Collaborating with MES to leverage funding for public health innovation

Read this if you are a State Medicaid Director, State Medicaid Chief Information Officer, State Medicaid Project Manager, or State Procurement Officer—or if you work on State Medicaid Enterprise System (MES) certification or modernization efforts.

As states transition to the Centers for Medicare & Medicaid Services' (CMS) Outcomes-Based Certification (OBC), many jurisdictions are also implementing (or considering implementation of) an Integrated Eligibility System (IES). Federal certification for a standalone Medicaid Enterprise System (MES) comes with its own challenges, especially as states navigate the recent shift to OBC for Medicaid Eligibility and Enrollment (E&E) services. Certification in the context of an IES creates a whole new set of considerations for states, as Medicaid eligibility overlaps with that of benefit programs like the Supplemental Nutrition Assistant Program (SNAP), Temporary Assistance for Needy Families (TANF), and others. We’ve identified the following areas for consideration in your own state's IES implementation: 

• Modernizing MES 
  It's likely your state has considered the pros and cons of implementing an IES, since CMS' announcement of increased federal funds for states committed to building new and/or enhanced Medicaid systems. Determining whether an IES is the right solution is no small undertaking. From coordinating on user design to system security, development of an IES requires buy-in across a wider range of programs and stakeholders. Certification will look different from that of a standalone MES. For example, your state will not only need to ensure compliance with CMS' Minimum Acceptable Risk Standards for Exchanges (MARS-E), but also account for sensitive data, such as medical information, across program interfaces and integration. 
  
  BerryDunn recommends one of the first steps states take in the planning phase of their IES implementation is to identify how they will define their certification team. Federal certification itself does not yet reflect the level of integration states want to achieve with an IES, and will require as much subject matter expertise per program included in the IES as it requires an understanding of your state's targeted integration outcomes and desired overlap among programs.
• Scale and scope of requirements
  Once your agency commits to designing an IES, the scope of its solution becomes much broader. With this comes a wider range of contract requirements. Requirements can be program-specific (e.g., relevant only to Medicaid) or program-agnostic (e.g., general technical, "look-and-feel", and security requirements that apply throughout the solution). Common requirements across certain programs (e.g., certain eligibility criteria) will also need to be determined. Requirements validation and the development of Requirements Traceability Matrixes (RTM) per program are critical parts of the development phase of an IES implementation.
  
  BerryDunn recommends a comprehensive mapping process of requirements to OBC and other federal certification criteria, to ensure system design is in compliance with federal guidance prior to entering go/no-go for system testing phases.
• Outcomes as they apply across programs
  CMS' transition to OBC changed the way states define their Medicaid program outcomes. Under this new definition outcomes are the value-add, or the end result, a state wishes to achieve as the result of its Medicaid eligibility solution enhancements. In the context of an IES, Medicaid outcomes have to be considered in terms of their relation to other programs. For example, presumptive eligibility (PE) between SNAP and Medicaid and/or cross-program referrals might become more direct outcomes when there is an immediate data exchange between and among programs.
  
  BerryDunn recommends consideration of what you hope to achieve with your IES implementation. Is it simply an upgrade to an antiquated legacy system(s), or is the goal ultimately to improve data sharing and coordination across benefit programs? While certification documentation is submitted to individual federal agencies, cross-program outcomes can be worked into your contract requirements to ensure they are included in IES business rules and design.
• Cost allocation
  In the planning phase of any Design, Development, and Implementation (DDI) project, states submit an Advance Planning Document (APD) to formally request Federal Financial Participation (FFP), pending certification review and approval. This APD process becomes more complex in an IES, as states need to account for FFP from federal programs in addition to CMS as well as develop a weighted cost allocation methodology to distribute shares equitably across benefit programs.
  
