Health and Human Services

Medicaid

As states start down the path of modernizing their legacy Medicaid Management Information Systems (MMIS), the COVID-19 pandemic and rapidly evolving face of healthcare have shed new light on the future of Medicaid. States are examining the Centers for Medicare and Medicaid Services (CMS) guidance of modular modernization and evaluating which as-a-Service option works best for them (SaaS, PaaS, IaaS). Mapping the needs to a Medicaid Modernization roadmap can be overwhelming. At GCOM, we work with states to create a roadmap that speaks to their unique needs. Transforming a 40-50-year-old legacy mainframe system operation to today's technology touches on every part of the agency's business operations. GCOM combines Medicaid subject matter expertise and deep experience as System Integrators to focus on delivering superior outcomes by understanding legacy business rules, legacy data, master data management, infrastructure transformations, stakeholder management, change management, testing, training, and implementation.

GCOM is committed to improving population well-being, addressing social inequity, and helping states realize their vision for creating  thriving, healthy communities. Understanding that each state is unique, GCOM is dedicated to meeting customers where they are to deliver what they need and innovating where we should, not just because we can. Our HHS Practice works with states to ensure technology serves the business and does not dictate how the business operates. There is no social service area where the motivation is greater than helping states serve children and families in need.

 

Business Rules Extraction

 

Since 2012, states have leveraged funding to incrementally modernize their legacy mainframe Health and Human Services (HHS) systems. The latest trends are for modular replacement of Comprehensive Child Welfare Information Systems (CCWIS), Integrated Eligibility Systems (IES) encompassing the large social services programs (e.g., SNAP, TANF, Energy Assistance, non-MAGI Medicaid), and Medicaid Management Information Systems (MMIS). States are inviting vendors to demonstrate their offerings, making critical decisions about infrastructure services, and beginning lengthy procurement processes. The question remains: how could states better inform their decision-making process? Are there steps prior to evaluating solutions that could create a shortlist of functions and features aligned with the agency's mission and vision? Could this list help focus the large procurements, helping states purchase solutions that deliver the best value for the state's needs?

The answer is yes. GCOM's approach to incremental modernization begins with Legacy Business Rules Extraction (BRE). BRE involves extracting executable code from the legacy system and identifying, analyzing, and documenting business rules. The result: a comprehensive use case to help the agency identify which logic to be retained, discarded or examined further. The BRE process helps the agency understand existing system data flows and integration requirements, enable business process re-engineering and eliminates the costly cycle of discovery meetings to gather requirements for the new system.

 

Additional benefits:

 

  • BRE project periods of performance range from six-to-12 months, giving states a quick win along their road to modernization
  • Cleaned up, clearer business requirements
  • State focus on the future while GCOM provides critical documentation and detailed business rules for review and disposition
  • A richer understanding of downstream vendor requirements to replace or rebuild critical systems
  • Solves the issue of outdated or missing system documentation
  • Helps states focus on outcomes rather than outputs

GCOM is committed to improving population well-being, addressing social inequity, and helping states realize their vision for creating  thriving, healthy communities. Understanding that each state is unique, GCOM is dedicated to meeting customers where they are to deliver what they need and innovating where we should, not just because we can. Our HHS Practice works with states to ensure technology serves the business and does not dictate how the business operates. There is no social service area where the motivation is greater than helping states serve children and families in need.

 

Long-Term Services and Supports

 

Long-Term Services and Supports (LTSS) is the fastest-growing program within Medicaid. The COVID-19 pandemic and subsequent quarantine shed new light on the benefits of LTSS' focus on delivering non-medical supports and services to populations that, without the program, could transition to long-term care facilities. As Medicaid continues to evolve, states look to modernize their existing LTSS systems. GCOM provides state agencies with infrastructure solutions for LTSS; our extensive experience with modernizing legacy hosting solutions. Our goal is to provide low-risk, reliable, and secure infrastructures which enable state governments to make informed decisions about technology investments.

 

GCOM's infrastructure modernization experience, combined with our LTSS subject matter expertise gained through a partnership with government agencies, helps deliver lower cost and timely implementations. GCOM is committed to improving population well-being, addressing social inequity, and helping states realize their vision for creating  thriving, healthy communities. Understanding that each state is unique, GCOM is dedicated to meeting customers where they are to deliver what they need and innovating where we should, not just because we can. Our HHS Practice works with states to ensure technology serves the business and does not dictate how the business operates. There is no social service area where the motivation is greater than helping states serve children and families in need.

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