Colorado Medicaid Enterprise Solutions (CMES) Transition
The Colorado Medicaid Enterprise Solutions (CMES) ecosystem is comprised of multiple system modules that together operate the Health First Colorado (Colorado’s Medicaid program), Child Health Plan Plus (CHP+), and other health coverage programs for Coloradans who qualify. Each of these modules serves a critical role in the ecosystem that supports our providers, Regional Accountability Entities (RAEs), counties, case managers, and other partners who provide quality care for our members.
Currently, the CMES ecosystem consists of four core modules.
- Medicaid Management Information System, operated by Gainwell Technologies
- Pharmacy Benefit Management System, operated by Prime Healthcare
- Business Intelligence Data Management system, operated by IBM
- Colorado Benefits Management System, built by Salesforce and operated by Deloitte
HCPF is increasing the number of modules in its CMES ecosystem to 16 in the current procurement, enabling the individual modules to focus on delivering specific technical or operational expertise that one large module vendor alone cannot for HCPF’s various programs. Modular procurements are a CMS requirement to maintain our enhanced federal funding. Modular procurements also allow HCPF to select the best vendor for each area of expertise and to replace modules as needed or as technology changes (avoiding vendor lock-in).
What is a module?
A “module” is a distinct health information solution (individual system) in the CMES. Each CMES module is a self-contained business process, or group of processes, implemented through software, data, and connections to other modules to enable more scalable, reusable solutions.
Send questions or comments to hcpf_cmes@state.co.us.