MS DOM Slashes IT Modernization Costs and Accelerates Timelines with Progress Data Platform
Challenge
MS DOM's critical operations, including claims adjudication (MESA), eligibility determination and managed care coordination, ran on siloed systems within separate vendors, driving up the cost and complexity of consolidating data for reporting and analytics. The fragmented nature of the data also made it difficult to comply with the CMS-mandated HL7 FHIR/USCDI standards for data sharing among providers, payers and beneficiaries.
Solution
- Implement the Progress Data Platform as a cloud-based operational data store (ODS) that consolidated administrative, claims, eligibility and clinical data into a reusable and scalable foundation.
- Leverage a Modernize-in-Place strategy with a flexible, standards-based architecture that met data interoperability requirements (FHIR, USCDI) without removing existing systems, accelerating modernization.
- Use native UI tooling to build rich end-user applications that enabled staff to query and analyze consolidated data, providing insights to detect fraud and abuse and generating financial reports for transparent public spending.
Result
- Delivered Provider Directory, Patient Access and advanced requirements for Provider Payments and Newborn Births (PC02) in less than 12 months.
- Obtained dramatically faster procurement and deployment cycles at roughly one-third the cost of the original RFP path, avoiding multi-year delays.
- Achieved readiness for future CMS rules and AI-driven use cases like policy analysis and eligibility scenarios.
Full Story
Challenge
The Mississippi Division of Medicaid (MS DOM) administers health coverage for eligible low-income Mississippians across the state. When the Centers for Medicare and Medicaid Services (CMS) final rules 9115 and 0057 mandated HL7 FHIR and USCDI standards for interoperable data sharing among providers, payers and beneficiaries—compliance became non-negotiable. But critical operations, including claims adjudication (MESA), eligibility determination and managed care coordination, ran on siloed custom-built legacy systems that created data barriers and lacked cloud readiness.
Three years into its modernization journey, the Mississippi Division of Medicaid was at a breaking point. Approaching deadlines and a slow procurement process stalled progress toward its goals, exposing the agency to potential penalties, staff turnover and delayed beneficiary outcomes. Sustaining momentum and stakeholder confidence required a faster path that preserved service quality and operational agility while navigating necessary regulatory processes.
Our experience with Progress has been different from other vendors in that we've really had a great relationship from day one. The software is excellent, and the people are even better. We've got a great team from Progress, great software and great solutions that are solving real-world day-to-day challenges for our agency today.
Chris Smith
Enterprise Architect at Mississippi Division of Medicaid
Solution
The Mississippi Division of Medicaid implemented the Progress® Data Platform as an operational data store (ODS) to consolidate administrative, claims, eligibility and clinical data into a single, reusable foundation that breaks down longstanding data silos. This strategic pivot enabled the agency to layer cloud-based, commercial off-the-shelf solutions atop its existing legacy systems through an incremental modernization approach, avoiding the high risks and delays of a full rip-and-replace overhaul.
"Our organization selected the Progress Data Platform for the ability to use it as an operational data store or ODS. We're going to put all our data into this platform: our administrative data, our claims data, our eligibility data and our clinical data," said Chris Smith, Enterprise Architect. "And we're going to reuse this ODS to fund and power all the requests for information that are internal and external to the agency."
The platform’s native support for JSON, XML and RDF data formats was key to positioning the agency for seamless healthcare data interoperability under CMS final rules 9115 and 0057, while its market-leading security controls meant that electronic health records could be securely shared in real time.
Using the platform’s native UI tools, the agency built a user app on top of the consolidated information to empower staff to search and analyze claims and financial data, providing insight into public spending and helping to detect fraud and abuse.
Result
The modernized platform delivers consistent, reliable outcomes for Medicaid beneficiaries across Mississippi by enabling secure, standards-based data sharing among providers, payers, internal programs and external partners.
The solution delivers full compliance and interoperability with federal standards such as FHIR and USCDI, enabling readiness for current and future CMS requirements. It also provides significant cost savings, costing roughly one‑third of the original RFP approach and eliminating the need for expensive change orders. Additionally, its scalable, standards‑based, and reusable architecture offers the agility needed to adapt to evolving regulations and emerging use cases.
The agency is now exploring expansion into AI use cases, including using generative AI for policy analysis to scans thousands of state plan and administrative code pages from the 1990s and identify gaps between CMS commitments and codified rules. MS DOM is also looking to apply the generative AI capabilities towards eligibility programs to reduce call center response times.
"Our experience with Progress has been different from other vendors in that we've really had a great relationship from day one. The software is excellent, and the people are even better," Smith noted. "We've got a great team from Progress, great software and great solutions that are solving real-world day-to-day challenges for our agency today."
Our organization selected the Progress Data Platform for the ability to use it as an operational data store or ODS. We're going to put all our data into this platform: our administrative data, our claims data, our eligibility data and our clinical data. And we're going to reuse this ODS to fund and power all the requests for information that are internal and external to the agency.
Chris Smith
Enterprise Architect at Mississippi Division of Medicaid