In 2015, the Centers for Medicare & Medicaid Services (CMS) published the Modularity Final Rule requiring states to follow a modular approach to Medicaid management.
While many states have embraced the shift, successfully modernizing their monolithic Medicaid Management Information Systems (MMIS) to modular Medicaid Enterprise Systems (MES), the journey to modularity does not come without risk. Due to the vital role of these systems in sustaining business operations — and, particularly, the complex nature of the claims, encounters and financial modules — states must be aware of the risks associated with these large-scale implementations and leverage all available tools and resources to mitigate them.
In this podcast episode, Fierce Healthcare sits down with Rajesh Sharma, vice president and general manager of Gainwell Technologies’ systems integration, data analytics and interoperability product offering, to discuss the opportunities and challenges that modernization presents.
Based on experience supporting more than 60 modular Medicaid projects for 23 Medicaid programs, Sharma shares practical and proven strategies to help states navigate the journey to modularity as well as lessons learned to avoid potential pitfalls along the way.