10 Simple Tips for Evaluating Medicaid Modular Solution Vendors
The push for Medicaid Modernization through modular solutions is going strong, but state Medicaid agencies still have challenges to work through. They have to contend with budget and resource constraints, higher-than-ever demand, and ongoing regulatory changes—and they need the right solutions and the right vendors to help them.
Because of our experience working with agencies with their modernization and transformation projects, the MicroPact Health, Human Services, and Benefits team has been able to help many of these agencies address their challenges. Through this work and discussions across agencies, MicroPact understands the most important criteria for choosing a vendor and defining how to work together.
Here are ten tips to guide you as you evaluate modular solution vendors.
- Consider Certification.
Certification can feel like a moving target. The checklists evolve and the Medicaid Enterprise Certification Toolkit (MECT) gets new additions—while leaving it up to each state to define modules. Look for a vendor who addresses all Medicaid checklist items and the various milestones required so the system you deploy can achieve certification and funding. Your vendor needs to understand the importance of the checklists, must be willing to assist you as you complete them, and must be able to meet the Medicaid Information Technology Architecture (MITA) 7 standards.
- Get Ready for Growth.
Recent data from Medicaid.gov states that the number of beneficiaries of Medicaid has increased to an all-time high—nearly 70,000,000 recipients. Key drivers of this increase include the 34 States that have implemented the Medicaid Expansion Enrollment (participation increased 52% since 2013), and the aging population entering Medicaid or Medicare. This growth is sure to continue. Ensure that your vendor can scale your solution to keep pace with increased demand.
- Understand Key Solution Attributes.
Do you know what you are getting? It’s not enough just to have a “modular solution.” In order to meet your regulatory and operational needs, it is imperative that your vendor provides a solution that is reusable and interoperable with the other solutions and applications you use. Is it flexible? Can you easily configure it to address changing federal reporting requirements? A best in breed solution can stretch to fit your changing needs.
- Expect Support.
Pick a vendor who can support your progress throughout design, development, implementation, and post-implementation. Work closely with them from the very beginning of negotiations to identify key roles and responsibilities to drive your projects toward final certification—so there’s no back-tracking. They should be willing to partner with any outside resources you may choose to help with the certification assessment, and to help you ease the post-implementation burden.
- Keep Your Hosting Options Open.
You may need on-premises modular solutions. You may want your vendor to host your solutions. You may choose a third-party cloud provider. Your best-case scenario is to find a solution vendor whose platform has the ability to support any of these options, and the flexibility to help you switch if you change your mind down the road.
- Insist on Security.
Data security is non-negotiable. Choose a vendor who can demonstrate a thorough understanding of your security compliance needs. If the vendor is hosting, they should offer dedicated hosting with encryption at rest. We recommend looking for vendors that have been FedRAMP certified, as these typically have a security posture that exceeds state and CMS requirements.
- Look for Licensing Options.
Select a vendor who provides the licensing option you want. Depending on your funding and your operating expenses, you may have a compelling reason to choose either a perpetual license or a Software as a Service (SaaS) license. With a perpetual license you will generally have higher upfront per-license costs and costs associated with hardware, maintenance, and upgrades, but you own the software indefinitely. The SaaS model typically comprises lower upfront costs but less control over upgrade and downtime, and often a higher total cost of ownership. Demand a detailed breakdown of fixed and variable costs, so you can make an informed decision.
- Protect your Project Timeline.
Scope creep is the enemy. Choose a vendor with a demonstrated track record both for diligence during the requirements phase and speedy execution. Ideally, your vendor will have subject matter expertise and dedicated professional services teams you can rely on. This will help you speed up the implementation of your modular solutions, lower your costs, and lower your risk.
- Select for Services Methodology.
Understand the way your vendor works before you make a commitment. Have them explain their services methodology so you know exactly how they will handle design and development, and how they cope with unexpected snags along the way. Vendors using AGILE methodology do their design and development in short “sprints” which are approved along the way, so that you can be sure you are getting what you anticipated throughout the process.
- Be Picky about Partnership.
The move to modular solutions is a huge step toward Medicaid Modernization. Before you make the investment in time and resources, evaluate the team the vendor will assemble for your project. Will they be able to work effectively both with your team and the Systems Integrator (SI) you have on the project? Are the individuals knowledgeable, flexible, and eager to help you on your journey? Find a vendor who can act as a true advisor and partner to help you get to the finish line.
The Medicaid Modernization efforts aren’t slowing down. Agencies will continue to grapple with system certification changes as well as budget and resource constraints. But if you start by applying these 10 tips, you can feel confident that you’ve chosen the right vendor for your new modular solutions.
Health, Human Services, and Benefits
Comprehensive solutions managing millions of claims annually – empowering agencies to better deliver services and benefits to deserving individuals.
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