  BerryDunn recommends States utilize the U.S. Department of Health & Human Services (HHS), Administration for Children & Families (ACF), Office of Child Support Enforcement's (OCSE) Cost Allocation Methodologies (CAM) Toolkit to inform your cost allocation model across benefit programs, as part of the APD development process
• Timeline
  A traditional MES implementation timeline accounts for project stages such as configuration sessions, requirement mapping, design validation, testing, CMS' Operational Readiness Review (ORR), etc. The project schedule for an IES is dependent on additional factors and variables. Scheduling of federal certification reviews for OBC and/or other programs might be held up by project delays in another area of the implementation, and project teams must be agile enough to navigate such changes
  
  BerryDunn recommends development of a thoughtful, comprehensive project schedule allowing ample time for each project phase across programs. We also recommend states cultivate relationships with federal partners including, but not limited to, CMS, to communicate when a development delay is anticipated. Engaging federal partners throughout the DDI phases will be a critical part of your IES implementation.

In theory, an IES benefits stakeholders on both sides of the system. Caseworkers avoid duplication of efforts, reduce administrative costs, and ensure program integrity, while individuals and families on the receiving end of public benefit programs experience a more efficient, streamlined application process. In practice, the development of a comprehensive business rules, case management, and workflow system across human services programs can prove to be a heavy lift for states, including but not limited to considerations around certification to secure FFP. Planning for the implications of an IES implementation ahead of time will go a long way in preparing your agency and state for this comprehensive certification effort.
 
For further reading
Keep an eye out for the next blog in this series, highlighting certification guidelines across an IES implementation (for CMS and other Federal programs). You can read more on OBC here. 

If you have questions about your specific situation, please contact the Medicaid Consulting team. We’re here to help. 

Read this if you are a State Medicaid Director, State Medicaid Chief Information Officer, State Medicaid Project Manager, or State Procurement Officer—or if you work on a State Medicaid Enterprise System (MES) certification or modernization efforts. 

The companion podcast to this article, Organization development: Preparing for Medicaid Enterprise Systems (MES) modernization, can be found in our virtual library.  

What is organization development (OD)? 

The purpose of OD is to improve organizational performance and outcomes. OD focuses on improving an organization’s capability through the alignment of strategy, structure, people, rewards, systems, metrics, and management processes.  

OD is a science-backed, interdisciplinary field rooted in psychology, culture, innovation, social sciences, quality management, project management, adult learning, human resource management, change management, organization behavior, and research analysis and design, among others.  

OD typically starts with a clear sense of mission, vision, and values that answers the question “what we are trying to be?” OD develops the culture and behaviors that reflect the organizational values.  

OD facilitates the transformation of the workplace culture to become strategic, meaning: vision-driven, values-based, and goals-aligned. This may include talent development for leaders and staff and redesigning organizational infrastructure. 

What is the scope of an OD effort? 

OD efforts are most effective when they encompass the entire organization becoming the basis for a strategic plan. OD can be just as effective when applied to a MES modernization project. In this application of OD, we facilitate stakeholder engagement with the intent of person-centered service, concurrent design for operations, processes, and training side-by-side with the systems design and development. This approach is also referred to as human-centered design (HCD).  

Regardless of the scope, OD reinforces benchmarks of high-performance organizations including: 

• Transparent and data-informed decision making 
• Developed leadership building connections with consistent expectations 
• Culture of continuous improvement and innovation 
• Team-based success and ownership for outcomes 
• Person-centered service 

What does OD look like in action? 

We facilitate leaders to assess their organization through the eyes of stakeholders, particularly staff and people served. Collaboratively, with no blame or shame, the leaders articulate where they are today and where they need to be in the future, and build a roadmap or strategic plan to get there. In the assessment and roadmap we use the following six focal points of the organization:  

• Excellent leadership 
• Effective strategy 
• A workforce that is confident, competent, consistent, and compassionate 
• Quality operations and process improvement 
• Person-centered service that results in a positive client experience 
• Quality program outcomes for the communities served 

The roadmap or strategic plan typically includes talent development, and redesign of the infrastructure, including structure, processes, communication mechanisms, performance management processes, deployment of resources, and job skills development approaches.  

Talent development ensures that your leaders are aligned, prepared, and most importantly leading and inspiring their people toward that vision and the development of the workforce. Talent development provides staff with the skills, knowledge, and abilities needed, and reinforces positive attitudes, beliefs, and willingness to work together towards common goals. This might also include restructuring business process redesign, it might include expanding roles or shifting roles.  

