Three Potential – And Logical – Waves for Medicaid Modular Modernization
We have talked about modularity before — in a white paper and in our previous blog, Three questions to guide your journey to modularity. As a quick refresher, CMS challenged states to implement modularity with specific characteristics outlined in its Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems rule1 — to improve customer support and provide health and human services more efficiently and cost-effectively.
There are many benefits to modularity and modernization, but that doesn’t necessarily mean it’s a simple process, given the many potential pieces and players in the puzzle. Gainwell Technologies recommends a carefully planned approach and thoughtful sequencing of modules based on complexity, benefits and state-specific needs.
Here are three possible waves for an approach your state can take:
First wave — Use your existing enterprise service bus (ESB) to expedite implementing the most valuable modules. Additional strategies, such as full implementation of a system integrator (SI) layer and ESB, are options. States should partner with vendors to determine a modernization roadmap based on refining a value-versus-complexity model to be state specific. This allows for data exchanges with existing solutions.
Second wave — Bring in additional Medicaid enterprise system (MES) modular solutions after the integration foundation for modernization is in place. States will follow the designated, state-specific modernization roadmap to implement other new modular MES solutions — such as provider, pharmacy and drug rebate, third-party liability (TPL), program integrity and member management.
Third wave — Modernize the core platform for claims and encounters processing and financial management, along with the Managed Care module. These core modules have the greatest complexity.
The level of ease or complexity of modularization will depend on a state’s degree of integration and dependency on the core, as shown in the graphic, which shows survey results from early adopters illustrating the value of modernization versus the ease of modulization. Each state will need its own specific sequencing and careful planning of modules.
It’s a different path for every state, and Gainwell can partner with you to navigate your own modularity and modernization journey. You can find a road to greater efficiency, data sharing and reliability. And continue to provide the vital health and human services your community needs and wants.
For more information, read our white paper on this topic.