More than 75 million people access comprehensive and cost-effective care through Medicaid, including low-income families, older adults, and individuals with disabilities or chronic conditions. Given the program’s importance in addressing the health needs of vulnerable populations, optimizing the experiences of Medicaid members and providers is critical. How they interact with the program can impact many outcomes, from member access and care utilization to provider participation and compliance.
As states move from integrated Medicaid Management Information Systems (MMIS) to modular Medicaid Enterprise Services (MES) frameworks, opportunities to improve the experience lifecycle are found in the MES components that most directly touch members and providers. With this focus on experience, state Medicaid leaders can align their MES solutions to support the overall program mission and improve the wellness of members.
For states looking to undertake this transition from traditional MMIS to MES modernization, below are four considerations to guide this journey.