Principles of lean are an important component of organization development when redesigning processes and helps organizations, such as state Medicaid agencies, do more with the current resources. With so many constraints placed on organizations, the lean approach is a critical component of optimizing existing resources and finding cost savings through changing “what we do” and “how we do it”, as opposed to cutting “what we do” or “changing who does it”. Resource optimization is just one of the benefits of organization development. 

Why is it important to redesign your organization and develop your staff when you're implementing a new technology system, such as a new Medicaid Enterprise System module? 

For state Medicaid Agencies, the organization goal isn't to modernize a system, the goal is for competent and compassionate staff serving clients and providers to improve health and wellness in our communities. Our goal is streamlined processes that improve accuracy and timeliness. Look at the outcomes of the program, then design the systems that enable business processes and the people who make that process happen every single day. We go back to why we are doing anything in the first place. Why do we need this change? What are we trying to accomplish? If we're trying to accomplish better service, a healthier community, and streamline processes so we are cost effective, then it leads us to modernizing our enterprise system and making sure that our people are prepared to be successful in using that system. Aligning to the organizational goals, or what we call the North Star, sets us up for success with the enterprise efforts and the human efforts. 

What can clients do to navigate some of the uncertainties of a modernization effort, and how can they prepare their staff for what's next? 

First articulate the goals or why you want the modernization, and build a foundation with aligned, and effective leaders. Assess the needs of the organization from a “social” or people perspective and a technical or systems perspective (note: BerryDunn uses a socio-technical systems design approach). Then, engage staff to develop a high-performance, team-based culture to improve lean processes. Design and develop the system to enable lean business processes and concurrently have operations design standard operating procedures, and develop the training needed to optimize the new system.  

Leaders must lead. If leaders are fragmented, if they are not effective communicators, if they do not have a sense of trust and connection with their workforce, then any change will be sub-optimized and probably will be a frustrating experience for all.  

If the workforce is in a place where staff live with suspicion or a lack of trust, or maybe some dysfunctional interpersonal skills, then they are not in a place to learn a new system. If you try to build a system based on a fragmented organizational structure or inconsistent processes, you will not achieve the potential of the modernization efforts and will limit how people view your enterprise system. The worst thing you can do is invest millions of dollars in the system based on a flawed organizational design or trying to get that system to just do what we've always done. 

By starting with building the foundation of engaging employees, not just to make people feel good, but also to help them understand how to improve their processes and build a positive workplace. Do we have the transparency in our data so that we understand what the actual problems are? Can employees articulate the North Star goals, the constraints, the reasons to update systems, then the organizations will have a pull for change as opposed to a push.

Medicaid agencies and other organizations can create a pull for change by engaging with their resources who can identify what gets in the way of serving the clients, i.e., what gets in the way of timeliness or adds redundancy or rework to the process. The first step is building that foundation, getting people leaning in, and understanding what's happening. By laying the foundation first, organizations help reduce the barriers between operations and systems, and ensure that they're working collaboratively toward organizational goals, always keeping the ‘why’ in mind and using measures to know when they are successful. 

How does a state focus on organization development when they are facing budget and staffing constraints? 

It is too easy to say, "invest in your people". In reality, the first thing that state Medicaid agencies or other organizations need do is redefine their sense of lean. Many inaccurately believe that lean means limited resources working really hard. Lean is tapping into the potential creativity and innovation of each staff member to look for ways to improve the process. Organizations should look at everything they do and ask “Does this add value to the end recipient of our service?” Even if I'm processing travel reimbursement requests, I still have a customer, I still have a need for timeliness and accuracy. If state Medicaid agencies can mobilize that type of focus with every single employee in their organization, they can achieve huge cost savings without the pain of cutting the workforce.   

In one state where BerryDunn’s organization development team provided this level and type of organizational transformation, there was a very deliberate focus on building this foundation prior to a large-scale system modernization.

