Navigating the Medicaid Modernization Minefield: The Role of the System Integrator

Date: May 11, 2017||   0  Comments

Contributed by Matthew Moreau 
Matthew Moreau is the VP Solution Strategy, Government Healthcare Solutions, Conduent

As technology has advanced, Medicaid platforms have become increasingly complex. To help States successfully and efficiently modernize their platforms, CMS has guided them to break their procurements into smaller pieces so multiple vendors can work on facets of the project in which they have the most expertise.

As a result, system integrators are tasked with working in conjunction with each modularity vendor, connecting disparate technology and ultimately keeping the project on track.

My colleagues and I recently had the opportunity to discuss the role system integrators play in supporting platform modernization projects during a standing-room only roundtable session at the 2017 State Healthcare IT Connect Summit. Three themes rose to the top of our conversation:

1. Change management.
All parties are still adjusting to multiple vendors being involved in a Medicaid modernization project. The system integrator often enters an agreement while there is still much uncertainty with active procurements for the platform modules. For instance, the system integrator may not be aware of what the specific technology solutions module vendors will use, or even the vendors that will be involved in the project.

2. Accountability vs. authority.
The overall goal for the system integrator is to create an environment in which different vendors can work collaboratively, and ultimately ensure a project is completed on time. But at the same time, the system integrator might not always have the authority to take action when needed to meet those goals. An important question for State Medicaid programs to consider and system integrators to understand is, “when there’s a bump in the road and something goes sideways – what authority does the system integrator have to make or impact change?”

3. Contracting terms.
Contracts need to align with accountability and authority, and need to be as clear as possible in the role of the system integrator. It’s important for States to make their contracts appealing for bidders while still protecting themselves and ensuring a cost-effective implementation. Vague contract terms create risks for both parties (State and vendor) and often forces vendors to add assumptions and contingencies to their bid during the procurement process.

Conduent has extensive experience in Medicaid management, providing administrative and care management solutions to Medicaid programs and federally funded U.S. government healthcare programs in 26 states, Puerto Rico and the District of Columbia. Conduent has also received CMS certification for its Pharmacy Benefit Management module, the Conduent Flexible Rx System. We expect the role of the system integrator to become more standardized as more States begin their modernization projects. We look forward to observing how the system integrator role continues to evolve and continuing this conversation at next year’s State Healthcare IT Connect Summit!

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