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Refactoring in Medicaid Modernization: What States Should Know

Two colleagues are sitting side by side at a desk exploring ways to modernize Medicaid, with one of the individuals pointing to something interesting on an open laptop

Medicaid modernization is a journey. At Gainwell Technologies, we know this journey well from helping states across the country create their modernization roadmaps. No two journeys are alike. They are shaped by existing systems, desired impacts and, of course, budgets.

Modernization and the Power of “Re”

A fundamental step in any Medicaid modernization journey is determining the activities that states should focus on to realize their objectives. These may include:  

    • Relearning. Capturing and preserving investments in existing applications through the modernization process.

    • Rehosting. Migrating legacy mainframe applications to lower-cost platforms.

    • Reinterfacing. Creating new interfaces to extend the features and value of legacy applications.

    • Rearchitecting. Engineering applications to enable true enterprise agility.

    • Retiring. Decommissioning legacy application from the application portfolio.

    • Refactoring. Optimizing code to improve application performance.

The Buzz About Refactoring

Refactoring involves analyzing legacy mainframe applications, creating baseline metrics for performance measurement, assessing code performance at runtime, identifying inefficient code segments and restructuring code. 

Done well, refactoring can deliver better code performance. It can also reduce the business risk of excessive batch windows or transaction response time. And it can defer or even eliminate mainframe capacity upgrades and help fund future modernization.

Many states are curious about refactoring. Why? Some with legacy code and no documentation see the opportunity to make changes without massive reengineering. Others with legacy infrastructure — think decades-old Cobol mainframes — see the opportunity to reduce their vulnerability to developer shortages if problems with the system arise. Not surprisingly, we also see states pursuing refactoring to avoid the cost of migration and replacement — making “lean changes” to the backend while creating a more modern front end. 

The Dos and Don’ts of Refactoring 

Over the last several years, Gainwell has helped numerous states achieve critical outcomes on refactoring initiatives. These outcomes include significant improvements in reverse engineering efficiency end quality and total cost of ownership savings on modernization initiatives.

Based on this experience, we know what states need to do to be successful. In fact, we believe that any state Medicaid agency considering refactoring should understand these top dos and don’ts: 

Do Have the Right Resources
Don’t Make It All About the Tools 

It’s easy to assume that refactoring is effectively a retooling exercise. However, there is much more to get right. It’s essential that agencies work with partners that have strong domain expertise and the right resources. Refactoring should never be done without a clear understanding of — and express connection to — the business case. It’s essential to take a big-picture approach that goes beyond toolsets and pure execution to include intentional investment in discovery and architecting the future state.

Do Make Time for Quality Practices
Don’t Sacrifice Quality for Speed

Another misperception we run into with refactoring relates to the speed and quality equation, which is key in any transformation effort. Some Medicaid agencies expect refactoring to be a quick fix. It’s true that it’s faster than new development, and that parallel activities can happen on a much broader scale. However, agencies shouldn’t move so quickly that they don’t determine the parity of both the systems or neglect quality practices in development and quality assurance.  

Do Focus on Business and Culture Change
Don’t Focus Solely on System Change 

When we work with states on refactoring, we never take a system-only view of the transformation. If Medicaid agencies don’t account for the broader implications of change, the risk of failure is very real in even the most circumscribed refactoring initiatives. It’s key to plan from the start to address the business impact and understand how the culture must evolve to support new ways of working. 

Do Know Your Risk Appetite 
Don’t Assume There is No Risk 

Medicaid agencies should take a clear-eyed view of risk when it comes to refactoring complex systems. These initiatives typically have lower risk than modernization through replacement. This is largely because they are completed in a very systematic way. However, risk increases if refactoring goes beyond recoding what exists to recoding new functionality. This is why agencies must know their risk appetite going in and align their approach accordingly.

From Assets to Outcomes

If refactoring is part of your roadmap, be sure to choose a transformation partner with a full suite of assets, hands-on Medicaid systems experience and a disciplined refactoring methodology, as these are prerequisites to an effective and efficient refactoring effort. At Gainwell, we bring a proven methodology, deep MMIS experience, strong commitment to quality and clear understanding of the market. Our assets are your springboard to outcomes. Don’t hesitate to contact us to learn more.