By developing the leaders and training the employees in how to improve their processes, improve teamwork and trust, and align to the goal of a positive client experience, they were able to effectively implement the new system and seamlessly move to remote pandemic conditions. Once the state Medicaid agency had aligned the technical systems and the people systems to the organizational goals, they were successful and more resilient for future changes.   

You can learn more in Part II of our Outcomes and Organization Development podcast and article. 

If you have any questions, please contact our Medicaid consulting team. We're here to help.

Read this if you are a State Medicaid Director, State Medicaid Chief Information Officer, State Medicaid Project Manager, or State Procurement Officer—or if you work on a State Medicaid Enterprise System (MES) certification or modernization efforts.

Over the last two years, the Centers for Medicare and Medicaid Services (CMS) has undertaken an effort to streamline MES certification. During this time, we have been fortunate enough to be a trusted partner in several states working to evolve the certification process. Through this collaboration with CMS and state partners, we have been in front of recent certification trends. The content we are covering is based on our experience supporting states with efforts related to CMS certification. We do not speak for CMS, nor do we have the authority to do so.

How does the focus on outcomes impact the way states think about funding for their Medicaid Enterprise Systems (MESs)?

Outcomes are becoming an integral part of states’ MES modernization efforts. We can see this on display in recent preliminary CMS guidance. CMS has advised states to begin incorporating outcome statements and metrics into APDs, Requests for Proposals (RFPs), and supporting vendor contracts.

Outcomes and metrics allow states and federal partners to have more informed discussions about the business needs that states hope to achieve with their Medicaid IT systems. APDs will likely take on a renewed importance as states incorporate outcomes and metrics to demonstrate the benefits of their Medicaid IT systems.

What does this renewed importance mean for states as they prepare their APD submissions?

As we’ve seen with initial OBC pilots, enhanced operations funding depends upon the system’s ability to satisfy certification outcomes and Key Performance Indicators (KPIs). 

Notably, states should also prepare to incorporate outcomes into all APD submissions—including updates to previously approved active APDs that did not identify outcomes in the most recent submission. 
 
This will likely apply to all stages of a project’s lifecycle—from system planning and procurement through operations. Before seeking funding for new IT systems, states should be able to effectively explain how the project would lead to tangible benefits and outcomes for the Medicaid program.

How do outcome statements align with and complement what we are seeing with outcomes-based or streamlined modular certification efforts?

Outcomes are making their way into funding and contracting vehicles and this really captures the scaling we discussed in our last conversation. States need to start thinking about reprocurement and modernization projects in terms of business goals, organizational development, and business process improvement and redesign. What will a state get out of the new technology that they do not get today? States need to focus more on the business needs and less on the technical requirements.

Interestingly, what we are starting to see is the idea that the certification outcomes are not going to be sufficient to warrant enhanced funding matches from CMS. Practically, this means states should begin thinking critically about want they want out of their Medicaid IT procurements as they look to charter those efforts.

We have even started to see CMS return funding and contracting vehicles to states with guidance that the outcomes aren’t really sufficiently conveying what tangible benefit the state hopes to achieve. Part of this challenge is understanding what an outcome actually is. States are used to describing those technical requirements, but those are really system outputs, not program outcomes.

What exactly is an outcome and what should states know when developing meaningful outcomes?

As states begin developing outcomes for their Medicaid IT projects, it will be important to distinguish between outcomes and outputs for the Medicaid program. If you think about programs, broadly speaking, they aim to achieve a desired outcome by taking inputs and resources, performing activities, and generating outputs.

As a practical example, we can think about the benefits associated with health and exercise programs. If a person wants to improve their overall health and wellbeing, they could enroll in a health and exercise program. By doing so, this person would likely need to acquire new resources, like healthy foods and exercise equipment. To put those resources to good use, this person would need to engage in physical exercise and other activities. These resources and activities will likely, over time, lead to improved outputs in that person’s heart rate, body weight, mood, sleeping patterns, etc.
 
In this example, the desired outcome is to improve the person’s overall health and wellbeing. This person could monitor their progress by measuring their heart rates over time, the amount of sleep they receive each night, or fluctuations in their body weight—among others. These outputs and metrics all support the desired outcome; however, none of the outputs alone improves this person’s health and wellbeing.

