Modernizing a Monolithic MMIS Doesn't Have to Break the Customer Experience

In brief: 

  • The public sector is hardly the first place that comes to mind when you think about innovative, easy-to-use information technology platforms.
  • Medicaid Management Information Systems are perhaps some of the industry’s most complex, monolithic, and siloed operations.
  • The outdated processes and technology make the customer journey an obstacle course of calls, transfers, and endless forms.
  • As states ditch the antiquated systems and move toward a modular environment, they can leverage centralized contact and operation centers to transform their technology, enhance the customer experience, and generate worthwhile returns.

Customers today demand a first-class experience, every time—even when it’s being delivered by the government. But let’s face it, the spartan design and utility of public sector information technology (IT) are failing to meet that expectation.

The legacy monolithic Medicaid Management Information Systems (MMIS) across the country operate with a deeply fragmented provider and recipient customer experience (CX). As a result, users must find their way through a complex landscape filled with different contact numbers, cold transfers between siloed business groups, and poorly executed self-service and automation options that complicate, rather than streamline, their experience.

Here's the good news: change is on the horizon. More states are transitioning away from these archaic systems in favor of a modernized Medicaid Enterprise System (MES) approach. That’s largely because the Centers for Medicare and Medicaid Services (CMS) mandated that MMIS replacements occur in a modular environment. As we explored in a related piece, modularity allows states to take advantage of the latest technologies and vendor specializations and implement new business processes more quickly and cost-effectively.

But what does a new kind of Medicaid IT system mean for customers? That remains to be seen, but there are two key scenarios to consider:

  • Scenario one: With a clear vision and a customer-oriented transformation strategy, the public sector can capitalize on a significant opportunity to transform Medicaid CX. More specifically, by factoring in a centralized contact and operation center in your transformation plans, you can improve CX during the move to modular.
  • Scenario two: Without a vision or plan that prioritizes customers, the multiple, siloed systems and vendors that operate in a modular environment will create redundant customer interactions and risk further complicating and fragmenting CX.

Incorporating CX strategy into your MES modularity roadmap (scenario one) gives states an opportunity to reconcile contact/communications services across vendor module contracts, which in turn, can help to unify CX. A state may have to extract the disparate elements of stakeholder support across in-flight procurements and stitch them back together in a strategic, intentional, and unified fashion to ensure that CX goals are met.

Despite perceptions that CX orientation is expensive or superficial, states are finding that this strategy is delivering real results. Centralizing Medicaid stakeholder interactions through a contact and operation center can bring tangible benefits to providers and recipients, and even drive improvements to the double bottom line by:

  • Making information more accessible
  • Creating time-savings  
  • Producing staffing efficiencies
  • Generating long-term cost savings

As you can see, standing up a centralized contact and operation center can drive critical outcomes for Medicaid agencies and their stakeholders. To expand on the list above, the increased adoption of self-service and automation, and the reduced costs of redundant communications infrastructure across modules allows for a more flexible staffing model, where pooled resources across customer service areas can more efficiently balance peaks and valleys in call volume and meet customer needs with fewer cold transfers and dead ends.

So how do you design and implement a customer-oriented transformation strategy? One that prevents modularity from breaking the CX and addresses the priorities that matter most. Get started with these three steps:

  1. Inventory customer contact infrastructure and operations across existing and planned future module contracts.
  2. Identify the existing or future module that is best positioned to lead the CX design for your Medicaid program. Do opportunities remain to bolster CX requirements in this procurement?
  3. Develop a pathway to a single platform and consolidated contact center operational support with this module. Like the overall modularity transformation, this CX pathway will require incremental steps over multiple fiscal years.

The time has come to take an altogether different approach to public sector information technology. By starting with these three actions, states can begin to move to a more customer-centric model that will deliver meaningful value to customers and can boost the bottom line. If your state is ready to get started, let us show you how we’re supporting some of the other states on this journey.