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Medicaid Modernization: Your Path May Vary

An aerial view of a blue and grey illustrated map with a line running through the center. As the line moves from left to right, it turns from yellow to red and has a circle and arrow in the middle signifying a point of focus.

A few weeks ago, I had the privilege of sitting down with Gainwell Technologies clients at MESC in Denver. Now I’m preparing to continue such conversations at the National Association of Medicaid Directors (NAMD) Conference in Washington, D.C.

These discussions affirm that state Medicaid agencies are intensifying efforts to transform healthcare for their members. But while they all share that same mission, agencies are taking multiple technology modernization paths to get there. These paths are informed by the states’ policy priorities, health technology ecosystems and budgets.

Some states are choosing to completely replace their legacy systems. Some are continuing their modularization journey. Others are turning toward a lower-risk alternative to modularization: modernizing in place. That approach acknowledges that modernization isn’t an all-or-nothing endeavor, and it’s a strategy we’re here to support as our clients advance toward an outcomes-based future.

“Don’t Move — Improve?”

What’s driving so many states to consider modernization in place? What I’ve heard loud and clear is that they want to move to a more modern system architecture. They’re seeking the benefits of greater system flexibility and agility alongside simpler, less costly maintenance. But they want those benefits without undergoing a massive system conversion.

It’s the enterprise systems equivalent of renovating a home instead of uprooting and moving somewhere new.

The good news? Today’s technology makes it possible for states to start small and advance incrementally, enhancing their systems when, where and how it makes the most sense for their programs and members. They’re preparing for phased implementations of systems and starting to request certification of modules beyond those in CMS’ Streamlined Modular Certification (SMC) guidance — trends highlighted by CMS in its “State of State Systems” address at MESC.

Planning for Outcomes

Integration platforms and partners like Gainwell are helping states align modernization strategies to desired outcomes and orchestrate people and systems to achieve those outcomes.

We appreciate the scope and importance of the work that Medicaid agencies do, and we’re committed to supporting states whether they choose to replace a legacy system, continue with modularization or modernize in place.

Every roadmap needs to be thoroughly grounded in outcomes — with flexibility to continuously adapt to state health policy objectives, respond to emerging health trends, harness technological innovations and manage cost of care.

It's a journey we’ll continue to explore with our clients at NAMD and beyond.

About the Author

Mark Knickrehm is chairman and chief executive officer of Gainwell Technologies. He leads an experienced team that empowers clients through technology to deliver health and human services programs that enable successful outcomes for beneficiaries nationwide.

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