States should think of outcomes as the big-picture benefits they hope to achieve for the Medicaid program. Sample outcomes could include improved eligibility determination accuracy, increased data accessibility for beneficiaries, and timely management of fraud, waste, and abuse.
 
By contrast, outputs should be thought of as the immediate, direct result of the Medicaid program’s activities. One example of an output might be the amount of time required to enroll providers after their initial application. To develop meaningful outcomes for their Medicaid program, states will need to identify big-picture benefits, rather than immediate results. With this is mind, states can develop outcomes to demonstrate the value of their Medicaid IT systems and identify outputs that help achieve their desired outcomes.

What are some opportunities states have in developing outcomes for their MES modernizations?

The opportunities really begin with business process improvement. States can begin by taking a critical look at their current state business processes and understanding where their challenges are. Payment and enrollment error rates or program integrity-related challenges may be obvious starting points; however, drilling down further into the day-to-day can give an even more informed understanding of your business needs. Do your staff end users have manual and/or duplicative processes or even process workarounds (e.g., entering the same data multiple times, entering data into one system that already exists in another, using spreadsheets to track information because the MES can’t accommodate a new program, etc.)? Is there a high level of redundancy? Some of those types of questions start to get at the heart of meaningful improvement.

Additionally, states need to be aware of the people side of change. The shift toward an outcomes-based environment is likely going to place greater emphasis on organizational change management and development. In that way, states can look at how they prepare their workforce to optimize these new technologies.

The certification landscape is seemingly changing weekly as states wait eagerly for CMS’ next guidance issuances. Please continue to check back for in-depth analyses and OBC success stories. Additionally, if you are considering an OBC effort and have questions, please contact our Medicaid Consulting team. 

The American Public Health Association annual conference’s thematic focus on preventing violence provided an illustration of the extent of the overwhelming demands on state public health agencies right now. Not only do you need to face the daily challenges of responding to the COVID-19 pandemic, you also need to address ongoing, complex issues like violence prevention.

The sheer breadth of sessions available at APHA shows the broad scope of public health’s reach and the need for multi-level, multi-sector interventions, all with a shrinking public health workforce. The conference’s sessions painted clear pictures of the critical public health issues our country currently faces, but did not showcase many solutions, perhaps leaving state health agency leaders wondering how to tackle these taxing demands coming from every direction with no end in sight.

BerryDunn has a suggestion: practice organizational self-care! It might seem antithetical to focus maxed-out resources on strengthening systems and infrastructure right now, but state public health agencies have little choice. You have to be healthy yourself in order to effectively protect the public’s health. Organizational health is driven by high-functioning systems, from disease surveillance and case investigation to performance management, and quality improvement to data-informed decision-making.  

State health agencies can use COVID-19 funding to support organizational self-care, prioritizing three areas: workforce, technology, and processes. Leveraging this funding to build organizational capacity can increase human resources, replace legacy data systems, and purchase equipment and supplies. 

1. Funding new positions with COVID sources can create upward paths for existing staff as well as expanding the workforce. 
2. Assessing the current functioning of public health data systems identifies and clarifies gaps that can be addressed by adopting new technology platforms, which can also be done with COVID funding.
3. Examining the processes used for major functions like surveillance or case investigation can eliminate unproductive steps and introduce efficiencies. 

So what now? Where to start? BerryDunn brings expertise in process analysis and redesign, an accreditation readiness tool, and an approach to data systems planning and procurement―all of which are paths forward toward organizational self-care. 

1. Process analysis and redesign can be applied to data systems or other areas of focus to prioritize incremental changes. Conduct process redesign on a broad or narrow scale to improve efficiency and effectiveness of your projects. 

2. Accreditation readiness provides a lens to examine state health agency operations against best practices to focus development in areas with the most significant gaps. Evaluate gaps in your agency’s readiness for Public Health Accreditation Board (PHAB) review and track every piece of documentation needed to meet PHAB standards.
3. Data system planning and procurement assistance incorporates process analysis to assess your current system functioning, define your desired future state, and address the gaps, and then find, source, and implement faster, more effective systems. 

