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Three Questions To Guide Your Journey to Modularity

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The topic of modularity has been core to many discussions as states work toward CMS’ challenge to improve the member experience and provide health and human services more efficiently and cost-effectively.

Modularity is a key component of that — for the flexibility it provides, enabling states to select modules based on the pain points they want to address and the outcomes they want to achieve. It enables states to implement individual components that work together seamlessly to support the Medicaid enterprise.

Decisions to modernize your MMIS can be complicated and sometimes confusing. So, we’d like to offer some valuable considerations based on Gainwell Technologies’ decades of experience working with Medicaid systems.

It’s important to do modularity for the right reasons for your needs and objectives. The answers to three questions will help you determine and understand the right roadmap for your modular journey:

  • What are the program’s priorities or desired outcomes you hope to achieve? — The first step is to define where you want to go and the outcomes you want to achieve, aligned with your business goals.
  • What are the greatest business or processing pain points in your program? — Modularity should be driven by business requirements and needs, not by a technology roadmap. These can span all areas — such as claims, program integrity, care management, provider, pharmacy and drug rebate — with modules implemented on a priority, phased basis.
  • What area of your program do you feel you can and should improve? — Agencies need to have a well-thought-out organizational structure in place to support implementing a modular MES. You’ll also need strong governance to support your program, in the areas of project, technical, information, testing and operations.

Gainwell has been supporting modularity through distinct business functions for 20+ years, and we have learned many lessons that we can share with states ready to make their modularity move. With a strategic approach, you can meet your state’s goals and build a stronger foundation designed to help protect the health and well-being of your communities. And in a more efficient, streamlined, reliable way.

For more details, click here to read our white paper on this topic.