Modular systems for Medicaid Administration

The Medicaid program has accrued political significance due to its positive impact on the health of underprivileged citizens. As a result, there has been constant fine-tuning of its policies (Affordable Care Act being the last update) to improve its reach to the needy sections cutting across the society. Simultaneously, the diversity and complexity of the program has increased too, alongside ever-sharpening compliance procedures.

From technology perspective, this necessitates continuous transformation of the systems to accommodate the compliance needs, and fraud and risk prevention regulations. However, the situation is complicated by legacy systems that have been in use for long, and, which, cannot be discarded in short notice. The Medicaid Enterprise System of today needs to be flexible in not just meeting the present needs, but also capable of incorporating changes for future needs.

Call for Modular approach

Even though there has been a tremendous increase in data creation, the outdated Medicaid systems do not have intelligence to harness it for fraud and risk identification. Since, the legacy systems are too ingrained to be discarded, the need for modular solutions for specific tasks has spiraled up.

The importance of modular approach has been recognized by Medicaid Information Technology Architecture (MITA) which enjoins ‘modularity standard’ as the first among the seven conditions and standards for Federal funding compliance. Among the seven are ‘business results condition’ and ‘interoperability condition’ too, which can be better addressed if the solution is modular.

Further, given the ever-expanding Medicaid system, it is no longer feasible to have multi-year, large-scale, ground-up implementation. Instead, the brownfield implementation, i.e. building over and above the legacy systems are rapidly gaining ground. While traditional project is hard to deploy in the timely and efficient fashion, this new way has an added advantage of giving industry stakeholders the power to delegate parts of their implementation to innovators.

Short-term implementations within short project spans is empowering the Medicaid Enterprise System, helping it navigate through the complex processes faster instead of waiting for long-term fixes. Additionally, the long-term implementation is handicapped by the fast-evolving technology landscape as well. In short periods of time, a technology is realizing its full life cycle and nearing maturity level, whereas, in the interim, more nimble technologies are trending in the market.

Modular systems, then, make more business sense.

Benefits from Modular approach

  • Faster implementation: To evolve the system in tandem with the changes in compliance, there is a need for faster project execution. It enables the stakeholders to deploy a pilot project faster, instead of following the standard bureaucratic procedure which will move at its own pace, and whose implementation the stakeholders don’t have much control over. A phased deployment will help fix the more urgent needs first, while giving a real-time report on the project progress.
  • Future-proofing systems: The pace of technological change cannot be controlled, but the systems can be implemented such that it makes one easier to accommodate changes as needed. A component-based framework will help future-proof the system in a way, thereby improving cost-effectiveness and efficiency gains.

Minimizing Total Cost of Ownership: The changes necessitated by policy updates do not necessarily require ground-up efforts. Instead, by configuring the modular systems into the main enterprise system, the requisite changes are executed without hassle. Therefore, every time there is a policy change, the systems do not need to be ripped and replaced. Rather, by infusing modular solutions, there can be a seamless system integration at each iteration, cumulatively reducing the total cost of ownership.

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