Health Tech

Identifying the Right Architecture for a Modern Medicaid System

Designing and implementing a modern Medicaid management system can seem daunting. While this type of initiative is certainly complex, a good place to start is by identifying the architecture which will serve as the foundation for the system.

There are three broad categories of system architectures that your organization might consider:

  1. On-premise or “on-prem.” Historically, most IT systems have used an on-premise architecture where software is installed and run on physical servers onsite at the client’s location. This approach has several drawbacks. It is often costly and difficult to maintain. Anytime the system needs updates, your IT staff will be responsible for scheduling and deploying either patches or full system upgrades. In addition, servers and other hardware can fail, causing system downtime.
  2. Cloud. A cloud-based architecture can either be client-hosted or vendor-hosted. In a client-hosted cloud system, your IT team will outsource servers and other hardware to a cloud provider for management. This approach tends to be more scalable and cost-efficient than an on-premise architecture. It also eliminates hardware-related headaches for IT staff. On the other hand, deploying and updating software can be complicated, since the software vendor and the cloud provider are separate entities.
    In contrast, with a software vendor-hosted cloud system, the software vendor manages both the software applications and the cloud vendor where the applications run. For example, the software vendor might manage Amazon Web Services on behalf of its customers. This can generate cost savings, since organizations don’t have to pay fees separately to a cloud vendor. It also eliminates any challenges associated with deploying and updating software in the cloud, since the software vendor handles that.
  3. Software-as-a-Service (SaaS) cloud. Unlike the software vendor-hosted cloud model, with the SaaS cloud approach, a software vendor is responsible for managing both the cloud environment and the software application customers use. Using the same cloud infrastructure, the vendor can manage the system for multiple clients. This generates significant savings from an infrastructure and product cost perspective.

When considering which of these approaches to use, keep in mind that many organizations across industries have adopted SaaS cloud solutions to support their operations. This model is gaining momentum for a variety of reasons.

  • Shorter implementation timelines and higher levels of system uptime. The processes for deploying SaaS-based systems tend to be repeatable and scalable, so implementation schedules are usually shorter than with other architectures. System uptime is also often better than with other models, since SaaS vendors are committed to outstanding system stability to meet service level agreements.
  • Headache-free software upgrades and hardware maintenance. When it comes to software enhancements, SaaS systems are far ahead of other models, since new product functionality can be released regularly, with limited or no customer involvement. There’s no need for IT teams to schedule system downtime or apply updates. From a hardware perspective, vendors also handle all maintenance and upgrades centrally.
  • Lower costs. The cost of SaaS solutions is also lower than other deployment models. Customers pay a subscription fee to participate in the network, rather than paying to deploy, host and manage the software solution on their own.

Gainwell has adopted a fully SaaS-based architecture for its Medicaid Management platform. This includes modules for Claims, Encounters and Financials; an EDI Gateway and Clearinghouse; Provider Service; Managed Care; and Prior Authorization. As the #1 Medicaid services provider in the United States, we support over 56 million beneficiaries and serve over 3 million providers annually with our systems.

To learn more about issues related to Medicaid Management technology and how Gainwell can help, download our white paper—Navigating the healthcare technology revolution: How states can prepare for the next generation of Medicaid Management systems.

The editorial staff had no role in this post's creation.