Systems Integration: It’s All About Enabling Quality Data Exchange

States generate and receive tremendous amounts of data in the course of administering their Medicaid programs: information about eligibility, claims, financials, pharmacy benefits and much, much more. As technology advances — and enrollment increases — the amount of data will only rise.

Under the urging of Centers for Medicare and Medicaid Services (CMS), states are now moving toward building modular Medicaid Enterprise Systems (MES) to replace their decades-old Medicaid Management Information Systems (MMIS). One of the great benefits of modularity is that the modules can come from multiple vendors that bring best practices and new ideas to specific business functions. Modules can be added or replaced as needed as they are connected via a systems integration platform, not embedded in a monolithic system.

“The best part of modularity is that states can select best-in-class technology from an array of vendors,” says Rajesh Sharma, Vice President and General Manager for Systems Integration, Data Analytics and Interoperability at Gainwell Technologies. “The challenge, however, is to ensure that these modular systems work together cohesively to support the Medicaid enterprise.”

To accomplish this, CMS has recommended that states use a Systems Integration (SI) platform to connect all the modules, providing a more integrated way to meet state agencies’ needs. The SI platform becomes the heart of the MES and facilitates all data exchanges happening in the MES ecosystem.

“The fast, efficient exchange of data with the highest quality is what it’s all about,” says Sharma. “The role of a systems integrator goes far beyond merely acting as a consultant. The systems integrator supplies the tools to translate and transform the data across system boundaries.”

Through modularity, complex MMIS systems are divided into separate, scalable components that address a specific business function. The role of a systems integrator is to enable these discrete components to work together seamlessly, ensuring greater visibility of information across programs for more informed decision-making.

“Gainwell has been in the Medicaid space for more than 50 years,” Sharma says. “If we’ve learned anything, it’s about how critically important it is for a technology partner to understand the Medicaid enterprise. Yes, systems integrators need to be highly skilled in architecting the free flow of data. But they also need to know how to connect all of that data in a way that most effectively helps a state administer its Medicaid program.”

Gainwell’s SI solution increases connectivity by promoting standardization, streamlined business processes and strong program governance. To accomplish this, the solution’s core components include:

• Real-time and near-real-time data exchanges to give states immediate insights for making faster, more-informed decisions
• Managed file transfer (MFT) to provide the secure transfer of data — including large file sizes — in an efficient and reliable manner

• Operational data store (ODS) to provide a single, up-to-date repository of data produced by the agency’s day-to-day operations
• Single sign-on (SSO) to allow access to all the modules through a single login, saving time, improving security and simplifying the user experience
• Identity relationship management to quickly verify identities and access privileges, thereby streamlining credentialing and reducing risk

“States are breaking free from their old, monolithic systems,” says Sharma. “And one of the best ways to gain freedom is through the cloud.”

A cloud-based platform allows states to capitalize on a true Software as a Service (SaaS) model and all the advantages that provides: flexibility, speed, and scalability — in both costs and capacity. Sharma warns, however, that some integrators work only with a handful of cloud vendors, which could greatly restrict the paths a state can take to fulfill its MES strategies.

“A cloud-agnostic solution allows states the flexibility to deploy on any cloud platform,” Sharma says. “And, ultimately, cloud-agnostic architecture ensures the portability of vital data.”

States should look for a systems integrator, Sharma says, that uses an agile, modern and interoperable platform to help them accelerate the evolution to a modular system. The increase in modularity will, in turn, increase their system’s ability to interact, interface and share data. And in the end, this streamlined flow of data will help states create a stronger foundation for protecting the health and well-being of the communities they serve.