Pursuing any of these three paths allows state health agency leaders to engage in organizational self-care in a realistic, productive manner so that the agency can meet the seemingly unceasing demands for public health action now and into the future.

Read this if your agency is planning to procure a services vendor.

In our previous article, we looked at three primary areas we, or a potential vendor, consider when responding to a request for services. In this follow-up, we look at additional factors that influence the decision-making process on whether a potential vendor decides to respond to a request for services.

• Relationship with this state/entity―Is this a state or client that we have worked with before? Do we understand their business and their needs?
  
  A continuing relationship allows us to understand the client’s culture and enables us to perform effectively and efficiently. By establishing a good relationship, we can assure the client that we can perform the services as outlined and at a fair cost.
• Terms and conditions, performance bonds, or service level agreements―Are any of these items unacceptable? If there are concerns, can we request exceptions or negotiate with the state?
  
  When we review a request for services our legal and executive teams assess the risk of agreeing to the state’s terms and compare them against our existing contract language. States might consider requesting vendors provide exceptions to terms and conditions in their bid response to open the door for negotiations. Not allowing exceptions can result in vendors assuming that all terms are non-negotiable and may limit the amount of vendor bid responses received or increase the cost of the proposal.
  
  The inclusion of well-defined service level agreements (SLAs) in requests for proposals (RFPs) can be an effective way to manage resulting contracts. However, SLAs with undefined or punitive performance standards, compliance calculations, and remedies can also cause a vendor to consider whether to submit a bid response.
  
  RFPs for states that require performance bonds may result in significantly fewer proposals submitted, as the cost of a performance bond may make the total cost of the project too high to be successfully completed. If not required by law that vendors obtain performance bonds, states may want to explore other effective contractual protections that are more impactful than performance bonds, such as SLAs, warranties, and acceptance criteria.
• Mandatory requirements―Are we able to meet the mandatory requirements? Does the cost of meeting these requirements keep us in a competitive range?
  
  Understanding the dichotomy between mandatory requirements and terms and conditions can be challenging, because in essence, mandatory requirements are non-negotiable terms and conditions. A state may consider organizing mandatory requirements into categories (e.g., system requirements, project requirements, state and federal regulations). This can help potential vendors determine whether all of the mandatory requirements are truly non-negotiable. Typically, vendors are prepared to meet all regulatory requirements, but not necessarily all project requirements.
• Onsite/offsite requirements―Can we meet the onsite/offsite requirements? Do we already have nearby resources available? Are any location requirements negotiable?
  
  Onsite/offsite requirements have a direct impact on the project cost. Factors include accessibility of the onsite location, frequency of required onsite participation, and what positions/roles are required to be onsite or local. These requirements can make the resource pool much smaller when RFPs require staff to be located in the state office or require full-time onsite presence. And as a result, we may decide not to respond to the RFP.
  
  If the state specifies an onsite presence for general positions (e.g., project managers and business analysts), but is more flexible on onsite requirements for technical niche roles, the state may receive more responses to their request for services and/or more qualified consultants.
• Due date of the proposal―Do we have the available proposal staff and subject matter experts to complete a quality proposal in the time given?
  
  We consider several factors when looking at the due date, including scope, the amount of work necessary to complete a quality response, and the proposal’s due date. A proposal with a very short due date that requires significant work presents a challenge and may result in less quality responses received.
• Vendor available staffing―Do we have qualified staff available for this project? Do we need to work with subcontractors to get a complete team?
  
  We evaluate when the work is scheduled to begin to ensure we have the ability to provide qualified staff and obtain agreements with subcontractors. Overly strict qualifications that narrow the pool of qualified staff can affect whether we are able to respond. A state might consider whether key staff really needs a specific certification or skill or, instead, the proven ability to do the required work.
  
