those that are more difficult to staff must be identified, as they represent gaps that must be filled.
Procure MMIS DDI Project Team Services. Based on the team gap assessment, states should contract for
qualified, experienced MMIS staff that brings expertise to the State Project Team.
THE BENEFITS OF SUPPLEMENTING YOUR TEAM
While the concept of contracting out for MMIS DDI project team support has been used before, it is
gaining more momentum now. A number of states have contracted out for key MMIS DDI project team
positions and, more recently, states have released Requests for Proposals that expand this approach by
contracting out for the majority of MMIS DDI Project Team services, including key functional positions.
The benefits of contracting out for MMIS DDI Project Team support include:
Benefits of MMIS DDI Project Team Contracted Support
Accelerated Project Readiness A PM structure that is in place within four to six weeks, rather than three to four
months, by avoiding lengthy and challenging state HR processes.
MMIS Specific Tools Access to libraries of MMIS Project Management Plans and proven MMIS project
& Templates tools and templates.
Proven Project Management Advantage of Certified Project Management professional expertise and project
Expertise managers with MMIS DDI experience.
Seasoned Senior Medicaid Medicaid consultants with strategic, policy expertise.
Expertise Medicaid subject matter and MITA expertise.
CMS guidance expertise, e.g., modular approach to ensure maximum Federal
Financial Participation (FFP).
Experienced MMIS IT professional expertise for your MMIS DDI Project Team.
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8. MMIS Solutions: A New Approach to Forming MMIS Project Teams
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Benefits of MMIS DDI Project Team Contracted Support
IT Professionals Ability to add SOA, EHR and HIT expertise to the MMIS DDI Project Team.
Cost Neutral Ability to maximize value through 90% enhanced Federal Financial Participation
Approach while minimizing the need for additional General Fund investment.
Time and Materials Contract Provides the state with maximum contract flexibility.
Provides a contract mechanism to increase or decrease MMIS Project Team
support based on project need.
Access to Talent Ability to phase in additional specialized talent when needed, i.e., during testing
and certification.
Exhibit 3. Benefits of MMIS DDI Project Team Contracted Support
MOVING AHEAD WITH YOUR MMIS DDI PROJECT
States in the planning stages of their MMIS DDI project should consider the approach that is best aligned
with their project needs and goals and consider the following:
Develop your MMIS DDI project team strategy and seek input. Don’t work in a vacuum. The MMIS DDI
project team has a significant impact on the success of your project. Develop your strategy and seek input
from CMS, partner states and vendors. Outside feedback will help validate assumptions and will become
a valuable source of information.
Implement your MMIS DDI project team strategy early. It is critical that you have your core MMIS DDI
project team in place as early as possible. Once the DDI project begins, the pace will be very fast and it
will be difficult to get maximum performance of project team members who are added mid project.
Contracting out for MMIS DDI project team services and support should be done early. Just as it is
important to fill key MMIS DDI project team roles with internal staff as early as possible, it’s just as
important to begin the procurement process for MMIS DDI project team support as early as possible.
Make sure that a procurement timeline is developed so that MMIS DDI project team support is on board
prior to, or as close as possible to, the DDI project start date.
Use a contract vehicle that maximizes flexibility. An important consideration to contracting out for MMIS
DDI project team support is the type of contract that should be used. Historically, states have used firm-
fixed-price contracts for managing the DDI vendor. While this works well for deliverable and
implementation contracts, it is less effective for service and support contracts. States should consider
using a Time and Materials (T&M) contract to procure MMIS DDI project team support services. This
form of contract will provide the greater flexibility needed to effectively manage the MMIS DDI project.
A T&M contract will allow the state to ramp up or scale back project support based on project need. A
T&M contract also will allow the state to establish rates for specific personnel that may be needed on a
periodic basis, such as testing support.
Reference recent or existing Requests for Proposals when developing your statement of work. States that
are considering this approach should look to other states that have used a similar approach and leverage
language and proposal sections that align best with your project goals and needs. Some states that have
contracted out for MMIS DDI project team support include Arkansas, Georgia, Iowa, Maryland, New
York, Missouri, Oklahoma, Oregon and Wisconsin
CONTACT INFORMATION
Based on our more than 25 years of experience supporting state MMIS DDI projects, we offer these
recommendations as our assessment of the MMIS DDI project team – challenges to formation,
composition and functional roles – and propose a new approach that mitigates project risk and ensures
success while complementing the existing organization’s talent pool. Contact us and we will share our
MMIS DDI project team staffing model, as well as our APD and budget templates with you.
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9. MMIS Solutions: A New Approach to Forming MMIS Project Teams
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Authors
Jarred Clark Jim Joyce
Managing Director Senior Vice President, Medicaid
Jarred.Clark@cognosante.com Jim.Joyce@cognosante.com
Cognosante Medicaid Management Services
7926 Jones Branch Drive, Suite 330, McLean, VA 22102
Phone (480) 423-8184 • Fax (480) 481-423-8108
Cognosante has successfully served state Medicaid agencies for 25 years in the acquisition and
improvement of Medicaid Management Information Systems (MMIS). We are nationally recognized for
our MMIS expertise and have a practice area dedicated exclusively to serving Medicaid agencies. We
have worked closely with the Centers for Medicare & Medicaid Services (CMS) to develop, document
and continually implement best practices for the Medicaid Information Technology Architecture (MITA).
We are currently providing technical support services for the design and development of an MMIS
Certification Manual that includes current MMIS certification review criteria, on-site review protocols for
each functional area being certified, and traceability regarding the source of the requirement.
Cognosante provides project management and personnel support, procurement strategy and acquisition
assistance, Medicaid Information Technology Architecture (MITA) 3.0 assessments and transformation
services, MITA State Self-Assessments, State Medicaid Health Information Technology (HIT) Plan
(SMHP) maintenance and support, and independent verification & validation (IV&V) and quality
assurance (QA) services. Cognosante has the knowledge and experience necessary to transform your
Medicaid practice. Contact us for assistance with your Medicaid needs.
To learn more about Cognosante, please visit www.cognosante.com.
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