The Quest for Medicaid Modularity: What To Look for in a Systems Integration Platform
Across the country, state Medicaid agencies are shifting away from monolithic Medicaid Management Information Systems (MMIS) in favor of more modular Medicaid Enterprise Systems (MES). The journey to modularity, however, isn’t always easy. Common challenges include:
- Compliance. The goals of the Centers for Medicare and Medicaid Services’ (CMS’) Cures Act Final Rule focus on two areas: access and choice. Patients should have access to their data at no additional cost, using the tools they choose.
- Program governance. States need to develop a cohesive approach to governance. This requires effective data management across all MES modules.
- Integration risks. The greatest risk in the modularization journey is onboarding the claims, encounters and financial module, which is highly complex.
- Long implementation timelines. Selecting an implementation partner with limited Medicaid domain expertise or partnering with several vendors that have varying levels of expertise and experience can lead to complications and longer implementation schedules.
- Custom builds, rather than configurable systems. Customization limits flexibility, scalability and ease of system upgrades.
- New requirements for technical expertise and staff. Modular systems mean that IT teams and other users may need new skills, such as working with cloud solutions or integrating systems.
While implementing an MES may seem daunting, a systems integration platform can dramatically reduce the effort required to make this transition.
Simplifying Medicaid Modularity With a Systems Integration Platform
CMS recommends state agencies use a systems integration (SI) platform to connect modules in their MES. An SI platform serves as the heart of an MES, facilitating data exchanges within the ecosystem. Not all SI platforms are created equal, however.
When evaluating an SI platform for your MES, it’s a good idea to ask these six questions:
- Is the solution cloud-agnostic? Cloud-agnostic platforms enable state agencies to move workloads to different cloud platforms while supporting robust security, governance, scalability, reliability and unified management. The result is more efficient operations. Cloud-agnostic solutions also help prevent vendor lock-in and make it easier to implement new capabilities over time.
- Does the platform offer seamless connectivity? State agencies should look for SI platform solutions that efficiently connect modules and provide services that will improve care access and outcomes.
- Will the platform serve as a driver of governance? It’s important to consider whether the SI platform will support the implementation of effective data management across all MES modules.
- Has the platform been designed using an advanced enterprise architecture? For example, are standardized API services available so members can securely access their health history? Can third-party apps access the information they need? Another key consideration is whether the architecture is multi-tenant. This approach lowers costs, improves efficiencies and simplifies deployments.
- Does the platform comply with industry standards? CMS requires modular systems to offer seamless coordination and integration across state and federal information systems. Standardized messaging and communication protocols are critical to exchanging data across the healthcare ecosystem. To comply with state and federal regulations, it’s essential that SI platforms use industry standards like FHIR and EDI for information exchange. Solutions should also comply with MITA, MECT and HIPAA, as well as state-specific regulations.
- Is robust monitoring a part of the platform? Integrated dashboards and analytics are essential for monitoring key performance indicators and ensuring SLAs are met.
When evaluating SI platform solutions, conducting due diligence up front can help ensure you select the right one for your agency’s needs. Download our Systems Integration and Interoperability Modernization Roadmap for more insights to help accelerate the implementation of an integrated MES.