  For example, technical staff may not have worked on this particular type of project, but on a similar one with easily transferable skills. We have several long-term relationships with our subcontractors and find they can be an integral part of the services we propose. If carefully managed and vetted, we feel subcontractors can be an added value for the states.
• Required certifications (e.g., Project Management Professional^® (PMP^®), Cybersecurity and Infrastructure Security Agency (CISA) certification)―Does our staff have the required certifications that are needed to complete this project?
  
  Many projects requests require specific certifications. On a small project, maybe other certifications can help ensure that we have the skills required for a successful project. Smaller vendors, particularly, might not have PMP®-certified staff and so may be prohibited from proposing on a project that they could perform with high quality.
• Project timeline―Is the timeline to complete the project reasonable and is our staff available during the timeframe needed for each position for the length of the project?
  
  A realistic and reasonable timeline is critical for the success of a project. This is a factor we consider as we identify any clear or potential risks. A qualified vendor will not provide a proposal response to an unrealistic project timeline, without requesting either to negotiate the contract or requesting a change order later in the project. If the timeline is unrealistic, the state also runs the risk that the vendor will create many change requests, leading to a higher cost.

Other things we consider when responding to a request for services include: is there a reasonable published budget, what are the minority/women-owned business (M/WBE) requirements, and are these new services that we are interested in and do they fit within our company's overall business objectives?

Every vendor may have their own checklist and/or process that they go through before making a decision to propose on new services. We are aware that states and their agencies want a wide-variety of high-quality responses from which to choose. Understanding the key areas that a proposer evaluates may help states provide requirements that lead to more high-quality and better value proposals. If you would like to learn more about our process, or have specific questions, please contact the Medicaid Consulting team.

Read this if your agency is planning to procure a services vendor. 

Every published request for services aims to acquire the highest-quality services for the best value. Requests may be as simple as an email to a qualified vendor list or as formal as a request for proposal (RFP) published on a state’s procurement website. However big or small the request, upon receiving it, we, or a potential vendor, triages it using the following primary criteria:

1. Scope of services―Are these services or solutions we can provide? If we can’t provide the entire scope of services, do we have partners that can?
   As a potential responding vendor, we review the scope of services to see if it is clearly defined and provides enough detail to help us make a decision to pursue the proposal. Part of this review is to check if there are specific requests for products or solutions, and if the requests are for products or solutions that we provide or that we can easily procure to support the scope of work. 
2. Qualifications―What are the requirements and can we meet them?
   We verify that we can supply proofs of concept to validate experience and qualification requirements. We check to see if the requirements and required services/solutions are clearly defined and we confirm that we have the proof of experience to show the client. Strict or inflexible requirements may mean a new vendor is unable to propose new and innovative services and may not be the right fit.
3. Value―Is this a service request that we can add value to? Will it provide fair compensation?
   We look to see if we can perform the services or provide the solution at a rate that meets the client’s budget. Sometimes, depending upon the scope of services, we can provide services at a rate typically lower than our competitors. Or, conversely, though we can perform the scope of services, the software/hardware we would have to purchase might make our cost lower in value to the client than a well-positioned competitor.

An answer of “no” on any of the above questions typically means that we will pass on responding to the opportunity. 

The above questions are primary considerations. There are other factors when we consider an opportunity, such as where the work is located in comparison to our available resources and if there is an incumbent vendor with a solid and successful history. We will consider these and other factors in our next article. If you would like to learn more about our process, or have specific questions, please contact the Medicaid Consulting team.
 

Read this if you or your government agency may be interested in project management or a project management office.

You may think that PMO stands for Project Management Office, Program Management Office, or Portfolio Management Office, and you would be correct. However, when establishing your PMO priorities, think:
1.    P – Planning and Processes
2.    M – Motivation
3.    O – Operations

Determining where your organization will focus your efforts is fundamental to the successful functioning of the PMO, whether the PMO is well established or just getting started. With multiple competing projects and initiatives, spending some time planning and developing your PMO priorities in the short term will save you time and effort moving forward. 

According to the Project Management Institute’s (PMI’s) research, they reported that "aligning projects and strategic objectives has the greatest potential to add value to an organization.” 

