Case Study – From Legacy Systems to Modernization: theta.’s Contributions to the Medicaid and CHIP Program (MACPro) Ecosystem

Summary:

theta. – an SBA-Certified HUBZone digital integration & management firm based in Baltimore, MD, working to create a world where tech works for everybody has been working with the Centers for Medicaid and CHIP Services (CMCS) since 2016, providing digital integration and product development services as a subcontractor to multiple prime contractors on various products in the MACPro ecosystem. This case study highlights theta.’s innovative contributions to the MACPro ecosystem, including cloud migration, agile software development, and testing.

Challenge:

The MACPro ecosystem is a complex set of disparate legacy systems created by different contractors for different purposes and with little regard for application collaboration across user workflows. As a result, these systems require significant manual intervention and are prone to error, resulting in inefficiencies and inaccuracies in Medicaid and CHIP program operations. Additionally, the development style used to create these systems is outdated, meaning that, as healthcare technology standards evolve, these systems have needed extensive updates to ensure compliance, leaving scant room for improvements.

Solution:

theta. has provided various innovative solutions to address the challenges facing the MACPro ecosystem, including:

• Cloud migration of MACPro: theta. migrated MACPro out of the Appian vendor’s commercial cloud offerings to CMS’ FEDRamp-approved AWS GovCloud environment, which provided several benefits such as increased efficiency, scalability, access and security control, and cost savings. Migrating to the cloud made integrating enterprise technologies and standards like ​​CMS’ IDM and EUA user management systems easier.
• Increased transparency and accountability: theta.’s software testing services for eAPD provided greater transparency and accountability in Medicaid and CHIP program operations. By ensuring the functionality and compliance of eAPD, theta. helped CMS and state Medicaid agencies provide accurate and up-to-date program information to the public. This resulted in greater trust and confidence in the Medicaid and CHIP programs and improved access to healthcare for millions of Americans.
• Agile software development for OneMAC: The One Medicaid and CHIP Program System (OneMAC) is a system developed with Centers for Medicare and Medicaid Services (CMS) stakeholders to replace the Medicaid and Children’s Health Insurance Program (CHIP) Program (MACPro) legacy system. OneMAC is a web-based system that provides a single portal for states and the federal government to manage Medicaid and CHIP program operations, including eligibility determination, enrollment, provider management, claims processing, and payment. OneMAC is designed to improve the efficiency, effectiveness, and accuracy of Medicaid and CHIP program administration while reducing administrative burden for states and improving the user experience for beneficiaries, providers, and other stakeholders. The OneMAC system is part of CMS’s broader Medicaid Enterprise Systems (MES) initiative, which aims to modernize and streamline the nationwide Medicaid and CHIP program administration. The MES initiative supports states in developing and implementing integrated technology systems that provide comprehensive support for Medicaid and CHIP operations while meeting federal standards for compliance, interoperability, and data analytics. At theta. we have supported CMCS using agile development methodologies to help develop and implement OneMAC. The agile approach has enabled faster development and delivery of features while ensuring stakeholder flexibility and collaboration.

Results:

The One Medicaid and CHIP Program System (OneMAC) is replacing the Medicaid and CHIP Program (MACPro) system by providing a more modern and integrated technology platform for states and the federal government to manage Medicaid and CHIP program operations. 

OneMAC is being developed and implemented in phases to gradually transition states from the old MACPro system to the new OneMAC system. As of late 2022, some states have already started using OneMAC, while others are still transitioning.

The OneMAC system is designed to offer a more streamlined and efficient approach to Medicaid and CHIP program administration, with enhanced features and capabilities compared to the older MACPro system. Some of the critical improvements offered by OneMAC include a more intuitive and user-friendly interface, improved automation and data analytics capabilities, enhanced security features, and greater flexibility to accommodate the unique needs of different states and populations.

The transition from MACPro to OneMAC is a complex and ongoing process involving close coordination between CMS, state Medicaid agencies, a diverse vendor community, and other stakeholders. The goal is to ensure a smooth and seamless transition to the new system while minimizing disruption to beneficiaries, providers, and other program participants. 

theta.’s contributions and innovations in the MACPro ecosystem have significantly impacted Medicaid and CHIP program operations, including:

• Increased efficiency, scalability, and cost savings: theta.’s cloud migration of MACPro resulted in significant cost savings and increased efficiency and scalability of the system. The cloud environment also made integrating new technologies and standards easier, making it possible to keep up with evolving healthcare technology.
• Improved user experience: The OneMAC system has improved the user experience for healthcare providers and state Medicaid agencies by consolidating all MACPro functionality, facilitating the consistent adjudication of State Plan Amendments (SPAs), managed care contracts and rates, and Advanced Planning Documents (APDs) with CMS staff and Medicaid staff.
• Streamlined application processes: theta.’s software testing services improved the functionality of the eAPD system, resulting in streamlined application processes for states and territories. This enabled state Medicaid programs to collect and submit planning and operational documents and performance measurement data more efficiently, ultimately improving the efficiency and effectiveness of Medicaid and CHIP program operations.

Conclusion:

theta.’s innovative solutions have enabled CMCS to respond more quickly to changes in Medicaid and CHIP programs while improving the user experience for healthcare providers and state Medicaid agencies. The results of theta.’s work in the MACPro ecosystem demonstrates our commitment to providing innovative and effective solutions to our clients. From legacy systems O&M to new product development and modernization, theta. has played a crucial role in transforming the MACPro ecosystem and improving healthcare outcomes for millions of Americans.