The “value” here must be determined by each organization, but through establishing your PMO priorities early, you promote a culture of project management in order to gain greater experience in project management practices and personnel. This allows for more efficient processes, more focused and flexible project managers, greater scope, schedule, and budgetary control, and ultimately more successful projects implemented.

Planning and processes

The first step in establishing the priorities for your PMO requires planning and evaluating existing processes. Identifying all projects for the upcoming year is an excellent place to start. For each project or initiative, you will want to pull together information that will assist you in the prioritization process. This may include items such as type of project, expected outcomes, aligned strategic objective(s), targeted length of the project, targeted start date, funding sources, types of approvals needed, resource capacity, and risk versus reward analysis. Each organization can make the determination of what kind of information is necessary in this step to make prioritization more streamlined and specific to their current structure and processes.

As new team members enter and exit project work, there is a risk that knowledge transfer of the PMO processes get lost, or deviations in processes begin to occur. PMI notes “high-performing organizations succeed through a strategic focus on people, processes, and outcomes” and 74% of these high-performing organizations are supported by a PMO. Taking the opportunity for continuous process improvement―to review and share the PMO processes and templates with the organization on a reoccurring basis―helps to ensure consistency across programs within the organization. With consistency comes efficiency, allowing your project teams to focus on the work at hand, and not recreate processes. Consistency and efficiency will help streamline administrative activities, improve resource estimates, and increase the likelihood that projects will come in on time and on budget.

Motivation 

The second step in establishing PMO priorities is motivation. Having a working knowledge of your organization will help in this step―knowing what excites or drives them to succeed. Motivating factors may vary for different organizations. For example, if you’re a government entity, the deciding factor in priority may be a legislative mandate. Early identification of your organization’s motivating factors allows you to expedite the prioritization efforts and increase planning time for high-priority projects, including aligning resources sooner. Here are a few ideas to consider when thinking about finding what motivates people in your organization:

• Durations/meeting timeframes
• Legislation/mandates
• Strategic plans and goals
• Recognition
• Policy
• Outcomes/potential impacts
• Level of risk
• Return on Investment (ROI)

Operations

The third step in establishing PMO priorities is operations. By outlining operational aspects of the projects before establishing your PMO priorities, you can see the big picture and organizational strategy. Per PMI, organizations which “align their PMO to strategy report 38% more projects meet the original goals and business intent, while 33% fewer projects are deemed as failures.” This allows you to understand dependencies between projects, identify possible duplication or gaps, and plan for resources earlier. Below are a few examples to consider with this step:

• High-level strategy (will the work be delivered in phases or at the end of the project)
• Approximate Full-Time Equivalents (FTEs) required
• Skill level needed for the resources
• Organizational charts and reporting relationships
• Approximate cost for the project/initiative

Now that you are aware of the three steps―planning and processes, motivation, and operations, you are ready to begin establishing your PMO priorities. Evaluating all three steps helps ensure you’ve considered everything before prioritizing the work, although some items may clearly have more weight than others. There is no magic formula for establishing PMO priorities, and given the same projects, different organizations would have different priorities. One organization may define and identify project work as high, medium, or low, while another PMO may number projects, with number one being the first project to start. Either way is right. 

The important take-away is for your PMO to develop a consistent methodology as you are establishing priorities now and in the future. 

Does your organization need help establishing your PMO processes, prioritizing, or developing strategic plans? Contact our Medicaid Consulting team for more information on how we can help.

Resources cited

Project Management Institute. PMI’s Pulse of the Profession: The High Cost of Low Performance. PMI.org. Accessed July 8, 2020. https://www.pmi.org/-/media/pmi/documents/public/pdf/learning/thought-leadership/pulse/pulse-of-the-profession-2014.pdf?v=eb9b1ac0-8cad-457f-81ec-b09dbb969a38 
Project Management Institute. PMI’s Pulse of the Profession – 9th Global Project Management Survey: Success Rates Rise – Transforming the High Cost of Low Performance. PMI.org. Accessed July 8, 2020. https://www.pmi.org/-/media/pmi/documents/public/pdf/learning/thought-leadership/pulse/pulse-of-the-profession-2017.pdf